Selective laser trabeculoplasty reduces diurnal IOP in advanced primary open-angle glaucoma: Study

Germany: In a new study conducted by Karin R. Pillunat and team it was found that after previous incisional glaucoma surgery, selective laser trabeculoplasty (SLT) is successful and safe in decreasing mean diurnal intraocular pressure (mdIOP, mean of 6 measures) to target IOP in around half of the eyes. The findings of this study were published in the Journal of Glaucoma.

Selective laser trabeculoplasty is helpful in decreasing intraocular pressure in around half of post-trabeculectomy (TE) eyes (IOP). This research looked at the effectiveness and safety of SLT in post-TE eyes that were uncontrolled on maximal tolerable medication and/or had visual field loss that was progressing.

For this study, the post-TE eyes of patients who were diagnosed with primary open-angle glaucoma and had been treated with 360 degrees SLT and had a 12-month follow-up were included in this retrospective analysis. The lowering of mean diurnal intraocular pressure (mdIOP, mean of 6 measures), peak IOP, and diurnal IOP variations were the primary goals. Factors impacting IOP reduction, SLT success, and failure rates were secondary results.

The results of this study stated as follow:

1. A total of 43 individuals' eyes were included in the study. During the first year, 10 eyes (23%) required further operations to minimize mdIOP, and they were classified as failures and were not included in the final study.

2. MdIOP [Q25, Q75] reduced from 15.2 [12.2 to 16.5] to 13.2 [11.6 to 15.3] mm Hg in the remaining 33 eyes (77%) 1 year after SLT, with 23 eyes (54%) showing a satisfactory mdIOP reduction.

3. Although the current study demonstrated a 20% reduction in mdIOP in only 12% of patients who received SLT post-TE, it should be noted that in most cases, the preoperative IOP was already relatively low, which is often inadequate to manage patients with advanced glaucoma.

In conclusion, SLT has the potential to lower not just mdIOP but also peak IOP and diurnal IOP changes in medicated post-TE eyes. The treatment is safe, quick, and can be performed by comprehensive ophthalmologists in around half of the instances.

Reference:

Pillunat, K. R., Herber, R., Wolfram, S., Jasper, C. S., Waibel, S., & Pillunat, L. E. (2021). Efficacy of Selective Laser Trabeculoplasty on Circadian Intraocular Pressure Following Trabeculectomy in Advanced Primary Open-angle Glaucoma. In Journal of Glaucoma (Vol. 31, Issue 2, pp. 96–101). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/ijg.0000000000001971