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BMC Ophthalmology
Published in: BMC Ophthalmology 1/2016

Open Access 01-12-2016 | Research article

Selective laser trabeculoplasty for early glaucoma: analysis of success predictors and adjusted laser outcomes based on the untreated fellow eye

Authors: Mikael Chun, Carolina P. B. Gracitelli, Flavio S. Lopes, Luis G. Biteli, Michele Ushida, Tiago S. Prata

Published in: BMC Ophthalmology | Issue 1/2016

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Abstract

Background

To identify success predictors and to study the role of the fellow untreated eye as a co-variable for adjustment of intraocular pressure (IOP) outcomes following selective laser trabeculoplasty (SLT) in early open-angle glaucoma (OAG) patients.

Methods

A case series was carried out. Patients with uncontrolled early OAG or ocular hypertension (inadequate IOP control requiring additional treatment) underwent SLT (one single laser session) performed by the same surgeon in a standardized fashion. The same preoperative medical regimen was maintained during follow-up for all patients. Post-treatment assessments were scheduled at week 1 and months 1, 2, and 3. In order to account for possible influence of IOP fluctuation on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed adjusting for IOP changes (between visits variation) of the untreated fellow eye (adjusted analysis). Pre and post-laser IOP values were compared using paired t-test. Factors associated with the magnitude of IOP reduction were investigated using multiple regression analysis.

Results

A total of 45 eyes of 45 patients were enrolled. Mean IOP was reduced from 20.8 ± 5.1 to 14.9 ± 2.9 mmHg at month 3 (p < 0.001). Adjusted success rate (defined as IOP reduction ≥ 20%) was 64% and mean percentage of IOP reduction was 23.1 ± 14.3% at last follow-up visit. Considering unadjusted post-laser IOP values, it was found a 20% greater absolute IOP reduction (median [interquartile range] 6 mmHg [4–7] vs 5 mmHg [3–7]; p = 0.04), with a success rate of 76%. Although baseline IOP was significantly associated with both adjusted and unadjusted post-laser IOP reduction, a stronger association was found when unadjusted IOP values were considered (p < 0.001 and R2 = 0.35; p < 0.001 and R2 = 0.67, respectively). Age, mean deviation (MD) index, central corneal thickness and type of glaucoma were not significant predictors (p ≥ 0.150).

Conclusions

In this group of patients with early OAG or ocular hypertension, our short-term results confirmed SLT as a safe and effective alternative for IOP reduction. Although better outcomes were found in eyes with higher preoperative IOP, this effect was mitigated when results were adjusted to the fellow untreated eye (to the influence of between visits-IOP fluctuations).
Literature
1.
2.
Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish 2nd RK, Wilson MR, Gordon MO. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120(6):701–13. discussion 829-730.CrossRefPubMed
3.
Sommer A, Tielsch JM, Katz J, Quigley HA, Gottsch JD, Javitt J, Singh K. Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey. Arch Ophthalmol. 1991;109(8):1090–5.CrossRefPubMed
4.
Boland MV, Ervin AM, Friedman DS, Jampel HD, Hawkins BS, Vollenweider D, Chelladurai Y, Ward D, Suarez-Cuervo C, Robinson KA. Comparative effectiveness of treatments for open-angle glaucoma: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;158(4):271–9.CrossRefPubMed
5.
The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol. 2000;130(4):429–40.CrossRef
6.
Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, Early Manifest Glaucoma Trial G. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002;120(10):1268–79.CrossRefPubMed
7.
8.
Glaucoma Laser Trial Research Group. The Glaucoma Laser Trial (GLT) and glaucoma laser trial follow-up study: 7. Results. Am J Ophthalmol. 1995;120(6):718–31.CrossRef
9.
Latina MA, Sibayan SA, Shin DH, Noecker RJ, Marcellino G. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998;105(11):2082–8. discussion 2089-2090.CrossRefPubMed
10.
Cvenkel B. One-year follow-up of selective laser trabeculoplasty in open-angle glaucoma. Ophthalmologica Journal international d'ophtalmologie International journal of ophthalmology Zeitschrift fur Augenheilkunde. 2004;218(1):20–5.CrossRefPubMed
11.
Gracner T, Falez M, Gracner B, Pahor D. Long-term follow-up of selective laser trabeculoplasty in primary open-angle glaucoma. Klin Monatsbl Augenheilkd. 2006;223(9):743–7.CrossRefPubMed
12.
Weinand FS, Althen F. Long-term clinical results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma. Eur J Ophthalmol. 2006;16(1):100–4.PubMed
13.
Almeida Jr ED, Pinto LM, Fernandes RA, Prata TS. Pattern of intraocular pressure reduction following laser trabeculoplasty in open-angle glaucoma patients: comparison between selective and nonselective treatment. Clin Ophthalmol. 2011;5:933–6.PubMed
14.
Katz LJ, Steinmann WC, Kabir A, Molineaux J, Wizov SS, Marcellino G, Group SLMS. Selective laser trabeculoplasty versus medical therapy as initial treatment of glaucoma: a prospective, randomized trial. J Glaucoma. 2012;21(7):460–8.CrossRefPubMed
15.
Shrivastava A, Singh K. The effect of cataract extraction on intraocular pressure. Curr Opin Ophthalmol. 2010;21(2):118–22.CrossRefPubMed
16.
Slabaugh MA, Chen PP. The effect of cataract extraction on intraocular pressure. Curr Opin Ophthalmol. 2014;25(2):122–6.CrossRefPubMed
17.
Parrish 2nd RK. The European Glaucoma Prevention Study and the Ocular Hypertension Treatment Study: why do two studies have different results? Curr Opin Ophthalmol. 2006;17(2):138–41.PubMed
18.
Mills RP, Budenz DL, Lee PP, et al. Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease. Am J Ophthalmol. 2006;141:24–30.
19.
Spaeth GL. The normal development of the human anterior chamber angle: a new system of descriptive grading. Trans Ophthalmol Soc U K. 1971;91:709–39.PubMed
20.
Damji KF, Shah KC, Rock WJ, Bains HS, Hodge WG. Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial. Br J Ophthalmol. 1999;83(6):718–22.CrossRefPubMedPubMedCentral
21.
Kano K, Kuwayama Y, Mizoue S, Ito N. Clinical results of selective laser trabeculoplasty. Nippon Ganka Gakkai Zasshi. 1999;103(8):612–6.PubMed
22.
Melamed S, Ben Simon GJ, Levkovitch-Verbin H. Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study. Arch Ophthalmol. 2003;121(7):957–60.CrossRefPubMed
23.
Song J, Lee PP, Epstein DL, Stinnett SS, Herndon Jr LW, Asrani SG, Allingham RR, Challa P. High failure rate associated with 180 degrees selective laser trabeculoplasty. J Glaucoma. 2005;14(5):400–8.CrossRefPubMed
24.
Rachmiel R, Trope GE, Chipman ML, Gouws P, Buys YM. Laser trabeculoplasty trends with the introduction of new medical treatments and selective laser trabeculoplasty. J Glaucoma. 2006;15(4):306–9.CrossRefPubMed
25.
26.
Rhodes KM, Weinstein R, Saltzmann RM, Aggarwal N, Kooner KS, Petroll WM, Whitson JT. Intraocular pressure reduction in the untreated fellow eye after selective laser trabeculoplasty. Curr Med Res Opin. 2009;25(3):787–96.CrossRefPubMed
27.
Koucheki B, Hashemi H. Selective laser trabeculoplasty in the treatment of open-angle glaucoma. J Glaucoma. 2012;21(1):65–70.CrossRefPubMed
28.
Mao AJ, Pan XJ, McIlraith I, Strasfeld M, Colev G, Hutnik C. Development of a prediction rule to estimate the probability of acceptable intraocular pressure reduction after selective laser trabeculoplasty in open-angle glaucoma and ocular hypertension. J Glaucoma. 2008;17(6):449–54.CrossRefPubMed
29.
Martow E, Hutnik CM, Mao A. SLT and adjunctive medical therapy: a prediction rule analysis. J Glaucoma. 2011;20(4):266–70.CrossRefPubMed
30.
31.
Lee JW, Liu CC, Chan J, Wong RL, Wong IY, Lai JS. Predictors of success in selective laser trabeculoplasty for primary open angle glaucoma in Chinese. Clin Ophthalmol. 2014;8:1787–91.CrossRefPubMedPubMedCentral
32.
Chen E, Golchin S, Blomdahl S. A comparison between 90 degrees and 180 degrees selective laser trabeculoplasty. J Glaucoma. 2004;13(1):62–5.CrossRefPubMed
33.
Hodge WG, Damji KF, Rock W, Buhrmann R, Bovell AM, Pan Y. Baseline IOP predicts selective laser trabeculoplasty success at 1 year post-treatment: results from a randomised clinical trial. Br J Ophthalmol. 2005;89(9):1157–60.CrossRefPubMedPubMedCentral
34.
Mahdy MA. Efficacy and safety of selective laser trabeculoplasty as a primary procedure for controlling intraocular pressure in primary open angle glaucoma and ocular hypertensive patients. Sultan Qaboos Univ Med J. 2008;8(1):53–8.PubMedPubMedCentral
35.
Klamann MK, Maier AK, Gonnermann J, Ruokonen PC. Adverse effects and short-term results after selective laser trabeculoplasty. J Glaucoma. 2014;23(2):105–8.CrossRefPubMed
36.
Abdelrahman AM, Eltanamly RM. Selective laser trabeculoplasty in Egyptian patients with primary open-angle glaucoma. Middle East Afr J Ophthalmol. 2012;19(3):299–303.CrossRefPubMedPubMedCentral
37.
Shibata M, Sugiyama T, Ishida O, Ueki M, Kojima S, Okuda T, Ikeda T. Clinical results of selective laser trabeculoplasty in open-angle glaucoma in Japanese eyes: comparison of 180 degree with 360 degree SLT. J Glaucoma. 2012;21(1):17–21.CrossRefPubMed
38.
Babighian S, Caretti L, Tavolato M, Cian R, Galan A. Excimer laser trabeculotomy vs 180 degrees selective laser trabeculoplasty in primary open-angle glaucoma. A 2-year randomized, controlled trial. Eye. 2010;24(4):632–8.CrossRefPubMed
39.
Tang M, Fu Y, Fu MS, Fan Y, Zou HD, Sun XD, Xu X. The efficacy of low-energy selective laser trabeculoplasty. Ophthalmic Surg Lasers Imaging. 2011;42(1):59–63.CrossRefPubMed
Metadata
Title
Selective laser trabeculoplasty for early glaucoma: analysis of success predictors and adjusted laser outcomes based on the untreated fellow eye
Authors
Mikael Chun
Carolina P. B. Gracitelli
Flavio S. Lopes
Luis G. Biteli
Michele Ushida
Tiago S. Prata
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Ophthalmology / Issue 1/2016
Electronic ISSN: 1471-2415
DOI
https://doi.org/10.1186/s12886-016-0385-z

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