Predictors of Success of Selective Laser Trabeculoplasty Adjusted for Intraocular Pressure Variations

Jun Seok Lee; Chong Eun Lee; Sam Seo; Kyoo Won Lee

doi:10.3341/jkos.2018.59.12.1166

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Lee, Lee, Seo, and Lee: Predictors of Success of Selective Laser Trabeculoplasty Adjusted for Intraocular Pressure Variations

Original Article

J Korean Ophthalmol Soc 2018;59(12):1166-1172.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.12.1166

Predictors of Success of Selective Laser Trabeculoplasty Adjusted for Intraocular Pressure Variations

Jun Seok Lee, MD¹, Chong Eun Lee, MD, PhD², Sam Seo, MD, PhD^1,, Kyoo Won Lee, MD, PhD¹

¹Cheil Eye Hospital, Daegu, Korea

²Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea

Address reprint requests to Sam Seo, MD, PhD Cheil Eye Hospital, #1 Ayang-ro, Dong-gu, Daegu 41196, Korea Tel: 82-53-959-1751, Fax: 82-53-959-1758 E-mail: vit.s0324@gmail.com

Received 12 July 2018 Revised 23 August 2018 Accepted 23 November 2018

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 the efficacy, and identify predictors of success of selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG) patients after adjusting for intraocular pressure (IOP) changes in the untreated fellow eye.

Methods

This retrospective chart review included 52 eyes of 52 OAG patients who underwent SLT in one eye and were fol-lowed-up for at least 1 year after the procedure. The IOP was measured before the treatment, at 1, 2, and 3 months posttreatment, and every 3 months thereafter. To account for the possible influence of IOP fluctuations on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed, after adjusting for IOP changes in the untreated fellow eye. Success was defined as an IOP decrease ≥20% of the pretreatment IOP. The success rate was determined based on Kaplan-Meier survival analysis and factors predictive of success were analyzed using the Cox proportional hazard model.

Results

The mean pretreatment IOP was 23.17 ± 6.96 mmHg. The mean IOP reduction was 5.59 ± 4.78 mmHg (29.7%) and the success rate was 65.4% at 1 year. The adjusted mean IOP reduction was 4.70 ± 4.67 mmHg (23.9%) and the adjusted success rate was 53.9%. Pretreatment IOP was associated with SLT success; the higher the pretreatment IOP, the greater the post-laser IOP reduction (p = 0.025). Age and mean deviation index did not show a significant association with SLT success (p = 0.066 and p = 0.464, respectively).

Conclusions

SLT is a safe and effective alternative method of IOP reduction in OAG patients. Herein, pretreatment IOP was the only factor significantly associated with SLT success. IOP fluctuations of the untreated eye should be considered for a better understanding of the impact of treatment.

Keywords: Intraocular pressure, Open-angle glaucoma, Predictive factors, Selective laser trabeculoplasty, Success rate

References

1. Heijl A, Leske MC, Bengtsson B, et al. reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Arch Ophthalmol. 2002; 120:1268–79.

2. Latina MA, Sibayan SA, Shin DH, et al. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998; 105:2082–8. discussion 2089–90.

3. Juzych MS, Chopra V, Banitt MR, et al. Comparison of long-term outcomes of selective laser trabeculoplasty versus argon laser abdominal in open-angle glaucoma. Ophthalmology. 2004; 111:1853–9.

4. Latina MA, Gulati V. Selective laser trabeculoplasty: stimulating the meshwork to mend its ways. Int Ophthalmol Clin. 2004; 44:93–103.

5. McIlraith I, Strasfeld M, Colev G, Hutnik CM. Selective laser abdominal as initial and adjunctive treatment for open-angle glaucoma. J Glaucoma. 2006; 15:124–30.

6. 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; 121:957–60.

7. Shazly TA, Smith J, Latina MA. abdominal safety and efficacy of selective laser trabeculoplasty as primary therapy for the treatment of pseudoexfoliation glaucoma compared with primary open-angle glaucoma. Clin Ophthalmol. 2010; 5:5–10.

8. Medeiros FA, Weinreb RN, Zangwill LM, et al. abdominal abdominal pressure fluctuations and risk of conversion from ocular abdominal to glaucoma. Ophthalmology. 2008; 115:934–40.

9. Wakabayashi Y, Higashide T, Sugiyama K. Improved prediction of fellow-eye response in one-eye trials using multiple intraocular pressure measurements. Jpn J Ophthalmol. 2011; 55:480–5.

10. Wilensky JT, Gieser DK, Dietsche ML, et al. Individual variability in the diurnal intraocular pressure curve. Ophthalmology. 1993; 100:940–4.

11. Damji KF, Bovell AM, Hodge WG, et al. Selective laser abdominal versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial. Br J Ophthalmol. 2006; 90:1490–4.

12. Rozsival P, Kana V, Hovorkova M. Selective laser trabeculoplasty. Cesk Slov Oftalmol. 2004; 60:267–74.

13. Weinand FS, Althen F. abdominal clinical results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma. Eur J Ophthalmol. 2006; 16:100–4.

14. Kim JS, Lee YG, Hong YJ. Q-switched, frequency doubled Nd:YAG laser trabeculoplasty. J Korean Ophthalmol Soc. 1999; 40:2591–6.

15. Kim YJ, Moon CS. One-year follow-up of laser trabeculoplasty abdominal Q-switched frequency-doubled Nd:YAG laser of 523 nm wavelength. Ophthalmic Surg Lasers. 2000; 31:394–9.

16. Nagar M, Ogunyomade A, O'Brart DP, et al. A randomised, abdominal study comparing selective laser trabeculoplasty with abdominal for the control of intraocular pressure in ocular hypertension and open angle glaucoma. Br J Ophthalmol. 2005; 89:1413–7.

17. Hodge WG, Damji KF, Rock W, et al. Baseline IOP predicts abdominal laser trabeculoplasty success at 1 year post-treatment: results from a randomised clinical trial. Br J Ophthalmol. 2005; 89:1157–60.

18. Kramer TR, Noecker RJ. Comparison of the morphologic changes after selective laser trabeculoplasty and argon laser trabeculoplasty in human eye bank eyes. Ophthalmology. 2001; 108:773–9.

19. Stein JD, Challa P. Mechanisms of action and efficacy of argon abdominal trabeculoplasty and selective laser trabeculoplasty. Curr Opin Ophthalmol. 2007; 18:140–5.

20. Rhodes KM, Weinstein R, Saltzmann RM, et al. Intraocular abdominal reduction in the untreated fellow eye after selective laser trabeculoplasty. Curr Med Res Opin. 2009; 25:787–96.

21. Rachmiel R, Trope GE, Chipman ML, et al. Laser trabeculoplasty trends with the introduction of new medical treatments and abdominal laser trabeculoplasty. J Glaucoma. 2006; 15:306–9.

22. Barkana Y, Belkin M. Selective laser trabeculoplasty. Surv Ophthalmol. 2007; 52:634–54.

23. Damji KF, Shah KC, Rock WJ, et al. Selective laser abdominal v argon laser trabeculoplasty: a prospective randomised clinical trial. Br J Ophthalmol. 1999; 83:718–22.

24. Kano K, Kuwayama Y, Mizoue S, Ito N. Clinical results of selective laser trabeculoplasty. Nippon Ganka Gakkai Zasshi. 1999; 103:612–6.

25. Song J, Lee PP, Epstein DL, et al. High failure rate associated with 180 degrees selective laser trabeculoplasty. J Glaucoma. 2005; 14:400–8.

26. Scherer WJ. Effect of topical prostaglandin analog use on outcome following selective laser trabeculoplasty. J Ocul Pharmacol Ther. 2007; 23:503–12.

27. Koucheki B, Hashemi H. Selective laser trabeculoplasty in the treatment of open-angle glaucoma. J Glaucoma. 2012; 21:65–70.

28. Mao AJ, Pan XJ, McIlraith I, et al. Development of a prediction rule to estimate the probability of acceptable intraocular pressure reduction after selective laser trabeculoplasty in open-angle abdominal and ocular hypertension. J Glaucoma. 2008; 17:449–54.

29. Martow E, Hutnik CM, Mao A. SLT and adjunctive medical abdominal: a prediction rule analysis. J Glaucoma. 2011; 20:266–70.

30. Lee JW, Liu CC, Chan JCh, et al. Predictors of success in selective laser trabeculoplasty for primary open angle glaucoma in Chinese. Clin Ophthalmol. 2014; 8:1787–91.

Figure 1.

Adjusted and non-adjusted intraocular pressure (IOP) profile during follow-up. Adjusted IOP values accounting the fellow untreated eye was higher than that of non-adjusted. p-value was 0.04, 0.00, 0.01 at 2 mo, 6 mo, 9 mo each. mo = month.

Figure 2.

Kaplan-Meier survival analysis. The success rate during follow-up period after adjusting for intraocular pressure changes of the untreated fellow eye.

Figure 3.

Scatterplot of intraocular pressure (IOP) reduction based on pre-treatment IOP. Scatterplot shows the positive relationship between the magnitude of IOP reduction and pre-treatment mean IOP.

Table 1.

Demographics and clinical variables of the study patients

Characteristics	Values (n = 52)
Age (years)	52.33 ± 15.06
Gender (male) (n, %)	29 (55.77)
Eye (right) (n, %)	31 (59.62)
Hypertension (n, %)	8 (15.38)
Diabetes (n, %)	6 (11.54)
Pretreatment IOP (mmHg)	23.17 ± 6.96
Number of medications before SLT	2.44 ± 1.38
Central corneal thickness (μ m)	551.61 ± 41.745
Lens status (phakic) (n, %)	45 (86.54)
Cup disc ratio	0.76 ± 0.15
MD (dB)	−12.85 ± 10.58
PSD (dB)	7.70 ± 4.91

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated. IOP = intraocular pressure; SLT = selective laser trabeculoplasty; MD = mean deviation; PSD = pattern standard deviation.

Table 2.

Laser outcomes for adjusted and non-adjusted success rates

Variables	Adjusted	Non-adjusted
Delta IOP (mmHg)	4.70 ± 4.67	5.59 ± 4.78
Delta IOP (%)	23.91	29.65
Success rate (%)	53.85	65.38

Values are presented as mean ± standard deviation unless otherwise indicated.

IOP = intraocular pressure.

Table 3.

Comparison of the success and failure group at 1 year

Characteristics	Success group (n = 28)	Failure group (n = 24)	p-value
Age (years)	48.21 ± 12.43	57.13 ± 16.64	0.037
Gender (male) (n, %)	16 (57.14)	13 (54.17)	0.829
Eye (right) (n, %)	18 (64.29)	13 (54.17)	0.458
Hypertension (n, %)	4 (14.29)	4 (16.67)	0.812
Diabetes (n, %)	3 (10.71)	3 (12.5)	0.841
Pretreatment IOP (mmHg)	25.46 ± 8.25	20.50 ± 3.67	0.007
Number of medications before SLT	2.46 ± 1.50	2.42 ± 1.25	0.901
Prostaglandin use before SLT (n, %)	18 (64.29)	19 (79.17)	0.192
CCT (μ m)	534.75 ± 39.49	560.60 ± 41.35	0.162
Lens status (phakic) (n, %)	24 (85.71)	21 (87.5)	0.851
Cup disc ratio	0.74 ± 0.15	0.78 ± 0.16	0.376
MD (%)	−10.48 ± 10.16	−15.71 ± 10.58	0.079
PSD (%)	7.42 ± 5.40	8.04 ± 4.32	0.657
Use of anti-inflammatory medication (n, %)	21 (75.00)	14 (58.33)	0.202

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated. IOP = intraocular pressure; SLT = selective laser trabeculoplasty; CCT = central corneal thickness; MD = mean deviation; PSD = pattern standard deviation.

Table 4.

Predictive factors associated with survival time for SLT

Variables	Adjusted survival		Unadjusted survival
Variables	Hazard ratio	p-value^*	Hazard ratio	p-value^*
Pretreatment IOP	1.136	0.025	1.476	0.047
Age (years)	0.976	0.066	1.004	0.863
MD (dB)	1.015	0.464	0.932	0.235

SLT = selective laser trabeculoplasty; IOP = intraocular pressure; MD = mean deviation.

^* Cox propotional regression model.

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