Long-Term Outcomes and Predictive Factors for Success of Selective Laser Trabeculoplasty

Ji Young Lee; You Kyung Lee; Jung Il Moon; Myoung Hee Park

doi:10.3341/jkos.2014.55.9.1347

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Lee, Lee, Moon, and Park: Long-Term Outcomes and Predictive Factors for Success of Selective Laser Trabeculoplasty

Original Article

J Korean Ophthalmol Soc 2014;55(9):1347-1354.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.9.1347

Long-Term Outcomes and Predictive Factors for Success of Selective Laser Trabeculoplasty

Ji Young Lee, MD, You Kyung Lee, MD, Jung Il Moon, MD, PhD, Myoung Hee Park, MD, PhD

Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Myoung Hee Park, MD, PhD, Department of Ophthalmology, The Catholic University of Korea, Yeouido St. Mary's Hospital, #10 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea, Tel: 82-2-3779-1243, Fax: 82-2-761-6869, E-mail: marypark@catholic.ac.kr

Received 13 December 2013 Revised 11 February 2014 Accepted 20 August 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate long-term outcomes and predictive success factors for selective laser trabeculoplasty (SLT).

Methods

This retrospective chart review included 66 eyes of 66 glaucoma or ocular hypertension patients who underwent SLT between 2004 and 2011. All patients were followed-up for at least 2 years after the procedure. The intraocular pressure (IOP) was measured before the treatment, at postoperative 1 week, 1 month and every 3 months thereafter. Success was defined as an IOP decrease ≥ 3 mm Hg or ≥ 20% of the pretreatment IOP. The success rate was determined based on the Kaplan-Meier survival analysis. The predictive success factors were analyzed using the Cox proportional hazard model.

Results

The mean follow-up period was 4.78 ± 1.98 (2-8) years. The mean pretreatment IOP was 23.79 ± 2.83 mm Hg. The mean IOP reduction was 6.64 ± 3.21 mm Hg. The success rates were 80%, 75%, 69%, 63%, 50%, 45%, and 42% after 1, 2, 3, 4, 5, 6, and 7 years, respectively. Only high pretreatment IOP was significantly correlated with success (p = 0.044).

Conclusions

SLT was an effective tool for lowering IOP in glaucoma patients. Higher pretreatment IOP was a predictive success factor.

Keywords: Glaucoma, Intraocular pressure, Predictive factor, Selective laser trabeculoplasty (SLT), Success rate

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Figure 1.

Mean IOP changes during follow-up. IOP = intraocular pressure.

Figure 2.

Mean IOP reduction during follow-up. IOP = intraocular pressure.

Figure 3.

Kaplan-Meier survival analysis. The success rate was 82%, 78%, 71%, 64%, 59%, 53%, 43% after 1, 2, 3, 4, 5, 6, 7 years.

Table 1.

Baseline characteristics

Factors	Values (n = 74)
Age (range)	55.45 ± 15.98 (30-86)
Sex
Male (%)	42 (63.6)
Female (%)	24 (36.4)
Laterality
OD (%)	33 (50.0)
OS (%)	33 (50.0)
Diagnosis
POAG (%)	57 (86.42)
PXG (%)	5 (7.62)
OHT (%)	4 (6.08)
Lens status
Phakic (%)	51 (77.26)
Pseudophakic (%)	15 (22.73)
Family history of glaucoma (yes/no)	6/66
Hypertension (yes/no)	15/66
Diabetes (yes/no)	7/66
MD, median (range) (dB)	−9.43 (-32.45∼0.65)
PSD, median (range) (dB)	4.53 (0.12-14.45)
Pretreatment IOP (range) (mm Hg)	23.79 ± 2.83 (14-38)
Baseline IOP (range) (mm Hg)	25.41 ± 4.96 (13-36)
Number of medications before SLT (range)	3.61 ± 1.35 (0-5)
Average pigmentation (range)	0.216 ± 0.55 (0-4)

Values are presented as mean ± SD unless otherwise indicated. POAG = primary open angle glaucoma; PXG = pseudoexfoliation glaucoma; OHT = ocular hypertension; MD = mean deviation; PSD = pattern standard deviation; IOP = intraocular pressure; SLT = selective laser trabeculoplasty.

Table 2.

Laser parameters

Factors	Values
Number of spots per eye	51.27 ± 5.94
Total dose per eye (mJ)	39.49 ± 6.57
Postopertative medication
Fluorometholone (%)	42 (63.58)
None (%)	24 (36.42)

Values are presented as mean ± SD unless otherwise indicated.

Table 3.

Mean IOP and change in pressure (mm Hg) from pre IOP

	Number of eyes	Mean IOP ± SD (mm Hg)	Mean IOP reduction (mm Hg) (%)	p-value^*
PreIOP	66	23.79 ± 2.83	−	−
1 week	66	17.36 ± 4.12	6.43 (27.1)	<0.001
1 month	66	17.34 ± 4.33	6.45 (27.0)	<0.001
3 months	66	17.59 ± 3.19	6.2 (26.1)	<0.001
6 months	54	17.51 ± 3.02	6.28 (26.1)	<0.001
1 year	46	16.72 ± 2.57	7.07 (29.5)	<0.001
2 years	40	17.01 ± 2.77	6.78 (28.5)	<0.001
3 years	30	17.19 ± 3.11	6.6 (27.7)	<0.001
4 years	27	17.78 ± 3.37	6.01 (25.3)	<0.001
5 years	18	17.75 ± 2.96	6.04 (25.4)	<0.001
6 years	9	17.68 ± 2.12	6.11 (25.7)	<0.001
7 years	5	18.16 ± 3.70	5.63 (23.6)	<0.001

IOP = intraocular pressure; SD = standard deviation.

^* Repeated measures ANOVA for paired data.

Table 4.

Comparison of the success group and failure group at 2 years

Factors	Success group (n = 43)	Failure group (n = 23)	p-value
Age (range)	54.67 ± 12.64 (39-86)	50.74 ± 9.31 (30-74)	0.075^*
Diagnosis
POAG	36	21	0.742^†
PXG	4	1
OHT	3	1
Family history of glaucoma (%)	4 (9.3)	2 (8.7)	0.686^†
Hypertension (%)	9 (20.9)	6 (26.2)	0.257^†
Diabetes (%)	5 (10.3)	3 (13.0)	0.461^†
MD, median (range) (dB)	−12.02 (-32.04∼0.59)	−8.55 (-32.45∼0.65)	0.643^‡
PSD, median (range) (dB)	5.12 (1.02-12.18)	4.86 (0.12-14.69)	0.578^‡
Baseline IOP (range) (mm Hg)	26.20 ± 4.56 (18-38)	23.91 ± 5.39 (14-36)	0.073^*
Pretreatment IOP (range) (mm Hg)	25.38 ± 2.68 (17-36)	20.52 ± 2.61 (13-31)	0.019^*
Number of medications before SLT (range)	3.39 ± 1.53 (0-4)	4.0 ± 0.80 (0-5)	0.082^*
TM pigmentation (range)	0.17 ± 0.59 (0-2)	0.27 ± 0.51 (0-2)	0.650^*
Total energy (mJ)	39.03 ± 6.68	40.35 ± 6.42	0.438^*
Use of anti-inflammatory medication (%)	26 (60.5)	16 (69.6)	0.248^†

Values are presented as mean ± SD unless otherwise indicated.

POAG = primary open angle glaucoma; PXG = pseudoexfoliation glaucoma; OHT = ocular hypertension; MD = mean deviation; PSD = pattern standard deviation; IOP = intraocular pressure; SLT = selective laser trabeculoplasty; TM = trabecular meshwork.

^* Independent t-test;

^† Chi-squre test;

^‡ Man-Whitney test.

Table 5.

Predictive factors associated with survival time for SLT

Covariates	Harzad ratio	95% CI	p-value^*
Age	0.971	0.936-1.005	0.093
Pretreatment IOP	0.838	0.739-0.936	0.044
Baseline IOP	0.953	0.781-1.125	0.335
Number of medications before SLT	1.361	0.943-1.779	0.149

SLT = selective laser trabeculoplasty; CI = confidence interval; IOP = intraocular pressure.

^* Cox propotional regression model.

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