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Journal List > J Korean Ophthalmol Soc > v.58(7) > 1010813

Hye, Seung, and Jong: The Effectiveness of Selective Laser Trabeculoplasty in Patients with Medically Uncontrolled Open-angle Glaucoma

Abstract

Purpose

To determine the effect of intraocular pressure (IOP) reduction of selective laser trabeculoplasty (SLT) on medically uncontrolled open-angle glaucoma (OAG) and the factors associated with the treatment result.

Methods

Forty-seven eyes of 47 OAG patients were enrolled for 180° SLT or 360° SLT, all under maximal tolerated medical therapy and with IOP above their target pressure. All patients were followed-up for at least 1 year after the procedure. Treatment success was defined as IOP reduction ≥20% from baseline at 12 months after SLT treatment without additional anti-glaucoma-tous intervention.

Results

The treatment success rate was 65.96%. Baseline IOP was 23.84 ± 4.52 mmHg in the success group and 21.44 ± 2.97 mmHg in the failure group (p = 0.035). Significant mean IOP reduction was observed at 6, 9, and 12 month follow-ups (p = 0.001 at 6 months; 0.041 at 9 months, and <0.001 at 12 months). The success rate did not vary significantly by sex (p = 0.362), age (p = 0.081), history of cataract surgery (p = 0.470), number of medications (p = 0.857), duration of medication (p = 0.613), or an-gular degree of SLT treatment (180° vs. 360°) (p = 0.137). There was a positive correlation between mean baseline IOP and mean reduction of IOP from baseline in the success group (p < 0.001, r = 0.861), while there was no such correlation in the failure group (p = 0.272, r = -2.921).

Conclusions

SLT was an effective treatment for IOP reduction until 12 months in medically uncontrolled OAG patients. A greater amount of IOP reduction is expected in patients with higher baseline IOP in the success group.

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jkos-58-828f1.tif
Figure 1.
Pearson correlation of baseline intraocular pressure (IOP) and IOP reduction after 12 months. IOP measurements obtained by Goldmann applanation tonometer.
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Table 1.
The general characteristics of 47 patients with medi-cally uncontrolled open-angle glaucoma
Characteristics Data
Age (years) 66.76 ± 11.90
Affected eye (n, %)
Right eye 24 (51.06)
Left eye 23 (48.94)
Sex (n, %)
Male 28 (59.57)
Female 19 (40.43)
Lens status, phakic (n, %) 32 (68.09)
Baseline IOP (mmHg) 23.02 ± 4.19
Type of laser (n, %)
180° SLT 14 (29.79)
360° SLT 33 (70.21)
Mean duration of medication (months) 59.51 ± 52.34
Number of medication (n, %)
1 7 (14.89)
2 23 (48.94)
3 17 (36.17)
Comorbidities
Hypertension 9 (19.15)
Diabetic mellitus type 2 24 (51.06)
Visual acuity
BCVA (logMAR) 0.19 ± 0.23
Refraction
Spherical power (diopters) -1.33 ± 2.41
Cylindrical power (diopters) -0.80 ± 0.71
Visual field
MD (dB) -15.86 ± 7.39
PSD (dB) 10.05 ± 2.90

Values are presented as mean ± SD or n (%) unless otherwise indicated. IOP = intraocular pressure; SLT = selective laser trabeculoplasty; BCVA = best corrected visual acuity; MD = mean deviation; PSD = pattern standard deviation.

Table 2.
Comparison of baseline characteristics between success and failure group
Characteristics Success* (n = 31) Failure (n = 16) p-value
Age (n, %) 0.081
>70 years old 20 (76.92) 6 (23.08)
≤70 years old 11 (52.38) 10 (47.62)
Sex (n, %) 0.362
Male 17 (60.71) 11 (39.29)
Female 14 (73.68) 5 (26.32)
Lens status, phakic (n, %) 0.470
Pseudo-phakic 11 (73.33) 4 (26.67)
Phackic 20 (62.50) 12 (37.50)
Baseline IOP (mmHg) 23.84 ± 4.52 21.44 ± 2.97 0.035
Type of laser (n, %) 0.137
180° SLT 7 (50.00) 7 (50.00)
360° SLT 24 (72.73) 9 (27.27)
Mean duration of medication (n, %) 0.613
>4 years 15 (62.50) 9 (37.50)
≤4 years 16 (69.57) 7 (30.43)
Number of medication (n, %) 0.857
1 4 (57.14) 3 (42.86)
2 16 (69.57) 7 (30.43)
3 11 (64.71) 6 (32.29)
Comorbidities
Hypertension 0.613
Yes 15 (62.50) 9 (37.50)
No 16 (69.57) 7 (30.43)
Diabetic mellitus type 2 0.469
Yes 5 (55.56) 4 (44.44)
No 26 (68.42) 12 (31.58)
BCVA (logMAR) 0.19 ± 0.25 0.18 ± 0.19 0.900
Refraction
Spherical power (diopters) -1.29 ± 2.51 -1.42 ± 2.37 0.900
Cylindrical power (diopters) -0.66 ± 0.74 -1.11 ± 0.57 0.117
Visual field
MD (dB) -15.40 ± 6.86 -16.71 ± 8.43 0.576
PSD (dB) 10.05 ± 2.82 10.05 ± 3.14 0.995

Values are presented as mean ± SD or n (%) unless otherwise indicated. IOP = intraocular pressure; SLT = selective laser trabeculoplasty; BCVA = best corrected visual acuity; MD = mean deviation; PSD = pat-tern standard deviation.

* Success was defined as ≥20% reduction in IOP from baseline at 12 months after treatment with no additional anti-glaucomatous intervention;

p-value was acquired from chi-square test except baseline IOP, BCVA, refraction, and visual field of which p-value was acquired from Student's t-test.

Table 3.
IOP reduction throughout the 12 months follow up period
Variables Success Failure p-value*
Baseline IOP (mmHg) 23.84 ± 4.52 21.44 ± 2.97 0.062
1 week 18.06 ± 3.87 17.75 ± 5.93 0.850
1 month 16.58 ± 3.51 16.19 ± 1.94 0.624
3 months 16.32 ± 4.34 17.19 ± 4.65 0.531
6 months 15.52 ± 3.00 19.00 ± 3.65 0.001
9 months 15.57 ± 2.83 19.62 ± 6.21 0.041
12 months 14.84 ± 2.33 20.81 ± 4.82 <0.001

Values are presented as mean ± SD unless otherwise indicated. IOP = intraocular pressure.

* p-value was acquired from Student’s t-test.

Table 4.
Association between success and demographic variables for multivariate logistic regression
Variables Adjusted OR 95% CI p-value
Age
≤70 years old 1 (ref)
>70 years old 5.833 0.755-45.062 0.091
Sex
Male 1 (ref)
Female 1.295 0.224-7.476 0.773
Lens status
Phackic 1 (ref)
Pseudo-phakic 1.008 0.151-6.730 0.994
Baseline IOP (mmHg) 1.264 0.967-1.652 0.086
Type of laser
180° SLT 1 (ref)
360° SLT 2.956 0.476-18.346 0.245
Number of medication
1 1 (ref)
2 1.002 0.127-7.892 0.999
3 1.519 0.154-14.941 0.720
Mean duration of medication
>4 years 1 (ref)
≤4 years 0.893 0.200-3.996 0.883
Comorbidities
Hypertension 0.194 0.022-1.689 0.138
Diabetic mellitus type 2 1.023 0.169-6.187 0.980

OR = odds ratio; CI = confidential interval; ref = reference; IOP = intraocular pressure; SLT = selective laser trabeculoplasty.

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