Selective Laser Trabeculoplasty Success Research Articles

Identifying Baseline Predictors of Selective Laser Trabeculoplasty Effectiveness: An Alternative Mathematical Approach.

Selective laser trabeculoplasty (SLT) emerges as a first-line treatment for newly diagnosed open-angle glaucoma and ocular hypertension. However, the interindividual response to SLT considerably varied. Large-scale clinical investigations concerning predictive factors for SLT effectiveness are limited. This study aimed to identify baseline predictors of the percentage intraocular pressure (IOP)-lowering effectiveness of SLT using an alternative mathematical approach. Mathematical equations of IOP under the steady state of aqueous humour flow were formulated. The conclusive equation integrates physiological variables, including trabecular outflow facility, uveoscleral outflow fraction, plasma protein concentration, albumin/globulin ratio, mean arterial pressure, episcleral venous pressure, and plasma osmolarity. The equation was employed to estimate the percentage of IOP reduction following SLT and subsequently subjected to global sensitivity analysis to determine significant predictors of the IOP-lowering effect of SLT using the Monte Carlo simulation of 8,192 samples. In the current model, a 50% improvement in the trabecular outflow facility impacted by SLT is associated with a mean percentage IOP reduction of 16.6%. Lower baseline trabecular outflow facilities were the strongest predictors, showing a correlation with greater effectiveness of SLT in terms of percentage of IOP reduction. The second most influential factor includes baseline uveoscleral outflow fraction, followed by baseline episcleral venous pressure. Specifically, lower baseline uveoscleral outflow fraction and episcleral venous pressure were found to be correlated with increased effectiveness of SLT. Baseline levels of plasma protein concentration, albumin/globulin ratio, mean arterial pressure, and plasma osmolarity have minimal impact on SLT success or failure. This study identifies baseline trabecular outflow facilities as the strongest predictor of SLT effectiveness. The results suggested that pre-SLT medical treatment that augments uveoscleral outflow and/or trabecular outflow facilities could compromise the effectiveness of subsequent SLT in terms of percentage IOP reduction compared to those who never received pre-SLT medication.

Factors Predicting Successful Selective Laser Trabeculoplasty to Prevent Glaucoma Progression to Surgery

Purpose: To investigate the factors predicting successful selective laser trabeculoplasty (SLT) to prevent glaucoma progression to surgery in patients whose intraocular pressure (IOP) is not controlled with medications.Methods: This retrospective chart review included 102 eyes of 92 glaucoma patients who underwent SLT between 2018 and 2020. Success was defined as the prevention of glaucoma surgery for at least 1 year with an IOP less than 21 mmHg or no progression of retinal nerve fiber layer thinning. Kaplan-Meier survival analysis and the Cox proportional hazard model were used for the analysis.Results: A low pretreatment IOP, good visual acuity, and a smaller visual field defect were significantly correlated with success. When the other eye underwent glaucoma surgery or its SLT treatment failed, the success rate of SLT was lower. As the pretreatment IOP increased by 1 mmHg, the SLT failure rate increased by 1,376 times and when the SLT for the other eye failed, it increased by 19,577 times. When the mean deviation of the visual field increased by 1 decibel (dB), the SLT failure rate decreased by 0.928 times (<i>p</i> < 0.05).Conclusions: SLT is more effective in early glaucoma patients with an IOP lower than 25 mmHg, smaller visual field defect, and good visual acuity to prevent glaucoma progression to surgery.

In vivo identification of Schlemm's canal and response to SLT

AbstractASOCT has been used to demonstrate a lack of Schlemm's canal (SC) or its dysgenesis in many Primary Congenital Glaucoma (PCG) eyes, and nearly half of Juvenile Open Angle Glaucoma (JOAG) eyes. There is an increasing evidence that even in adult‐onset POAG, apart from the trabecular meshwork (TM), the post TM structures like the SC and collector channels are also affected which may contribute to the outflow resistance. Absence or dysgenesis of the SC is expected to be associated with a poor outflow facility.We evaluated the response of Selective laser trabeculoplasty (SLT) and correlated the visibility of SC on ASOCT in eyes with JOAG. This is because we had previously observed that only 40% of patients diagnosed with JOAG respond to SLT. In this study, we observed that detection of SC on ASOCT among patients undergoing SLT, (even without having evident angle dysgenesis on gonioscopy) was a significant predictor deciding the response to SLT. Success of SLT was defined as a reduction of IOP by 20% or more from pre‐laser value at 6‐months follow‐up without any further IOP‐lowering medication or surgery. A successful reduction in IOP at six‐month follow‐up was correlated with the extent of angle dysgenesis on ASOCT (ADoA).We observed that presence of SC was associated with 8.3 times greater chances of success of SLT than its absence. Also if the presence of SC was detected in >50% ASOCT scans in one eye, it was associated with 21.4 times greater chances of SLT success (p = 0.009). Hence in vivo imaging of the angle is a non‐invasive method of detecting angle dysgenesis, in the absence of an apparent goniodysgenesis. It may help in selecting potential candidates for SLT (or other angle based surgeries) by predicting possible outcome and thus providing more realistic expectations when advising patients, regarding the likelihood of success /failure of their treatment.

Selective Laser Trabeculoplasty and Outcomes of Subsequent Phacoemulsification Combined with Kahook Dual Blade Goniotomy.

IntroductionTo investigate the relationship between intraocular pressure (IOP)-lowering success of selective laser trabeculoplasty (SLT) and combined phacoemulsification/Kahook Dual Blade (phaco/KDB) goniotomy in eyes with mild to severe open angle glaucoma (OAG).MethodsEyes undergoing combined phaco/KDB goniotomy and that had previously undergone SLT were analyzed. Data collected included demographics, glaucoma type and severity, IOP, and topical IOP-lowering medications before and after both procedures. Eyes were divided into two groups based on success of SLT, defined as IOP reduction of at least 20% maintained on at least two consecutive follow-up visits without any subsequent medication additions or interventions. Phaco/KDB goniotomy success was defined as IOP reduction of at least 20% and/or reduction in the number of IOP-lowering medications of at least one up to 12 months of follow-up.ResultsOverall, SLT was successful in 20 of 43 eyes (46.5%), of which 63.6% (7/11) had successful phaco/KDB goniotomy at 12 months follow-up. Among eyes with unsuccessful SLT, 60.0% (9/15) had successful phaco/KDB at 12 months follow-up. Phaco/KDB success rate was similar in patients regardless of their previous response to SLT at all postoperative time points up to 12 months follow-up (p = 0.87).ConclusionsThe presence or lack of IOP-lowering response to SLT did not influence the success rate of subsequent phaco/KDB goniotomy in eyes with mild to severe OAG. Patients who did not respond to SLT still benefited from phaco/KDB goniotomy at a later date.

OUTCOME OF LASER MANAGEMENT IN GLAUCOMA DISEASE

The study aimed to evaluate the efficacy and predictive factors of success after selective laser trabeculoplasty (SLT) for treating various types of open-angle glaucoma in iraq. Design: The study employed a retrospective cohort design. Materials and Methods: The study retrospectively recruited subjects diagnosed with open-angle glaucoma receiving first time selective laser trabeculoplasty. Primary open-angle glaucoma (POAG), ocular hypertension (OHT) and other types of open-angle glaucoma were included. Reduced intraocular pressure (IOP) of 20% or decreased number of antiglaucoma drugs usage after SLT was defined as success. Various parameters were analyzed for association with SLT success. Results: 192 eyes were recruited in the study. Mean pre- and postSLT IOP were 19.31 ±3.59 and 15.04±3.13 mmHg, respectively. IOP decreased significantly in all follow-up visits (p<0.001). Overall, 59.4% met the treatment endpoint. More than 10% postSLT IOP elevation at 1 hour was the only covariate positively associated with SLT success in both univariate (odds ratio (OR) = 1.042, p = 0.037) and multivariate analyses (OR = 1.040, p = 0.046). Underlying hypertension and preSLT IOP were negatively associated with SLT success in both univariate (OR = 0.970, p = 0.026, OR = 0.955, p < 0.001) and multivariate analysis (OR = 0.970, p = 0.026, OR = 0.991, p < 0.001). Conclusion: IOP significantly decreased as well as the number of antiglaucoma drugs needed after SLT. More than 10% postSLT IOP elevation at 1 hour was a positive predictor whereas systemic hypertension and preSLT IOP were negative predictors of SLT success.

Energy Dose-Response in Selective Laser Trabeculoplasty: A Review.

Précis:A literature review of selective laser trabeculoplasty (SLT) energy dose-response found no definitive relationship between intraocular pressure (IOP) reduction with respect to total or pulse energy, race, pigmentation, or application pattern.Purpose:SLT is a safe and effective treatment for lowering IOP. Although evidence is mounting for the advantage of its use as a first-line treatment for IOP reduction, the SLT procedures in use vary widely. The purpose of this literature review was to investigate whether there were any relationships between SLT energy and efficacy for lowering IOP in the published literature.Methods:A literature review was undertaken that included studies in which energy levels required for successful SLT treatment were investigated: in general, with respect to angle pigmentation, race or ethnicity, and treatment arc extent.Results:There was no indication that higher (or lower) energy used in the treatment leads to greater (or less) IOP reduction. Similar results were obtained regarding the level of trabecular meshwork pigmentation. Race was not found to be associated with altered dose response in SLT. There were indications that treating the full 360 degrees, as opposed to smaller arcs, could be beneficial for more IOP reduction. IOP reduction from SLT was found to be similar to that provided by topical medications.Conclusions:The optimal energy level of SLT needed for IOP reduction has not yet been definitively established, with all reported pulse energies resulting in similar IOP reduction. Furthermore, similar lack of conclusive findings exists regarding optimal SLT energy dosage for use in different races and degrees of trabecular meshwork pigmentation. This parameter and each of the abovementioned factors requires further research.

Effectiveness of selective laser trabeculoplasty in advanced open‐angle glaucoma

AbstractPurposeTo study the effectiveness and safety of selective laser trabeculoplasty (SLT) for the treatment of advanced open‐angle glaucoma.MethodsWe carried out a prospective longitudinal study, including patients with advanced open‐angle glaucoma. Selective laser trabeculoplasty has been indicated either after failure of medical treatment or in cases of poor adherence to medical treatment. Measurements were obtained at 1 week, 1 month, 3 months and 6 months. Success was defined as a reduction in intraocular pressure (IOP) of more than 20% from baseline or a reduction of at least one antiglaucoma eye drops with stable intraocular pressure. A p value less than 0.05 was considered as statistically significant.ResultsFifty‐nine eyes were included in the study. Three types of glaucoma were present in our study: primary open‐angle glaucoma was the most common type followed by exfoliative glaucoma and pigmentary glaucoma. The success rate was 76.5% for failure of medical treatment and 80% for poor adherence. The most frequent side effects were the inflammatory reaction (18.6%) and the early IOP spikes (25.4%). The predictors of its effectiveness were the initial intraocular pressure (p = 0.03) and the percentage reduction in intraocular pressure at 1 month (p = 0.002).ConclusionsSelective laser trabeculoplasty is an effective and easy‐to‐perform physical treatment of advanced open‐angle glaucoma with a satisfactory safety profile (1,2). It overcomes poor adhesion problems. Our results need to be extended to assess long‐term success.Bibliography1. Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye (Lond). 2018 May;32(5):863–876.2. Sina Elahi, Harsha L Rao, Alina Dumitru, Kaweh Mansouri. Predictors of Success in Selective Laser Trabeculoplasty: Data From the Lausanne Laser Trabeculoplasty Registry. J Glaucoma. 2020 Jul;29(7):550–555.

Five-Year Long-Term Follow-Up of Selective Laser Trabeculoplasty in Open-Angle Glaucoma.

Selective laser trabeculoplasty (SLT) is known as a safe laser therapy for an effective reduction in intraocular pressure (IOP). The aim of this study was to examine the therapeutic success of SLT in open-angle glaucoma (OAG) patients with a long-term follow-up of 5 years. Forty-six eyes of forty OAG patients, some with previous intraocular surgery, underwent SLT (24 males, 16 females). Therapeutic success was categorized as: category (I) - IOP reduction ≤ 21 mmHg and > 20% compared to baseline IOP with additional glaucoma medication; category (II) - IOP reduction ≤ 18 mmHg and > 30% compared to baseline IOP with additional glaucoma medication; category (III) - IOP reduction ≤ 18 mmHg without any additional glaucoma medication at all follow-ups. Therapeutic failure was defined as the necessity of any further glaucoma surgery (IV). (1) SLT was well tolerated in all eyes, and no severe side effects or complications were recorded. (2) After 1-year follow-up, therapeutic success was 27% (I), 30% (II), and 3% (III). The therapeutic failure rate was 40% (IV). (3) After 2years follow-up, therapeutic success was 7% (I), 10% (II), and 0% (III). The therapeutic failure rate was 83% (IV). (4) After 3years follow-up, the therapeutic failure rate increased up to 100% (IV). SLT seemed to be effective in lowering IOP in the first year in the present cohort, however, the long-term effect is low and additional local therapy or surgical interventions are necessary.

Efficacy of Selective Laser Trabeculoplasty on Circadian Intraocular Pressure Following Trabeculectomy in Advanced Primary Open-angle Glaucoma.

In about 50% of post-trabeculectomy (TE) eyes, selective laser trabeculoplasty (SLT) is effective in further lowering intraocular pressure (IOP). To investigate the efficacy and safety of SLT in post-TE eyes, uncontrolled on maximum tolerated medication, and/or with progression of visual field loss. This retrospective study consecutively included post-TE eyes of patients diagnosed with primary open-angle glaucoma who had been treated with 360 degrees SLT and had a follow-up after 12 months. Primary endpoints were the reduction of mean diurnal intraocular pressure (mdIOP, mean of 6 measurements), peak IOP, and diurnal IOP fluctuations. Secondary outcomes were factors influencing IOP reduction, SLT success, and failure rates. Forty-three eyes of 43 patients were included. During the first year, 10 eyes (23%) needed additional procedures to reduce mdIOP and were accounted as failures and excluded from final analysis. Of the remaining 33 eyes (77%) mdIOP [Q25, Q75] dropped from 15.2 [12.2 to 16.5] to 13.2 [11.6 to 15.3] mm Hg (P=0.027), 23 eyes (54%) showed a sufficient mdIOP reduction, 1 year after SLT. SLT is effective and safe in lowering mdIOP to target IOP in about 50% of eyes after prior incisional glaucoma surgery.

Selective laser trabeculoplasty lowered the untreated fellow eye long-term intraocular pressure: a 3-year observational study.

To explore the long-term intraocular pressure (IOP)-lowering effect of monocular selective laser trabeculoplasty (SLT) in the untreated fellow eyes of open-angle glaucoma (OAG) patients. This was a retrospective observational study. Consecutive Chinese OAG patients who received monocular SLT treatment were included in this study. One hundred and eighty degree SLT was conducted as adjunctive treatment when anti-glaucoma medication was not sufficiently effective after clinical evaluation. Treatment success was defined as more than 20% IOP reduction of the baseline IOP levels. IOP-decreasing amplitude and SLT success rate of both eyes were investigated during the 3-year follow-up period. Age, gender, baseline IOP levels, number of medications, and SLT energy parameters were analyzed to determine its influence on IOP reduction effect and treatment success rate. A total of 32 Chinese OAG patients were included in this study and 25 of them completed the 3-year follow-ups. Their pretreatment IOPs were 18.85 ± 2.81mmHg in the treated eyes and 17.38 ± 2.37mmHg in the fellow eyes. At the 3-year follow-up visits, IOP decreased to 2.76 ± 3.72mmHg (14.16%) in the treated eyes and 2.16 ± 2.73mmHg (11.95%) in the fellow eyes, with a success rate of 47.83% (11 in 23 cases) and 44.00% (11 in 25 cases), respectively. IOPs of both eyes decreased significantly after SLT from 6months and lasted to 3years after treatment. Baseline IOP level was positively correlated with IOP reduction in the treated eyes and other factors were not correlated with IOP reduction and treatment success. Monocular SLT treatment as adjunctive treatment could lower IOPs not only in the treated eyes but also in the untreated eyes in poor medication-controlled OAG patients. In addition, its IOP reduction effect could last to 3years after treatment in clinical practice.

In Vivo Imaging of the Schlemm's Canal and the Response to Selective Laser Trabeculoplasty

To evaluate the presence of angle dysgenesis on ASOCT (anterior segment optical coherence tomography) (ADoA) as a predictive factor in determining outcomes of selective laser trabeculoplasty (SLT). A prospective clinical cohort study. Patients with juvenile-onset open-angle glaucoma (JOAG) without angle dysgenesis on gonioscopy. JOAG patients with uncontrolled intraocular pressure (IOP), who were to undergo SLT, were evaluated for the presence or absence of ADoA, which was defined as the absence of Schlemm's canal (SC) and/or presence of a hyperreflective membrane (HM) over the trabecular meshwork, as identified on ASOCT before the SLT procedure. Furthermore, the number of ASOCT B-scans in which SC was identified as present, were then quantified. Success of SLT was defined as a reduction of IOP by 20% or more from pre-laser value at 6-month follow-up without any further IOP-lowering medication or surgery. Only 1 repeat SLT was admissible for defining SLT success over the 6-month period. A successful reduction in IOP at 6-month follow-up was correlated with the extent of ADoA. In comparison to pre-SLT IOP, 57.1% eyes (20/35) showed more than 20% reduction in IOP at 6 months with a mean reduction of 7.6 ± 1.8 mm Hg (29.6%). When all 3 observers agreed, SC was identified in 90% eyes (18/20) with success vs 26.6% eyes (4/15) with failure (P < .001). All eyes (5/5) with presence of HM showed failure (P < .001). All eyes (19/19) in which SC was present in >50% ASOCT B scans (>25/50 scans/eye) showed success (P < .001). On a bias-reduced regression analysis, the identification of SC on any 2 consecutive scans increased the chances of success at 6 months by 8.3 times, whereas the identification of SC in >50% of ASOCT scans was associated with a 21.4 times greater chance of success. The presence of SC on ASOCT is a strong predictor for successful IOP reduction after SLT in JOAG eyes.

Outcomes of selective laser trabeculoplasty in corticosteroid-induced ocular hypertension and glaucoma.

To report the outcomes of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced ocular hypertension and glaucoma. A retrospective chart review of patients who underwent SLT for steroid-induced ocular hypertension or glaucoma between January 2014 and October 2018. Success of SLT was defined as ⩾20% IOP reduction from baseline without further medical or surgical intervention and/or a reduction in the number of glaucoma medications by ⩾1 from baseline while maintaining the target IOP. Main outcome measures were change in IOP from baseline and reduction in the number of medications post-laser. A total of 25 eyes of 17 patients were included in the study. The mean duration of follow-up was 18.8 ± 4.5 months. IOP decreased from 23.7 ± 6.7 mmHg pre-laser to 14.4 ± 3.2 mmHg post-laser, at the last follow-up visit (p < 0.001). The mean number of medications was 1.8 ± 1.6 medications pre-laser and 1.4 ± 1.3 medications post-laser (p = 0.262). The overall success rate at 12 months was 72%. No visually significant complications were encountered during the whole duration of follow-up. SLT is a safe and effective procedure that can result in well-controlled IOP in patients with steroid-induced ocular hypertension and glaucoma.

Relationship between selective laser trabeculoplasty and excisional goniotomy outcomes in glaucomatous eyes

ObjectiveTo evaluate the relationship between intraocular pressure (IOP)-lowering success with selective laser trabeculoplasty (SLT) and Kahook Dual Blade (KDB) goniotomy in eyes with glaucoma. DesignRetrospective chart review. Participants30 eyes of 24 patients undergoing phacoemulsification combined with a KDB with 6 months follow-up and who had previously undergone SLT in the same eye. MethodsData collected from electronic health records included demographic and glaucoma status, IOP and IOP-lowering medication after SLT and KDB. SLT and KDB success were defined as IOP reduction ≥20% or medication reduction ≥1 at 2 and 6 months, respectively. Main outcomeAssociation between SLT success and KDB success. ResultsOverall, SLT was successful in 17 of 30 eyes (56.7%) at 2 months, and KDB was successful in 18 of 30 eyes (60%) at 6 months. Nine of 17 eyes (52.9%) with prior successful SLT had successful subsequent KDB, whereas 9 of 13 (69.2%) with prior unsuccessful SLT had successful KDB. There was no significant relationship between SLT and KDB outcome in these 30 eyes (p = 0.465 by Fisher's exact test). ConclusionNo relationship between success of SLT and subsequent KDB was observed. However, patients with history of failed SLT still benefited from subsequent KDB.

Outcome After Selective Laser Trabeculoplasty for Glaucoma Treatment in a Thai Population

PurposeThe study aimed to evaluate the efficacy and predictive factors of success after selective laser trabeculoplasty (SLT) for treating various types of open-angle glaucoma in a Thai population.DesignThe study employed a retrospective cohort design.Materials and MethodsThe study retrospectively recruited Thai subjects diagnosed with open-angle glaucoma receiving first time selective laser trabeculoplasty. Primary open-angle glaucoma (POAG), ocular hypertension (OHT) and other types of open-angle glaucoma were included. Reduced intraocular pressure (IOP) of 20% or decreased number of antiglaucoma drugs usage after SLT was defined as success. Various parameters were analyzed for association with SLT success.ResultsNinety-six eyes were recruited in the study. Mean pre- and postSLT IOP were 19.31±3.59 and 15.04±3.13 mmHg, respectively. IOP decreased significantly in all follow-up visits (p<0.001). Overall, 59.4% met the treatment endpoint. More than 10% postSLT IOP elevation at 1 hour was the only covariate positively associated with SLT success in both univariate (odds ratio (OR) = 1.042, p = 0.037) and multivariate analyses (OR = 1.040, p = 0.046). Underlying hypertension and preSLT IOP were negatively associated with SLT success in both univariate (OR = 0.970, p = 0.026, OR = 0.955, p < 0.001) and multivariate analysis (OR = 0.970, p = 0.026, OR = 0.991, p < 0.001).ConclusionIOP significantly decreased as well as the number of antiglaucoma drugs needed after SLT. More than 10% postSLT IOP elevation at 1 hour was a positive predictor whereas systemic hypertension and preSLT IOP were negative predictors of SLT success.

&lt;p&gt;Short-Term Efficacy of Selective Laser Trabeculoplasty in Omani Eyes with Glaucoma: A Single Institutional Study&lt;/p&gt;

PurposeThere is some evidence suggesting a different nature of response to selective laser trabeculoplasty (SLT) among different races. Therefore, we aimed to assess the short-term efficacy, safety and nature of outcome of SLT in Omani eyes.Patients and MethodsA retrospective review was performed of patients with open-angle glaucoma (OAG) or ocular hypertension (OHTN) who underwent a single session of 360-degree SLT between January 1, 2017 and December 31, 2018. The main outcome was mean IOP reduction and attainment of treatment success at 5 weeks and 12 weeks post treatment defined as at least 20% IOP reduction from baseline without further medications or interventions. Secondary outcomes were frequency of adverse events and factors predicting success.ResultsA total of 33 eyes of 33 Omani patients who underwent treatment with SLT were analyzed. The nature of response to laser followed a gradual pattern as the mean IOP reduction from baseline was 20.2% (5.21 mm Hg, P <0.001) at 5 weeks and further enhanced to 27.2% (6.95 mm Hg, P <0.001) at 12 weeks. Short-term success was achieved in 51.5% and 72.2% of eyes at 5 and 12 weeks, respectively. SLT was most effective in OHTN subgroup and those with higher baseline IOP (both P <0.001). Side effects were an infrequent occurrence, minor and transient.ConclusionThe short-term success of SLT in Omani eyes was clinically relevant and comparable to the gradual pattern seen in patients of Indian ancestry. It is a safe therapeutic option in selective Omani eyes.

The outcomes of selective laser trabeculoplasty at six months

Purpose: To study the intraocular pressure (IOP)-lowering effects of selective laser trabeculoplasty (SLT) at six months and to determine factors that can predict the success of SLT.&#x0D; Study design: Prospective cohort study with convenience sampling.&#x0D; Material and methods: The patients were seen at the Glaucoma Clinic, Selayang Hospital from October 2017 to September 2018. Patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), and ocular hypertension (OHT) of mild to moderate severity that needed further IOP reduction were recruited. Baseline characteristics were documented followed by water drinking test (WDT) and SLT. Follow-up was scheduled at one week, six weeks, three months, and six months. WDT was repeated at six months.&#x0D; Results: Eighteen eyes of 18 patients were recruited. IOP at baseline, 1 week, 6 weeks, 3 months, and 6 months was 19.3 ± 3.7,16.7 ± 3.8,16.5 ± 2.7,16.6 ± 3.2 and 15.3 ± 3.8 mmHg, respectively (P &lt; 0.05). The reduction of baseline IOP, peak IOP, and IOP fluctuation were 20.7%, 26.7%, and 31.4%, respectively (P &lt; 0.05). The cumulative success at six months was 44%. The significant success predictors were mean deviation on Humphrey visual field and IOP one week post-SLT.&#x0D; Conclusions: SLT can be used to treat mild to moderate POAG, NTG, and OHT patients, either as first-line treatment or as an adjunct to medical therapy.

Outcomes of pattern scanning laser trabeculoplasty and selective laser trabeculoplasty: Results from the lausanne laser trabeculoplasty registry.

To compare the long-term safety and efficacy of pattern scanning laser trabeculoplasty (PSLT) and selective laser trabeculoplasty (SLT). This was a retrospective database analysis (Lausanne Laser Trabeculoplasty Registry) of patients having had laser trabeculoplasty (LT) prior to 2017 with a minimum follow-up of 1year. Inclusion criteria were age ≥40years and diagnosis of ocular hypertension (OHT) and open-angle glaucoma (OAG). Selective laser trabeculoplasty (SLT) eyes were matched to PSLT eyes according to baseline intraocular pressure (IOP), baseline number of ocular hypotensive medications (OHM) and glaucoma diagnosis. Success was defined as an IOP≤20% from baseline or an IOP equal or lower than baseline accompanied by a reduction in OHM. Multivariate regression models were used to study associations between success and baseline clinical parameters. From 280 eyes in the database, 81 eyes had PSLT and were matched with 81 SLT eyes (162 patients). Mean age was 69.4±12.1years, and 56.2% were female. Mean IOP was 18.6±5.3 and 18.2±4.1mmHg at baseline and 15.9±3.0 and 16.0±3.4mmHg at 12months and 15.2±2.7and 16.2±3.4mmHg at 24months, for PSLT and SLT, respectively. 60.5% of PSLT and 65.4% of SLT eyes achieved treatment success (p=0.20). Number of OHM was 1.0±1.0 and 1.4±1.2, respectively (p=0.052). Baseline IOP (OR=1.23, p<0.01) and number of OHM (OR=1.67, p<0.01) were associated with success in both PSLT and SLT, while LT modality was not [OR=0.81 (0.43-1.53), p=0.52], and a diagnosis of primary OAG was negatively associated (OR=0.42, p=0.04). Our study did not find any significant differences between PSLT and SLT in terms of safety and efficacy in patients with OHT and glaucoma. Baseline IOP was associated with higher success rates in both procedures. Additional studies are needed to evaluate the outcomes of PSLT in non-Caucasian populations and the ability of repeat PSLT to achieve additional IOP reduction.

Need and Time to Redo Selective Laser Trabeculoplasty in Glaucoma Patients

Purpose: Examine the need and the timeframe to redo selective laser trabeculoplasty (SLT) that was applied in open angle glaucoma or ocular hypertensive patients. Methods: Patients received SLT as primary, adjunctive or replacement therapy. Data were recorded up to 5.5 years after SLT treatment. Target pressure was defined as intraocular pressure at least 20% lowered. On exceeding the target pressure, patients received a second SLT. Primary outcome were the need and the time to redo the SLT. We examined differences between the groups (primary, replacement or adjunct SLT) and correlations between time and need to redo and pre-SLT parameters. Results: 108 patients (194 eyes) could be followed for at least 0.5 year and up to 4.5 years, with a mean follow up of 22.35 ± 18.94 months. Our population at start was a varied one; 34% of patients received primary SLT, 50% had replacement SLT, 16% had SLT as adjunctive treatment. These three groups showed no difference in evolution of IOP or medication in time. Time to redo varied, with a mean of 31.13 ± 11.24 months. Conclusion: We set out to have a general idea of how many patients could be expected to need a retreatment with SLT after a first successful SLT in a private clinic setting. In our population, the percentage of redo needed was 5.6% after 2 years, 35.4% after 3 years and 45.4% after 4 years. No differences could be measured with regard to the type of SLT performed nor could any significant correlation be found between need to redo and pre-SLT characteristics.

Outcome of Selective Laser Trabeculoplasty in Young Patients with Primary Open-Angle Glaucoma and Ocular Hypertension.

Purpose To determine the effectiveness and safety of selective laser trabeculoplasty (SLT) in young patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). Methods This was a retrospective clinical study. Fifty-six eyes from 56 young (age ≤ 40 y) patients with POAG or OHT treated with SLT were included. According to age, patients were divided into group 1 and group 2. Patients in group 1 were younger than 18 years old, and patients in group 2 were between 18 and 40 years old. Patients were evaluated before treatment and at 1 hour, 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after treatment. We also collected older patients (age ≥ 60 y) who received SLT during the same period for comparison at 1-year follow-up. Possible factors affecting the success of SLT, including baseline IOP, age, sex, diagnosis (POAG or OHT), and whether or not use of antiglaucoma medication before treatment, were analyzed. Results SLT treatment produced significant reduction in IOP in the young patients with POAG or OHT during the 1-year follow-up period（P < 0.05）. Mean IOP at 1 hour after SLT was lower in group 1 than in group 2 (P < 0.01), but at other follow-up time points, IOP values were not different (P > 0.05). IOP reduction and success rate were not significantly different between young and old patients at 1 year after treatment. IOP measurements over a 24-hour period were recorded before and after the SLT in 20 young adult patients. IOP values were significantly lower in the treated patients at all time points than at pretreatment (P < 0.05), and 24-hour mean IOP, peak IOP, valley IOP, and fluctuation in IOP were also lower in SLT-treated patients (P < 0.05). Baseline IOP was found as a predictor of SLT success in young patients (OR = 1.895, P=0.003), whereas age, gender, diagnosis, and whether or not use of antiglaucoma medication were not correlated with SLT success (P=0.725, P=0.750, P=0.061, and P=0.201, respectively). Conclusion In this study, SLT was found as an effective and safe treatment for young patients with POAG and OHT. High baseline IOP predicted high SLT success.

Predictors of Success in Selective Laser Trabeculoplasty: Data From the Lausanne Laser Trabeculoplasty Registry.

The purpose of this study was to determine the factors associated with the outcomes of selective laser trabeculoplasty (SLT). This was a database analysis (Lausanne Laser Trabeculoplasty Registry) of patients who had SLT between 2015 and 2017. Exclusion criteria were age below 40 years and diagnosis other than ocular hypertension and open-angle glaucoma. Intraocular pressure (IOP) and number of medications were recorded before and at various follow-ups after laser treatment. Success was defined as "complete" if an IOP reduction of at least 20% was observed at a given time, and "qualified" if any reduction of IOP was observed with either at least a 20% difference from baseline or a reduction in IOP-lowering medications. Associations of complete and qualified success with patients' baseline characteristics, laser settings, and clinical examination findings were studied using multivariate regression and survival analysis. A total of 170 eyes (126 patients) were included. Mean age was 68.3±12.2 years and 57.9% of the study cohort were female individuals. Average baseline IOP was 18.7±4.8 mm Hg, and average IOP reduction was 3.3±4.3 (-17.6% from baseline) and 3.5±3.9 mm Hg (-18.7% from baseline) at years 1 and 2, respectively. Male sex [odds ratio (OR)=2.79, P=0.02], baseline IOP (OR=1.15, P<0.01), and medical treatment before SLT (OR=2.57, P=0.03) were positive predictors of success. Total energy was associated with the duration of success. SLT outcome was strongly correlated to the outcome of the fellow eye, which represented the strongest predictor (OR=17.33, P<0.01). SLT achieved good IOP-lowering in a majority of patients with mild-to-moderate glaucoma, while it was inefficient in up to 35% of eyes. SLT success in the fellow eye was a strong predictive factor.