Baseline Factors Predictive of SLT Response: A Prospective Study

Department of Ophthalmology, University of Montreal, Montreal, QC, Canada.
Journal of Ophthalmology (Impact Factor: 1.43). 07/2012; 2012(11):642869. DOI: 10.1155/2012/642869
Source: PubMed


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.

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Available from: Mark Lesk, Jan 02, 2016
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    ABSTRACT: Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering the intraocular pressure in patients with glaucoma. It achieves its results by selective absorption of energy in the trabecular pigmented cells, sparing adjacent cells and tissues from thermal damage, with minimal morphological tissue alteration following treatment. On the basis of the peer-reviewed medical literature, SLT is efficacious in lowering IOP, as initial treatment or when medical therapy is insufficient in all types of open-angle glaucoma in all races. SLT achieves intraocular pressure reduction similar to that of argon laser trabeculoplasty but without the tissue destruction and side effects. Observed side effects following SLT were almost uniformly transient and minor. We review highlights of recently published studies on the mechanisms and clinical outcome of SLT in order to address frequently raised issues pertinent to SLT in the clinical practice.
    Preview · Article · May 2013
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    ABSTRACT: To evaluate the predictive value of clinical parameters, including biomechanical properties on the outcome of selective laser trabeculoplasty (SLT) in medically uncontrolled open angle glaucoma (OAG). Sixty-eight eyes from 68 patients with OAG and IOP insufficiently regulated by topical medications were enrolled. Patients' follow-up occurred 6 and 12 months after the procedure. The recorded parameters intraocular pressure (IOP), angle characteristics, central corneal thickness (CCT) and biomechanical properties of the eyes, including corneal hysteresis CH and corneal resistance factor CRF measured with the Ocular Responses Analyzer (ORA, Reichert Ophthalmic Instruments) were tested on their predictive value of SLT-induced IOP lowering effect using correlation analyses and regression models. Mean IOP reduction 12 months after SLT was 4.2 ± 5.7 mmHg (23.2 %, from baseline 18.1 ± 5.2 mmHg). The preoperative IOP correlated significantly with IOP reduction (maximum Spearman's correlation r = 0.75, p < 0.001). In linear regression analysis, the corneal biomechanical properties (CH and CRF) together with the baseline IOP revealed good modelling for the IOP lowering effect of SLT (R(2) = 0.64, respectively). In addition to the baseline IOP biomechanical properties (CH and CRF) are significant predictors of SLT induced IOP lowering effect in medically uncontrolled OAG.
    Full-text · Article · Jul 2013 · Albrecht von Graæes Archiv für Ophthalmologie
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    ABSTRACT: Background: Selective laser trabeculoplasty (SLT) is one of common therapies for early-stage primary open angle glaucoma (POAG). However, it always been used as a method of treating medically uncontrolled open angle glaucoma in China. So the assessment of efficacy of SLT as the initial therapy for POAG is still lack. Objective: This clinical study was to compare the efficacy of SLT in early-stage POAG eyes with or without primary medical therapy. Methods: A prospective non-randomized controlled study was designed. Sixty-five eyes of 37 patients with early-stage POAG were divided into without pre-treated group (30 eyes of 16 patients) and with pre-treated group (35 eyes of 21 patients). SLT was performed on the inferior trabecular meshwork of 180° in all the patients aged 12-57 years old using a 532 nm frequency-doubled, Q-switched Nd: YAG laser with the pulse 3 ns, spot diameter 400 μm. The emitting energy was set from an initial energy of 0.6 mJ to decreased energy successively at 0.1 mJ interval till bubbles coming out. The following-up was 6 months. Primary outcome of SLT included the changes of intraocular pressure (IOP) and effective rate, and the secondary outcome included the perimetry and C/D value. The safety index was evaluated as the incidence of irritative symptom. Results: After SLT 1 day to 6 months, the IOP was lower than that before SLT in all the patients (all at P<0.05). The IOP was (24.03 ± 3.76) mmHg and (19.18 ± 3.86) mmHg respectively at preoperation and postoperative 1 month in without pretreated group, with a mean decreasing value of (4.85 ± 4.31)mmHg, in with pretreated group, the IOP was (23.63 ± 4.29)mmHg at preoperation and (17.07 ± 4.15)mmHg at postoperative 1 month, with a mean difference of (6.28 ± 3.57)mmHg, with a significant difference in the IOP lowing value between the two groups(P=0.045), but there were no significant differences in the IOP lowing value between without and with pretreated groups in 1 hour, 1 day, 3 months and 6 months after SLT (all at P>0.05). The effective rate was 75.00% and 76.67% in without and with pretreated groups respectively at the end of following-up (P=0.882). No obvious changes were seen in visual field and C/D value before and after SLT in both groups. Also, no serious complication was found in the patients during the following-up duration. Conclusions: SLT has a good outcome in lowing-IOP for early stage POAG. There is no obvious impact to the clinical efficacy of SLT whether with or without the primary administration of anti-glaucomatous eye drops. Long-term effect of SLT remains to be observed.
    No preview · Article · Feb 2014 · Zhonghua Shiyan Yanke Zazhi/Chinese Journal of Experimental Ophthalmology
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