The Effectiveness of Selective Laser Trabeculoplasty in Patients with Medically Uncontrolled Open-angle Glaucoma

Won Park Hye; Soo Han Seung; Woon Park Jong

doi:10.3341/jkos.2017.58.7.828

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

Original Article

J Korean Ophthalmol Soc 2017;58(7):828-835.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.828

The Effectiveness of Selective Laser Trabeculoplasty in Patients with Medically Uncontrolled Open-angle Glaucoma

Won Park Hye, M.D.^1,², Soo Han Seung, M.D., MPH^1,^2,³, Woon Park Jong, M.D.^2,

¹The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

³Department of Ophthalmology, Suncheon Medical Center, Suncheon, Korea

Address reprint requests to Jong Woon Park, MD Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea Tel: 82-31-900-0590, Fax: 82-31-900-0049 E-mail: unij143@naver.com

* This study was presented as an e-poster at the 116th Annual Meeting of the Korean Ophthalmological Society 2016.

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 12 January 201724 April 2017 Accepted 16 June 2017

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 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.

Keywords: Intraocular pressure (IOP), Maximal tolerated medical therapy (MTMT), Selective laser trabeculoplasty (SLT), Uncontrolled glaucoma

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Figure 1.

Pearson correlation of baseline intraocular pressure (IOP) and IOP reduction after 12 months. IOP measurements obtained by Goldmann applanation tonometer.

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

^* 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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