Baseline Factors Predictive of SLT Response: A Prospective Study.

Department of Ophthalmology, University of Montreal, Montreal, QC, Canada.
Journal of Ophthalmology (Impact Factor: 1.94). 01/2012; 2012:642869. DOI: 10.1155/2012/642869
Source: PubMed

ABSTRACT Purpose. To study the response to Selective Laser Trabeculoplasty (SLT) according to baseline medical treatment, angle pigmentation, age, diagnosis (open-angle glaucoma or ocular hypertension), and baseline intraocular pressure (IOP). Methods. 74 eyes of 74 patients were enrolled in this study. Baseline characteristics were recorded for each patient. IOP in the treated and fellow eyes was measured at baseline, and 1 month, 6 months, and 12 months following SLT. IOP changes in the different groups were compared using two-way ANOVA and Pearson's correlation. Results. The mean age of our cohort was 71 ± 10 years. The mean baseline IOP was 21.5 ± 5 mmHg, and the mean change in IOP from baseline in the treated eye at one year was -4.67 ± 3.40 mmHg. Higher baseline IOP was highly correlated with greater absolute IOP decrease. Prostaglandin analogue use at baseline was shown to be associated with a statistically decreased IOP-lowering response following SLT when corrected for baseline IOP. No significant differences in IOP response were found when comparing groups stratified for age, angle pigmentation, phakic status, gender, or diagnosis. Discussion. The results of this study confirm the finding that higher baseline IOP is a predictor of greater IOP response following SLT, and that pretreatment with prostaglandin analogue therapy is associated with a decreased IOP-lowering response following SLT. The study is limited by the small number of eyes with data available for complete case analysis.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The aim of this study was to report on the course and long-term effect of selective laser trabeculoplasty on intraocular pressure of pseudophakic patients suffering from open angle glaucoma or ocular hypertension with insufficient intraocular pressure lowering despite maximally tolerated topical and systemic intraocular pressure lowering medication. Patients and Methods: A retrospective chart review of patients who underwent selective laser trabeculoplasty (360°) between 2008 and 2010 at the University hospital Zurich was undertaken. Intraocular pressure values before intervention, on the day of the intervention, 1 day, 1 month, 3 months and every 3 months up to 43 months after the intervention were analysed with respect to lens status. Results: Out of 153 treated eyes of 111 patients (mean age 70.6 years ± 11.13 SD) 40 were pseudophakic. Mean baseline intraocular pressures were 19.00 mmHg ± 4.61 in the pseudophakic group and 20.12 mmHg ± 4.89 in the phakic group. One month after selective laser trabeculoplasty intraocular pressure reduction measured between - 0.33 and - 4.10 mmHg (CI 95 %) in the pseudophakic group and between - 3.64 and - 5.58 mmHg (CI 95 %) in the phakic group, the difference at this time point was significant (p = 0.01). Beyond one month after selective laser trabeculoplasty there was no statistically significant difference in intraocular pressure reduction between pseudophakic and phakic patients. The mean decrease in intraocular pressure from baseline to the last follow-up of 43 months was 0.67 mmHg in the pseudophakic group and 0.25 mmHg in the phakic group (p = 0.72). Conclusions: One month after selective laser trabeculoplasty pseudophakic patients showed a statistically significant diminished reduction of intraocular pressure compared to phakic patients. Later on there was no statistically significant difference in intraocular pressure reduction between pseudophakic and phakic patients. Therefore we conclude that there was no clinically relevant influence of pseudophakia on the long-term effect of selective laser trabeculoplasty.
    Klinische Monatsblätter für Augenheilkunde 04/2014; 231(4):357-362. DOI:10.1055/s-0034-1368235 · 0.67 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim: To investigate the determinants of success of selective laser trabeculoplasty (SLT) in Chinese open-angle glaucoma patients. Methods: This prospective cohort study sequentially recruited Chinese subjects with unilateral or bilateral primary open-angle glaucoma (POAG) or normal tension glaucoma (NTG). All subjects received a single session of 360-degree SLT treatment. Success was defined as IOP reduction >= 20%. The following were analyzed in univariate and multivariate regression analyses for association with SLT success: type of glaucoma, age, sex, lens status, presenting IOP, pre-SLT IOP, day 1 IOP, 1-week IOP, number and type of anti-glaucoma medications, number of SLT shots and energy, retinal nerve fiber layer (RNFL) thickness, Visual Field Index, endothelial cell count, central corneal thickness, Snellen visual acuity, and spherical equivalent. Results: In 111 eyes of 65 subjects, there were 51 POAG eyes and 60 NTG eyes. The overall success was 53.15% with a mean IOP reduction of 19.81 +/- 15.93%. In univariate analysis, a thinner RNFL [coefficient = -0.027; odds ratio (OR) = 0.95; P = 0.017] was associated with success. In multivariate analysis, a lower day 1 IOP (coefficient = -0.29; OR = 0.75; P = 0.049) and using topical carbonic anhydrase inhibitors (CAI) (coefficient = 2.92; OR = 18.63; P = 0.0020) were associated with success. In both univariate and multivariate analyses, a higher pre-SLT IOP significantly predicted success (coefficient = 0.20/0.46; OR = 1.23/1.58; P = 0.0017/0.0011) and using 3 anti-glaucoma medications (coefficient = -1.08/-3.74; OR = 0.3/0.024; P = 0.037/P = 0.0081) was associated with SLT failure. Conclusion: The positive predictors of SLT success included: higher pre-SLT IOP, use of topical CAI, thinner RNFL, and lower day 1 IOP. Using 3 anti-glaucoma medications was associated with failure.
    Clinical Ophthalmology 06/2014; 23(5):321-325. DOI:10.1097/IJG.0000000000000049 · 0.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To compare the results obtained with SLT trabeculoplasty after an initial treatment (SLT-1) and after a second treatment (SLT-2). Subgroup analysis according to trabecular pigmentation and the existence of a high myopia. Materials and methods Retrospective study of 77 patients, 152 SLT sessions performed in the Ophthalmology Department of Clermont-Ferrand University Medical Center, 118 SLT-1, 34 SLT-2. Three comparable groups of patients were assembled: group 1 (glaucoma patients with normal or subnormal trabecular pigmentation), group 2 (glaucoma patients with high myopia), and group 3 (glaucoma patients with significant trabecular pigmentation). The results were compared between groups, for SLT-1 and SLT-2. Results Intraocular pressure lowering was consistent with data reported in the literature. Comparison of the results of SLT-1 versus SLT-2 did not find any significant difference in terms of IOP change. However, after SLT-2, the IOP response appears significantly greater (P = 0.03) in the group with significant trabecular pigmentation compared to the non-myopic group with normal trabecular pigmentation. Discussion Our results are consistent with the literature for efficacy, tolerance and reproducibility of SLT. No reduction in SLT efficacy was observed after a second session. Trabecular pigmentation is not a predictor of the response after the first session. In the case of retreatment (SLT-2), the differences observed lead to the hypothesis that it may be appropriate to perform at least two SLT treatments in patients with significant trabecular pigmentation in order to obtain maximal effect. Myopia, a variable not previously studied, does not seem to influence SLT outcomes. Conclusion Trabecular pigmentation and the presence of myopia do not appear to be predictive of a successful first treatment. However, our study leads us to suggest the hypothesis that the maximal response of SLT in patients with significant trabecular pigmentation is not obtained until after at least two sessions. This observation opens an interesting perspective on the therapeutic strategy to adopt in the case of pigmentary glaucoma.
    Journal francais d'ophtalmologie 05/2014; DOI:10.1016/j.jfo.2013.08.008 · 0.36 Impact Factor


Available from