Factors affecting the corneal endothelium after selective laser trabeculoplasty in primary open angle and angle closure glaucoma

Selective laser trabeculoplasty: An updated narrative review

Selective laser trabeculoplasty (SLT) has experienced a resurgence in interest, primarily driven by promising findings from the Laser in Glaucoma and Ocular Hypertension Trial. By offering SLT as an initial drug-free treatment option, we may be able to thwart issues such as adherence and persistence that plague our current medical management protocols. In this comprehensive narrative review, we delve into the current body of literature that explores the utility of SLT across a wide spectrum of scenarios and glaucoma subtypes. We present evidence that provides valuable insight into the efficacy and benefits of SLT, positioning it as a viable option in the management of glaucoma. Careful consideration of the associated risks and challenges is also necessary for successful adoption into clinical practice. Despite the ample evidence supporting SLT's efficacy, some questions remain regarding its long-term effects and the potential need for retreatment. This review aims to shed light on these aspects to guide clinicians in making informed decisions and tailoring treatment plans to individual patient needs. This review also provides the readers with a bird's eye view of the potential impact of SLT and adds clarity to the various therapeutic protocols that one can follow to ensure optimal clinical outcomes for our patients.

Comparison of Lens Extraction Versus Laser Iridotomy on Anterior Segment, Choroid, and Intraocular Pressure in Primary Angle Closure Using Machine Learning

PRCIS

Treatment strategy of primary angle closure (PAC) is not clear due to the large number of clinical and anatomic-topographic parameters in PAC, influencing the treatment algorithm. Using the machine learning method DD-SIMCA, we justify the expediency of early lens extraction (LE) in PAC.

PURPOSE

To compare the anatomic and functional efficacy of LE and laser peripheral iridotomy (LPI) in patients with PAC using Machine Learning.

MATERIALS AND METHODS

This prospective study included 120 patients aged 41-80 years: 60 eyes with PAC, 30 with PAC suspects, and 30 with healthy eyes (control). Thirty PAC eyes with intraocular pressure (IOP) up to 30 mm Hg were treated using LE with intraocular lens implantation and 30 eyes with LPI. All subjects underwent Swept Source optical coherence tomography. We analyzed 35 parameters of each eye including the lens vault, the choroidal thickness, the anterior chamber angle, and iris specifications such as iris curvature. Considering the correlations between them, the machine learning method DD-SIMCA 1-class classification was applied: the proximity of each sample to the target class (control) was characterized by the total distance to it.

RESULTS

After LE, IOP was significantly lower than after LPI ( P =0). Every third eye with PAC after LE reached the target class: specificity according to DD-SIMCA equals 0.67. This was not observed for the eyes after LPI: specificity equals 1.0. After LE, all parameters of the anterior chamber angle did not differ from the control (all P >0.05). After LPI, there was an increase in anterior chamber depth ( P =0) and a decrease in lens vault ( P =0), but results comparable to the control were achieved only for iris curvature ( P =1.000).

CONCLUSION

The efficacy of LE in PAC is higher than LPI due to the better postoperative anterior chamber topography and lower IOP. This study lends further clinical and anatomic support to the emerging notion of LE as an effective treatment for PAC.