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Schmidl D, Hommer N, Hommer A. An Exploratory Retrospective Data Analysis Comparing the Outcomes of Selective Laser Trabeculoplasty and Argon Laser Trabeculoplasty in Patients with Open-Angle Glaucoma or Ocular Hypertension in Vienna, Austria, from the Year 2012 to 2022. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2075. [PMID: 38138178 PMCID: PMC10744835 DOI: 10.3390/medicina59122075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The aim of the present study was to compare the short-term outcomes of selective laser trabeculoplasty (SLT) with argon laser trabeculoplasty (ALT) in patients with glaucoma in a real-world setting. Materials and Methods: The present study was conducted as a retrospective case-control study. The main outcome was the change in intraocular pressure (IOP) three months after laser surgery. In addition, the number of substances used for lowering of IOP and adverse events (AEs) were assessed. Results: Charts from 25 patients were included in the present study, of which 12 had received ALT and 13 SLT. In both groups, IOP significantly decreased from baseline values 6 weeks and 3 months after laser treatment (p < 0.01 vs. baseline at each timepoint for both groups). While after 6 weeks, no difference between groups was found, after 3 months, the decrease in IOP was significantly more pronounced in the SLT group (-26 ± 21% in the ALT group vs. -41 ± 14% in the SLT group, p = 0.018 between groups, ANOVA). Three months after laser treatment, the number of IOP-lowering substances used by each patient had decreased with no difference between groups (ALT: from 2.7 ± 0.8 to 2.3 ± 0.9 substances; SLT: from 1.8 ± 1.2 to 1.3 ± 1.1 substances, p = 0.386). Only a few AEs were observed. Two patients in the ALT and one patient in the SLT group required trabeculectomy within 1 year after laser treatment due to IOP decompensation. Conclusions: In the present study, SLT was at least as effective as ALT with fewer AEs and a similar reduction in concomitant IOP-lowering medication.
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Affiliation(s)
- Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (N.H.)
| | - Nikolaus Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (N.H.)
- Hommer Ophthalmology Institute, Albertgasse 39, 1080 Vienna, Austria
- Department of Ophthalmology, Hanusch Hospital, 1140 Vienna, Austria
| | - Anton Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (N.H.)
- Hommer Ophthalmology Institute, Albertgasse 39, 1080 Vienna, Austria
- Department of Ophthalmology, Hera Hospital, 1090 Vienna, Austria
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Rolim-de-Moura CR, Paranhos A, Loutfi M, Burton D, Wormald R, Evans JR. Laser trabeculoplasty for open-angle glaucoma and ocular hypertension. Cochrane Database Syst Rev 2022; 8:CD003919. [PMID: 35943114 PMCID: PMC9361429 DOI: 10.1002/14651858.cd003919.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Open-angle glaucoma (OAG) is an important cause of blindness worldwide. Laser trabeculoplasty, a treatment modality, still does not have a clear position in the treatment sequence. OBJECTIVES To assess the effects of laser trabeculoplasty for treating OAG and ocular hypertension (OHT) when compared to medication, glaucoma surgery or no intervention. We also wished to compare the effectiveness of different laser trabeculoplasty technologies for treating OAG and OHT. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2021, Issue 10); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; LILACS, ClinicalTrials.gov and the WHO ICTRP. The date of the search was 28 October 2021. We also contacted researchers in the field. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing laser trabeculoplasty with no intervention, with medical treatment, or with surgery in people with OAG or OHT. We also included trials comparing different types of laser trabeculoplasty technologies. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. Two authors screened search results and extracted data independently. We considered the following outcomes at 24 months: failure to control intraocular pressure (IOP), failure to stabilise visual field progression, failure to stabilise optic neuropathy progression, adverse effects, quality of life, and costs. We graded the 'certainty' of the evidence using GRADE. MAIN RESULTS We included 40 studies (5613 eyes of 4028 people) in this review. The majority of the studies were conducted in Europe and in the USA. Most of the studies were at risk of performance and/or detection bias as they were unmasked. None of the studies were judged as having low risk of bias for all domains. We did not identify any studies of laser trabeculoplasty alone versus no intervention. Laser trabeculoplasty versus medication Fourteen studies compared laser trabeculoplasty with medication in either people with primary OAG (7 studies) or primary or secondary OAG (7 studies); five of the 14 studies also included participants with OHT. Six studies used argon laser trabeculoplasty and eight studies used selective laser trabeculoplasty. There was considerable clinical and methodological diversity in these studies leading to statistical heterogeneity in results for the primary outcome "failure to control IOP" at 24 months. Risk ratios (RRs) ranged from 0.43 in favour of laser trabeculoplasty to 1.87 in favour of medication (5 studies, I2 = 89%). Studies of argon laser compared with medication were more likely to show a beneficial effect compared with studies of selective laser (test for interaction P = 0.0001) but the argon laser studies were older and the medication comparator group in those studies may have been less effective. We considered this to be low-certainty evidence because the trials were at risk of bias (they were not masked) and there was unexplained heterogeneity. There was evidence from two studies (624 eyes) that argon laser treatment was associated with less failure to stabilise visual field progression compared with medication (7% versus 11%, RR 0.70, 95% CI 0.42 to 1.16) at 24 months and one further large recent study of selective laser also reported a reduced risk of failure at 48 months (17% versus 26%) RR 0.65, 95% CI 0.52 to 0.81, 1178 eyes). We judged this outcome as moderate-certainty evidence, downgrading for risk of bias. There was only very low-certainty evidence on optic neuropathy progression. Adverse effects were more commonly seen in the laser trabeculoplasty group including peripheral anterior synechiae (PAS) associated with argon laser (32% versus 26%, RR 11.74, 95% CI 5.94 to 23.22; 624 eyes; 2 RCTs; low-certainty evidence); 5% of participants treated with laser in three studies of selective laser group had early IOP spikes (moderate-certainty evidence). One UK-based study provided moderate-certainty evidence that laser trabeculoplasty was more cost-effective. Laser trabeculoplasty versus trabeculectomy Three studies compared laser trabeculoplasty with trabeculectomy. All three studies enrolled participants with OAG (primary or secondary) and used argon laser. People receiving laser trabeculoplasty may have a higher risk of uncontrolled IOP at 24 months compared with people receiving trabeculectomy (16% versus 8%, RR 2.12, 95% CI 1.44 to 3.11; 901 eyes; 2 RCTs). We judged this to be low-certainty evidence because of risk of bias (trials were not masked) and there was inconsistency between the two trials (I2 = 68%). There was limited evidence on visual field progression suggesting a higher risk of failure with laser trabeculoplasty. There was no information on optic neuropathy progression, quality of life or costs. PAS formation and IOP spikes were not reported but in one study trabeculectomy was associated with an increased risk of cataract (RR 1.78, 95% CI 1.46 to 2.16) (very low-certainty evidence). AUTHORS' CONCLUSIONS Laser trabeculoplasty may work better than topical medication in slowing down the progression of open-angle glaucoma (rate of visual field loss) and may be similar to modern eye drops in controlling eye pressure at a lower cost. It is not associated with serious unwanted effects, particularly for the newer types of trabeculoplasty, such as selective laser trabeculoplasty.
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Affiliation(s)
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mohamed Loutfi
- School of Medicine, University of Liverpool, Liverpool, UK
| | - David Burton
- Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Richard Wormald
- Cochrane Eyes and Vision, Queen's University Belfast, Belfast, UK
| | - Jennifer R Evans
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, UK
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Abe RY, Maestrini HA, Guedes GB, Nascimento MM, Iguma CI, de Miranda Santos HD, Nasr MG, Lucena-Junior RP, Prata TS. Real-world data from selective laser trabeculoplasty in Brazil. Sci Rep 2022; 12:1923. [PMID: 35121762 PMCID: PMC8817042 DOI: 10.1038/s41598-022-05699-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
Evaluate real-world data of outcomes from selective laser trabeculoplasty (SLT) performed in different regions of Brazil and investigate potential predictors of success associated with treatment. Multicenter retrospective case series with patients who underwent a primary SLT procedure. A total of 835 eyes from 835 patients were included. The mean follow-up was 916.8 ± 563.0 days. The mean age was 64.5 ± 14.9 years and 56.6% were women. We observed an intraocular pressure reduction comparing baseline to post-SLT measurements (18.4 ± 3.8 mmHg versus 14.8 ± 3.5 mmHg; P < 0.001) and mean number of glaucoma medications (1.8 ± 1.3 versus 1.4 ± 1.4; P < 0.001). We observed visual acuity loss over time (0.1 ± 0.3 versus 0.2 ± 0.3 logMAR, baseline and post-SLT, respectively, P = 0.009) and decrease in visual field mean deviation values (- 5.4 ± 5.9 versus - 5.7 ± 6.0 dB; P = 0.054) The Kaplan-Meier survival analysis showed an estimated probability of treatment success of 88% at 12 months, declining to 70% at 24 months and 54% at 36 months post-SLT. In the multivariable model, we found that a denser angle pigmentation (HR 0.69; 95% CI 0.57-0.85, P = 0.001) and corticosteroid treatment following SLT (HR 0.59; 95% CI 0.39-0.91, P = 0.018) were significantly associated with a lower risk for failure. Primary SLT achieved relatively high success rates without sight-threating complications in this real-world study with a large sample of Brazilian patients. These findings corroborate previous studies regarding SLT outcomes and may help clinicians to identify the best candidates for laser treatment.
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Affiliation(s)
- Ricardo Y Abe
- Hospital Oftalmológico de Brasília, SGAS 607 Avenida L2 Sul, Distrito Federal, Brasília, ZIP Code 70200670, Brazil. .,Department of Ophthalmology - University of Campinas, Campinas, Brazil.
| | | | | | | | - Camila I Iguma
- Hospital Oftalmológico de Brasília, SGAS 607 Avenida L2 Sul, Distrito Federal, Brasília, ZIP Code 70200670, Brazil
| | | | | | | | - Tiago S Prata
- Hospital Medicina Dos Olhos, Osasco, São Paulo, Brazil.,Departamento de Oftalmologia, UNIFESP/EPM, São Paulo, Brazil
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Selective laser trabeculoplasty following failed combined phacoemulsification cataract extraction and excimer laser trabeculotomy can control intraocular pressure for a limited time. Int Ophthalmol 2022; 42:739-746. [PMID: 35113311 PMCID: PMC8917025 DOI: 10.1007/s10792-021-02039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/22/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE To assess the efficacy of selective laser trabeculoplasty (SLT) following failed phacoemulsification cataract extraction combined with excimer laser trabeculotomy (phaco-ELT). METHODS Retrospectively, the medical records of patients with primary or secondary open-angle glaucoma or ocular hypertension who underwent SLT between January 2001 and February 2015 by one surgeon at a single center after a failed phaco-ELT were evaluated. Exclusion criteria were: angle-closure glaucoma, optic nerve atrophy due to disease other than glaucoma, and additional glaucoma procedures between phaco-ELT and SLT. The main outcome measures were time to failure and Kaplan-Meier survival. Complete success was defined as a reduction of intraocular pressure (IOP) of > 3 mmHg and > 20% compared to baseline, and the number of AGM ≤ baseline. RESULTS A total of 23 eyes of 21 subjects were included. Baseline IOP was 19.7 (range, 19.1-22.7) mmHg, and the number of AGM at baseline was 2.5 (range, 1.9-2.9). Median time to failure after SLT was 7.2 (range, 6.6-7.8) months. The number of antiglaucoma medications did not change during that time. CONCLUSIONS In eyes in which the IOP is no longer controlled following phaco-ELT, SLT could be an option to slow disease progression or prolong time until incisional filtration surgery. However, time to failure after SLT is limited. Thus, close follow-up visits are necessary in order to not delay an incisional surgery.
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Gack C, Laemmer R, Hohberger B. Five-Year Long-Term Follow-Up of Selective Laser Trabeculoplasty in Open-Angle Glaucoma. Klin Monbl Augenheilkd 2021; 239:1239-1244. [PMID: 34921359 DOI: 10.1055/a-1668-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Selective laser trabeculoplasty (SLT) is known as a safe laser therapy for an effective reduction in intraocular pressure (IOP). The aim of this study was to examine the therapeutic success of SLT in open-angle glaucoma (OAG) patients with a long-term follow-up of 5 years. METHODS Forty-six eyes of forty OAG patients, some with previous intraocular surgery, underwent SLT (24 males, 16 females). Therapeutic success was categorized as: category (I) - IOP reduction ≤ 21 mmHg and > 20% compared to baseline IOP with additional glaucoma medication; category (II) - IOP reduction ≤ 18 mmHg and > 30% compared to baseline IOP with additional glaucoma medication; category (III) - IOP reduction ≤ 18 mmHg without any additional glaucoma medication at all follow-ups. Therapeutic failure was defined as the necessity of any further glaucoma surgery (IV). RESULTS (1) SLT was well tolerated in all eyes, and no severe side effects or complications were recorded. (2) After 1-year follow-up, therapeutic success was 27% (I), 30% (II), and 3% (III). The therapeutic failure rate was 40% (IV). (3) After 2 years follow-up, therapeutic success was 7% (I), 10% (II), and 0% (III). The therapeutic failure rate was 83% (IV). (4) After 3 years follow-up, the therapeutic failure rate increased up to 100% (IV). CONCLUSION SLT seemed to be effective in lowering IOP in the first year in the present cohort, however, the long-term effect is low and additional local therapy or surgical interventions are necessary.
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Affiliation(s)
- Christina Gack
- Augenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Robert Laemmer
- Augenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Zhou R, Sun Y, Chen H, Sha S, He M, Wang W. Laser Trabeculoplasty for Open-Angle Glaucoma: A Systematic Review and Network Meta-Analysis. Am J Ophthalmol 2021; 229:301-313. [PMID: 32888900 DOI: 10.1016/j.ajo.2020.07.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 07/16/2020] [Accepted: 07/30/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE We sought to comprehensively evaluate the effectiveness of different types of laser trabeculoplasty (LT) in the treatment of open-angle glaucoma. DESIGN Systematic review and network meta-analysis. METHODS Eligible randomized controlled trials were identified by searching PubMed, EMBASE, Cochrane Library, SCOPUS, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Service System for studies published between January 1, 2000 and April 20, 2020. Eight interventions were evaluated, including argon LT (ALT), medications, 180-degree selective LT (SLT), 270-degree SLT, 360-degree SLT, new LT, transscleral 360-degree SLT with SLT performed without gonioscopy, and low-energy 360-degree SLT. The primary outcome was reduction of medicated and unmedicated intraocular pressure (IOP) at 6 months. Secondary outcomes included reduction of IOP at 12 months, incidences of complications, and change in number of medications. Head-to-head meta-analysis and network meta-analysis were performed using Stata and R software. RESULTS In total, 22 studies were included, involving 2859 eyes of 2704 patients. In terms of IOP reduction at 6 and 12 months, there were no statistically significant differences in both medicated and unmedicated IOP between any pairs of interventions considered herein, as determined based on both head-to-head and network meta-analyses (all P > .05). In terms of reduction of medications, the individuals treated with 180-degree SLT required fewer medications than those treated with ALT at 12 months (0.28 [95% confidence interval, 0.06-0.50]; P = .014). No severe adverse outcomes were reported for any of the interventions. CONCLUSIONS All the available types of LT are equally effective for decreasing IOP compared with medication-based therapy. The 180-degree SLT was slightly more effective than ALT in terms of reducing the number of medications needed. Additional well-performed randomized controlled trials with larger sample sizes are needed.
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Liu Y, Fan X, Wu L. Selective laser trabeculoplasty lowered the untreated fellow eye long-term intraocular pressure: a 3-year observational study. Lasers Med Sci 2021; 37:1487-1493. [PMID: 34350528 DOI: 10.1007/s10103-021-03253-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
To explore the long-term intraocular pressure (IOP)-lowering effect of monocular selective laser trabeculoplasty (SLT) in the untreated fellow eyes of open-angle glaucoma (OAG) patients. This was a retrospective observational study. Consecutive Chinese OAG patients who received monocular SLT treatment were included in this study. One hundred and eighty degree SLT was conducted as adjunctive treatment when anti-glaucoma medication was not sufficiently effective after clinical evaluation. Treatment success was defined as more than 20% IOP reduction of the baseline IOP levels. IOP-decreasing amplitude and SLT success rate of both eyes were investigated during the 3-year follow-up period. Age, gender, baseline IOP levels, number of medications, and SLT energy parameters were analyzed to determine its influence on IOP reduction effect and treatment success rate. A total of 32 Chinese OAG patients were included in this study and 25 of them completed the 3-year follow-ups. Their pretreatment IOPs were 18.85 ± 2.81 mmHg in the treated eyes and 17.38 ± 2.37 mmHg in the fellow eyes. At the 3-year follow-up visits, IOP decreased to 2.76 ± 3.72 mmHg (14.16%) in the treated eyes and 2.16 ± 2.73 mmHg (11.95%) in the fellow eyes, with a success rate of 47.83% (11 in 23 cases) and 44.00% (11 in 25 cases), respectively. IOPs of both eyes decreased significantly after SLT from 6 months and lasted to 3 years after treatment. Baseline IOP level was positively correlated with IOP reduction in the treated eyes and other factors were not correlated with IOP reduction and treatment success. Monocular SLT treatment as adjunctive treatment could lower IOPs not only in the treated eyes but also in the untreated eyes in poor medication-controlled OAG patients. In addition, its IOP reduction effect could last to 3 years after treatment in clinical practice.
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Affiliation(s)
- Yan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xiang Fan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Lingling Wu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, People's Republic of China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Teus MA, Belda JI, Lavín C, GarcÃa-Feijoà J, Falvey H, Buseghin G, Soler M, Appierto M. Cost-effectiveness analysis of iStent Inject® implantation during cataract surgery compared to cataract surgery alone for mild to moderate open-angle glaucoma patients in Spain. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1939685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Miguel A Teus
- Ophtalmology Department, Hospital Universitario Príncipe De Asturias, University of Alcalá, Madrid, Spain
| | - Jose I Belda
- Ophthalmology Department, Hospital Universitario Torrevieja, Alicante, Spain
| | - Cosme Lavín
- Ophthalmology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Julián GarcÃa-FeijoÃ
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto De Investigación Sanitaria Del Hospital Clínico San Carlos (Idissc), OFTARED, Madrid, Spain
| | - H Falvey
- Health Economics and Market Access Department, Glaukos, San Clemente, California, United States
| | - Giorgio Buseghin
- Health Economics and Market Access Department, Glaukos, San Clemente, California, United States
| | - María Soler
- Health Economics Department, Outcomes’10 S.L.U, Castellón De La Plana, Spain
| | - Marilena Appierto
- Health Economics Department, Outcomes’10 S.L.U, Castellón De La Plana, Spain
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Gedde SJ, Vinod K, Wright MM, Muir KW, Lind JT, Chen PP, Li T, Mansberger SL. Primary Open-Angle Glaucoma Preferred Practice Pattern®. Ophthalmology 2021; 128:P71-P150. [DOI: 10.1016/j.ophtha.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
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Ahmed IIK, Podbielski DW, Patel V, Falvey H, Murray J, Botteman M, Goeree R. A Canadian Cost-Utility Analysis of 2 Trabecular Microbypass Stents at Time of Cataract Surgery in Patients with Mild to Moderate Open-Angle Glaucoma. ACTA ACUST UNITED AC 2020; 3:103-113. [DOI: 10.1016/j.ogla.2019.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
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Lee EY, Farrokhyar F, Sogbesan E. Laser Trabeculoplasty Perceptions and Practice Patterns of Canadian Ophthalmologists. J Curr Glaucoma Pract 2020; 14:81-86. [PMID: 33867755 PMCID: PMC8028031 DOI: 10.5005/jp-journals-10078-1283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To describe the current practice patterns and perceptions of Canadian ophthalmologists using laser trabeculoplasty (LTP). Materials and methods A cross-sectional survey of 124 members of the Canadian Ophthalmological Society (COS) who perform LTP was conducted. Descriptive statistics and Chi-square comparative analyses were performed on anonymous self-reported survey data. Results Of the 124 respondents, 34 (27.4%) completed a glaucoma fellowship. Use of selective laser trabeculoplasty (SLT) (94.4%) was preferred over argon laser trabeculoplasty (ALT) (5.6%). The most frequently cited reasons for SLT preference was less damage to trabecular meshwork (30.7%), availability (16.2%), and repeatability (16.2%). In all, 47.6% of the respondents performed LTP concurrently with medical treatment, 33.9% used it after medical treatment, and 17.7% used it as first-line treatment. Majority (87.1%) of the respondents believed that SLT is effective when repeated. In suitable patients, 41.9% of the respondents stated on average they repeat SLT once, 26.6% twice, and 19.4% greater than 2 times, respectively. Of those who repeat SLT on patients, 80.7% found repeat SLT treatments have good outcomes for patients. In all, 105 (84.7%) ophthalmologists responded they would benefit from an LTP practice guideline. Significantly more ophthalmologists without glaucoma fellowships perceived they would benefit from a practice guideline (p value <0.001). Conclusion This survey provides valuable practical information on how LTP is used in the treatment of glaucoma in Canada. Clinical significance The findings may serve as a baseline survey to trend future practices. How to cite this article Lee EY, Farrokhyar F, Sogbesan E. Laser Trabeculoplasty Perceptions and Practice Patterns of Canadian Ophthalmologists. J Curr Glaucoma Pract 2020;14(3):81–86.
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Affiliation(s)
- Elizabeth Y Lee
- Department of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Surgery, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Enitan Sogbesan
- Department of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
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Hong Y, Song SJ, Liu B, Hassanpour K, Zhang C, Loewen N. Efficacy and safety of micropulse laser trabeculoplasty for primary open angle glaucoma. Int J Ophthalmol 2019; 12:784-788. [PMID: 31131237 DOI: 10.18240/ijo.2019.05.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/12/2019] [Indexed: 01/12/2023] Open
Abstract
AIM To evaluate the efficiency and safety of micropulse laser trabeculoplasty (MLT) for primary open angle glaucoma (POAG) patients. METHODS Retrospective study. POAG patients undergoing MLT in Peking University Third Hospital from June 2016 to November 2017. Seventy-two eyes of 72 POAG patients were enrolled. Only one eye of each patient was treated by MLT. The intraocular pressure (IOP) before MLT and at 1d, 1, 4, 12 and 24wk and glaucoma medication before and after treatment were compared. RESULTS The IOP was 20.6±5.9 mm Hg before MLT and 20.8±6.8 mm Hg at 2h after MTL. The IOP at 1d, 1, 4, 12 and 24wk was 17.9±4.4, 18.0±4.3, 17.5±3.4, 17.0±2.7, and 16.5±2.9 mm Hg, respectively. The IOP before and after MLT demonstrated a statistically significant difference by ANOVA analyses (F=5.797, P<0.001). Least significant difference t-tests showed there was no statistically significant difference between pre-MLT IOP within 2h after MLT (P=0.207). The statistically significant difference was confirmed between the pre-MLT IOP at 1d, 1, 4, 12 and 24wk after MLT (P=0.006, 0.009, 0.001, <0.001, <0.001, respectively). The number of glaucoma medications before MLT was 1.7±1.4 and 1.5±1.4 24wk after MLT with a significantly statistical difference (t=2.219, P=0.031). CONCLUSION MLT is effective and safe for POAG patients. No patient experienced IOP spikes after MLT. The IOP 6mo after treatment decreased significantly with less glaucoma medication.
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Affiliation(s)
- Ying Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China.,Department of Ophthalmology, School of Medicine, University of Pittsburgh, PA 15213, USA
| | - Si-Jia Song
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Bo Liu
- Peking University Health Center, Peking University Third Hospital, Beijing 100191, China
| | - Kiana Hassanpour
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran 16666-94516, Iran
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Nils Loewen
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, PA 15213, USA
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Tufan AK, Onur İU, Yiğit FU, Ağaçhan A, Aşık Nacaroğlu Ş. Selective Laser Trabeculoplasty vs. Fixed Combinations with Timolol in Practice: A Replacement Study in Primary Open Angle Glaucoma. Turk J Ophthalmol 2017; 47:198-204. [PMID: 28845323 PMCID: PMC5563547 DOI: 10.4274/tjo.87300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/18/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To evaluate the potential of selective laser trabeculoplasty (SLT) in two arms (360˚ vs. 180˚) as a replacement for fixed combinations (FCs) with timolol in primary open angle glaucoma over 6 months. MATERIALS AND METHODS Of 40 patients in a prospective, comparative, interventional case series, 18 eyes and 22 eyes were randomized to SLT 180º and SLT 360º groups, respectively, along with 40 fellow-control eyes. FC with timolol was discontinued on the day of treatment for the eye to be operated on, while ongoing therapy was not interrupted for the contralateral eye. Eyes were examined for intraocular pressure (IOP) elevation 1 hour and 1 day after SLT. The follow-up visits were then scheduled for 1 week, 1 month, 3 months, and 6 months after, during the which the IOP of both eyes and any possible complications were evaluated. RESULTS There were no statistically significant differences in mean IOPs through 6 months among the groups with exception of postlaser 1 hour and postlaser 1 day (p<0.001 and p=0.010, respectively). Multiple comparison analysis showed significantly higher IOP in both SLT 180º and SLT 360º subgroups compared to their controls at postlaser 1 hour (p=0.007, p<0.001) but significantly lower IOP only in SLT 360º subgroup compared to the controls at postlaser day 1 (p=0.013). CONCLUSION SLT offers promising potential as a substitute equivalent to efficacy of FCs with timolol. However, SLT 360˚ may not achieve additional IOP reduction.
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Affiliation(s)
- Ali Kutlay Tufan
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - İsmail Umut Onur
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Fadime Ulviye Yiğit
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Ahmet Ağaçhan
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Şenay Aşık Nacaroğlu
- Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey
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Konstas AGP, Quaranta L, Bozkurt B, Katsanos A, Garcia-Feijoo J, Rossetti L, Shaarawy T, Pfeiffer N, Miglior S. 24-h Efficacy of Glaucoma Treatment Options. Adv Ther 2016; 33:481-517. [PMID: 26909513 PMCID: PMC4846688 DOI: 10.1007/s12325-016-0302-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Indexed: 11/28/2022]
Abstract
Current management of glaucoma entails the medical, laser, or surgical reduction of intraocular pressure (IOP) to a predetermined level of target IOP, which is commensurate with either stability or delayed progression of visual loss. In the published literature, the hypothesis is often made that IOP control implies a single IOP measurement over time. Although the follow-up of glaucoma patients with single IOP measurements is quick and convenient, such measurements often do not adequately reflect the untreated IOP characteristics, or indeed the quality of treated IOP control during the 24-h cycle. Since glaucoma is a 24-h disease and the damaging effect of elevated IOP is continuous, it is logical that we should aim to understand the efficacy of all treatment options throughout the 24-h period. This article first reviews the concept and value of diurnal and 24-h IOP monitoring. It then critically evaluates selected available evidence on the 24-h efficacy of medical, laser and surgical therapy options. During the past decade several controlled trials have significantly enhanced our understanding on the 24-h efficacy of all glaucoma therapy options. Nevertheless, more long-term evidence is needed to better evaluate the 24-h efficacy of glaucoma therapy and the precise impact of IOP characteristics on glaucomatous progression and visual prognosis.
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Affiliation(s)
- Anastasios G P Konstas
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- 3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | - Banu Bozkurt
- Department of Ophthalmology, Selcuk University, Konya, Turkey
| | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | | | - Luca Rossetti
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
| | - Tarek Shaarawy
- Glaucoma Sector, University of Geneva, Geneva, Switzerland
| | | | - Stefano Miglior
- Department of Ophthalmology, University Bicocca of Milan, Milan, Italy
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Ekici F, Waisbourd M, Katz LJ. Current and Future of Laser Therapy in the Management of Glaucoma. Open Ophthalmol J 2016; 10:56-67. [PMID: 27014388 PMCID: PMC4780519 DOI: 10.2174/1874364101610010056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/22/2022] Open
Abstract
There has been tremendous progress in the past decades in the utilization of lasers for treating patients with glaucoma. This article reviews the use of lasers in different areas of glaucoma, including the shift from argon laser trabeculoplasty (ALT) to selective laser trabeculoplasty (SLT), laser trabeculoplasty as an initial treatment for glaucoma, new laser trabeculoplasty procedures under investigation, and other recent laser treatment modalities such as endoscopic cyclophotocoagulation and laser-assisted deep sclerectomy.
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Affiliation(s)
- Feyzahan Ekici
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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A Comparison of Resident-performed Argon and Selective Laser Trabeculoplasty in Patients With Open-angle Glaucoma. J Glaucoma 2016; 25:e157-61. [DOI: 10.1097/ijg.0000000000000207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Koc M, Durukan I, Koban Y, Ceran BB, Ayar O, Ekinci M, Yilmazbas P. Effect of selective laser trabeculoplasty on macular thickness. Clin Ophthalmol 2016; 9:2335-8. [PMID: 26719665 PMCID: PMC4689286 DOI: 10.2147/opth.s89221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To investigate the effects of selective laser trabeculoplasty (SLT) on macular thickness change. Methods Forty eyes of 40 consecutive patients with uncontrolled primary open-angle glaucoma with medical treatment were included in this prospective study. SLT was performed to the inferior 180°, and macular thickness was measured. Data were collected before SLT, and 1 week and 1 month after SLT. Macular thickness evaluation was performed in five quadrants, the central 1 mm quadrant (fovea = F), the nasal 3 mm quadrant surrounding F (NQ), temporal quadrant, superior quadrant (SQ), and inferior quadrant (IQ). The preoperative and postoperative thicknesses were compared. Results There was an increase in macular thickness in the NQ, IQ, and SQ on the first week after SLT compared to preoperative measurements. On the other hand, there was no significant increase in the F and temporal quadrant. On the first month after SLT, thickness in the NQ, IQ, and SQ was back to preoperative measurements, and there was no significant change between the preoperative measurements in any quadrant. Conclusion There was no significant increase in macular thickness shortly after SLT in our study.
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Affiliation(s)
- Mustafa Koc
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Irfan Durukan
- Ophthalmology Clinic, Kayserigoz Hospital Kayseri, Turkey
| | - Yaran Koban
- Department of Ophthalmology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Basak Bastanci Ceran
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Orhan Ayar
- Department of Ophthalmology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Metin Ekinci
- Department of Ophthalmology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Pelin Yilmazbas
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Patel V, El Hawy E, Waisbourd M, Zangalli C, Shapiro DM, Gupta L, Hsieh M, Kasprenski A, Katz LJ, Spaeth GL. Long-term outcomes in patients initially responsive to selective laser trabeculoplasty. Int J Ophthalmol 2015; 8:960-4. [PMID: 26558209 DOI: 10.3980/j.issn.2222-3959.2015.05.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/03/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tolerated medical therapy (MTMT). METHODS The Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the charts of glaucoma patients who underwent SLT after receiving MTMT. Eyes that did not achieve their target pressure within 3mo following SLT were excluded from the study. Changes in mean IOP and number of glaucoma medications used were analyzed at 1, 3, and 5y following SLT. RESULTS Seventy-five eyes of 67 patients were included in the study. Fifteen eyes that received SLT failed to achieve their target pressure within 3mo and were excluded from the study. The average follow-up time was 37.4mo (±14.4). Mean IOP was significantly reduced 1y after treatment (P=0.005). It was also reduced 3, 5y after treatment without reaching statistical significance (P=0.20 and P=0.072, respectively). There was a significant decrease in mean number of medications used 1, 3, 5y after treatment (P<0.001, P<0.001, and P=0.039, respectively). In the span of 5y, 2 eyes (2.7%) underwent repeat SLT, 7 eyes (9.3%) underwent glaucoma surgery and an additional 3 eyes (4.0%) underwent both. CONCLUSION SLT significantly reduced the number of glaucoma medications used 5y following treatment in glaucoma patients receiving MTMT. SLT may delay operating-room surgery.
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Affiliation(s)
- Varun Patel
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia 19104, USA
| | - Eman El Hawy
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia 19104, USA
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia 19104, USA
| | - Camila Zangalli
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia 19104, USA
| | - Daniel M Shapiro
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia 19104, USA
| | - Lalita Gupta
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia 19104, USA
| | - Michael Hsieh
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia 19104, USA
| | | | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia 19104, USA
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia 19104, USA
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Arora KS, Robin AL, Corcoran KJ, Corcoran SL, Ramulu PY. Use of Various Glaucoma Surgeries and Procedures in Medicare Beneficiaries from 1994 to 2012. Ophthalmology 2015; 122:1615-24. [PMID: 26092196 DOI: 10.1016/j.ophtha.2015.04.015] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 04/13/2015] [Accepted: 04/13/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Determine how procedural treatments for glaucoma have changed between 1994-2012. DESIGN Retrospective, observational analysis. PARTICIPANTS Medicare Part B beneficiaries. METHODS We analyzed Medicare fee-for-service paid claims data between 1994-2012 to determine the number of surgical/laser procedures performed for glaucoma in the Medicare population each year. MAIN OUTCOME MEASURES Number of glaucoma-related procedures performed. RESULTS Trabeculectomies in eyes without previous scarring decreased 52% from 54 224 in 1994 to 25 758 in 2003, and a further 52% to 12 279 in 2012. Trabeculectomies in eyes with scarring ranged from 9054 to 13 604 between 1994-2003, but then decreased 48% from 11 018 to 5728 between 2003-2012. Mini-shunts done via an external approach (including ExPRESS [Alcon Inc, Fort Worth, TX]) increased 116% from 2718 in 2009 to 5870 in 2012. The number of aqueous shunts to the extraocular reservoir increased 231% from 2356 in 1994 to 7788 in 2003, and a further 54% to 12 021 in 2012. Total cyclophotocoagulation procedures increased 253% from 2582 in 1994 to 9106 in 2003, and a further 54% to 13 996 in 2012. Transscleral cyclophotocoagulations decreased 45% from 5978 to 3268 between 2005-2012; over the same period, the number of endoscopic cyclophotocoagulations (ECPs) increased 99% from 5383 to 10 728. From 2001 to 2005, the number of trabeculoplasties more than doubled from 75 647 in 2001 to 176 476 in 2005, but since 2005 the number of trabeculoplasties decreased 19% to 142 682 in 2012. The number of laser iridotomies was fairly consistent between 1994-2012, increasing 9% over this period and ranging from 63 773 to 85 426. Canaloplasties increased 1407% from 161 in 2007 to 2426 in 2012. Between 1994-2012, despite a 9% increase in beneficiaries, the total number of glaucoma procedures and the number of glaucoma procedures other than laser procedures decreased 16% and 31%, respectively. CONCLUSIONS Despite the increase in beneficiaries, the number of glaucoma procedures performed decreased. Glaucoma procedures demonstrating a significant increase in use include canaloplasty, mini-shunts (external approach), aqueous shunt to extraocular reservoir, and ECP. Trabeculectomy use continued its long-term downward trend. The continued movement away from trabeculectomy and toward alternative intraocular pressure-lowering procedures highlights the need for well-designed clinical trials comparing these procedures.
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Affiliation(s)
- Karun S Arora
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Alan L Robin
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; University of Maryland Department of Ophthalmology, Baltimore, Maryland; Kellogg Institute, University of Michigan, Ann Arbor, Michigan; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
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Selective laser trabeculoplasty (SLT): 1-year results in early and advanced open angle glaucoma. Int Ophthalmol 2015; 36:55-61. [PMID: 25943174 DOI: 10.1007/s10792-015-0079-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to examine the efficacy of selective laser trabeculoplasty (SLT) in eyes with early and more advanced stages of open angle glaucoma within 1 year of follow-up. Retrospective chart review in a consecutive series of patients treated by SLT to reduce intraocular pressure (IOP) or decrease number of topical medications in cases of discomfort and allergy. The cup-to-disc ratio of the optic nerve and the GSS 2 (glaucoma staging system 2) was used to differentiate between early (group 1) and more advanced (group 2) stages of glaucoma. At the time of SLT treatment, no new signs of glaucoma progression were seen. Only the first treated eye of every patient was included in the analysis. In group 1 (early glaucoma), 27 eyes were included. IOP reduction <21 mmHg/>20 % of the preoperative IOP-value and reduction of medication were achieved in 17 eyes (62.96 %). Successful re-treatment was necessary in 2 eyes (7.4 %). In group 2 (advanced glaucoma), 44 eyes underwent SLT. In eight eyes (18.18 %), filtrating surgery was necessary after initial SLT. In the remaining 36 eyes, IOP reduction <21 mmHg/>20 % of the baseline IOP was achieved in 26 eyes (59.09 % of 44 eyes) and IOP reduction <18 mmHg/> 30 % of the baseline IOP in 22 eyes (50 % of 44 eyes). SLT was safe and effective in nearly 2/3 of early glaucoma patients and also in 50 % of advanced glaucoma patients using stronger criteria of success. Failure of SLT in advanced glaucoma should lead to immediate filtrating surgery, which seems not to be associated with higher risk of fibrosis.
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Abstract
PURPOSE To compare the efficacy of selective laser trabeculoplasty (SLT) in phakic and pseudophakic eyes in open-angle glaucoma and ocular hypertension. MATERIALS AND METHODS Charts of 28 pseudophakic eyes and 60 phakic eyes that underwent 360-degree SLT were retrospectively reviewed. Patients were examined at 1, 3, 6, and 12 months. Treatment success was defined as ≥20% intraocular pressure (IOP) reduction, with no additional medications, laser, or glaucoma surgery. Mean IOP change, mean percentage of IOP reduction, and success rates for phakic and pseudophakic eyes were compared. RESULTS Mean percentage of IOP reduction post-SLT at 1-, 3-, 6-, and 12-month visits were 21.4%, 25.8%, 24.8%, and 23.7%, respectively, in the pseudophakic group and 22.8%, 25.0%, 25.7%, and 21.2%, respectively, in the phakic group. Success rates ranged between 60% and 64% in the pseudophakic group and between 58% and 73% in the phakic group. No statistically significant differences in IOP change, percentage of IOP reduction, and success rate were seen between the groups at any of the post-SLT visits (P>0.05). CONCLUSIONS Application of 360-degree SLT seems to be an efficient and safe treatment option for the management of phakic and pseudophakic open-angle glaucoma and ocular hypertension.
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Wong MOM, Lee JWY, Choy BNK, Chan JCH, Lai JSM. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol 2015; 60:36-50. [DOI: 10.1016/j.survophthal.2014.06.006] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
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Tardif A, Bonnin N, Borel A, Viennet A, Pereira B, Chiambaretta F. [Selective laser trabeculoplasty: results after a first and a second session, overall comparison and results for three indications]. J Fr Ophtalmol 2014; 37:353-7. [PMID: 24679450 DOI: 10.1016/j.jfo.2013.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 07/22/2013] [Accepted: 08/26/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the results obtained with SLT trabeculoplasty after an initial treatment (SLT-1) and after a second treatment (SLT-2). Subgroup analysis according to trabecular pigmentation and the existence of a high myopia. MATERIALS AND METHODS Retrospective study of 77 patients, 152 SLT sessions performed in the Ophthalmology Department of Clermont-Ferrand University Medical Center, 118 SLT-1, 34 SLT-2. Three comparable groups of patients were assembled: group 1 (glaucoma patients with normal or subnormal trabecular pigmentation), group 2 (glaucoma patients with high myopia), and group 3 (glaucoma patients with significant trabecular pigmentation). The results were compared between groups, for SLT-1 and SLT-2. RESULTS Intraocular pressure lowering was consistent with data reported in the literature. Comparison of the results of SLT-1 versus SLT-2 did not find any significant difference in terms of IOP change. However, after SLT-2, the IOP response appears significantly greater (P=0.03) in the group with significant trabecular pigmentation compared to the non-myopic group with normal trabecular pigmentation. DISCUSSION Our results are consistent with the literature for efficacy, tolerance and reproducibility of SLT. No reduction in SLT efficacy was observed after a second session. Trabecular pigmentation is not a predictor of the response after the first session. In the case of retreatment (SLT-2), the differences observed lead to the hypothesis that it may be appropriate to perform at least two SLT treatments in patients with significant trabecular pigmentation in order to obtain maximal effect. Myopia, a variable not previously studied, does not seem to influence SLT outcomes. CONCLUSION Trabecular pigmentation and the presence of myopia do not appear to be predictive of a successful first treatment. However, our study leads us to suggest the hypothesis that the maximal response of SLT in patients with significant trabecular pigmentation is not obtained until after at least two sessions. This observation opens an interesting perspective on the therapeutic strategy to adopt in the case of pigmentary glaucoma.
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Affiliation(s)
- A Tardif
- Service d'ophtalmologie, pôle RMND-M2O, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - N Bonnin
- Service d'ophtalmologie, pôle RMND-M2O, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
| | - A Borel
- Service d'ophtalmologie, pôle RMND-M2O, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - A Viennet
- Service d'ophtalmologie, pôle RMND-M2O, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - B Pereira
- Department of Clinical Research and Innovation (DRCI), CHU de Clermont-Ferrand, Villa Annexe IFSI, rue Montalembert, 63000 Clermont-Ferrand, France
| | - F Chiambaretta
- Service d'ophtalmologie, pôle RMND-M2O, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France
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Wang W, He M, Zhou M, Zhang X. Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with open-angle glaucoma: a systematic review and meta-analysis. PLoS One 2013; 8:e84270. [PMID: 24367649 PMCID: PMC3868565 DOI: 10.1371/journal.pone.0084270] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/13/2013] [Indexed: 11/24/2022] Open
Abstract
Objective To examine possible differences in clinical outcomes between selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) in open-angle glaucoma at different times post-treatment. Methods Randomized controlled trials (RCTs) comparing SLT versus ALT were searched through August 2013. The main outcome measure was IOP, and secondary outcomes included the number of glaucoma medications, the success rate, and adverse events. Results Six RCTs, involving 482 eyes treated with laser trabeculoplasty, were included in the meta-analysis. For all patients (including first and previous laser trabeculoplasy), no significant difference in IOP lowering was observed between SLT and ALT at one hour (P = 0.40), one week (P = 0.72), one month (P = 0.37), six months (P = 0.08), one year (P = 0.34), two years (P = 0.58), three years (P = 0.34), four years (P = 0.47), and five years (P = 0.50). A statistically significant difference in favor of SLT was found when comparing the IOP reduction at three months after intervention (weighted mean difference (WMD): 1.19 mmHg [0.41; 1.97]; I2=0%; P = 0.003). For patients who were naive to laser, there was no significant difference of reduction in IOP comparing SLT with ALT at any time point. In patients’ previous LT, no statistically significant difference in IOP reduction was found at six months (WMD: 1.92 mmHg [-0.91; 4.74]; I2 = 77.3%; P = 0.18). There was no significant difference in the reduction in the number of glaucoma medications, the success rate, or adverse event rates between the two treatments. Conclusions SLT has equivalent efficacy to ALT with a similar constellation of side effects. In the case of retreatment, SLT appears to be similar to ALT in IOP lowering at six months.
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Affiliation(s)
- Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Miao He
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Minwen Zhou
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiulan Zhang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People’s Republic of China
- * E-mail:
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Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review. Eye (Lond) 2013; 28:249-58. [PMID: 24310236 DOI: 10.1038/eye.2013.267] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 11/09/2013] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Systemic review to compare selective laser trabeculoplasty (SLT) to other glaucoma treatment options in terms of their intraocular pressure (IOP)-lowering effect. METHODS Searches of the following databases were performed: PubMed, Cochrane Central Register of Controlled Trials, Ovid, EMBASE, metaRegister of Controlled Trials, and ClinicalTrials.gov. Only randomised controlled trials (RCTs) published in peer-reviewed journals comparing SLT to other glaucoma treatment options were considered. The main outcome measure was the change in IOP from baseline. RESULTS An initial search of PubMed identified 23 RCTs with 17 meeting the inclusion criteria. Nine RCTs compared 180° SLT to 180° argon laser trabeculoplasty (ALT) and one trial compared 360° SLT to 360° ALT, all reporting no difference in terms of IOP reduction from baseline. One RCT reported better outcomes with SLT at 1 year but this effect regressed at 2 years. Three trials compared 360° SLT to medical therapy and found no difference between the two treatment options. One trial found greater IOP reduction with latanoprost vs 90° and 180° SLT, and greater IOP reduction with 180° and 360° SLT versus 90° SLT, however no differences were found between 360° SLT versus latanoprost or 360° vs 180° SLT. Two trials compared 180° SLT to 360° SLT finding no difference in IOP reduction. Two trials compared 180° SLT to 90° SLT, one finding no significant difference and one finding greater IOP reduction with 180° SLT over 90° SLT. One trial compared excimer laser trabeculotomy (ELT) to 180° SLT, finding no differences in IOP reduction up to 3 months follow-up but greater IOP reduction with ELT at time intervals between 9 and 24 months. There were no RCTs identified that compared SLT to surgery. CONCLUSION In terms of the IOP lowering effect, there is no difference between SLT and ALT. Three trials indicate no difference between 360° SLT and medical therapy, with one of the trials indicating greater IOP reduction with latanoprost over 90° and 180° SLT. Three trials indicate no difference between 180° SLT and 360° SLT. It is inconclusive whether 90° is less efficacious than 180° SLT. One trial reports greater IOP reduction with ELT over 180° SLT in the long term.
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Wang H, Cheng JW, Wei RL, Cai JP, Li Y, Ma XY. Meta-analysis of selective laser trabeculoplasty with argon laser trabeculoplasty in the treatment of open-angle glaucoma. Can J Ophthalmol 2013; 48:186-92. [DOI: 10.1016/j.jcjo.2013.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 12/02/2012] [Accepted: 01/03/2013] [Indexed: 10/26/2022]
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Alon S. Selective Laser Trabeculoplasty: A Clinical Review. J Curr Glaucoma Pract 2013; 7:58-65. [PMID: 26997784 PMCID: PMC4741175 DOI: 10.5005/jp-journals-10008-1139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/29/2012] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering the intraocular pressure in patients with glaucoma. It achieves its results by selective absorption of energy in the trabecular pigmented cells, sparing adjacent cells and tissues from thermal damage, with minimal morphological tissue alteration following treatment. On the basis of the peer-reviewed medical literature, SLT is efficacious in lowering IOP, as initial treatment or when medical therapy is insufficient in all types of open-angle glaucoma in all races. SLT achieves intraocular pressure reduction similar to that of argon laser trabeculoplasty but without the tissue destruction and side effects. Observed side effects following SLT were almost uniformly transient and minor. We review highlights of recently published studies on the mechanisms and clinical outcome of SLT in order to address frequently raised issues pertinent to SLT in the clinical practice. KEY MESSAGES Selective laser trabeculoplasty is a safe and effective treatment modality for lowering the intraocular pressure in patients with glaucoma. How to cite this article: Alon S. Selective Laser Trabeculoplasty: A Clinical Review. J Current Glau Prac 2013; 7(2):58-65.
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Affiliation(s)
- Skaat Alon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel; Glaucoma Clinical Fellow, New York Eye and Ear Infirmary, New York, USA
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Samples JR, Singh K, Lin SC, Francis BA, Hodapp E, Jampel HD, Smith SD. Laser Trabeculoplasty for Open-Angle Glaucoma. Ophthalmology 2011; 118:2296-302. [DOI: 10.1016/j.ophtha.2011.04.037] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 04/05/2011] [Indexed: 10/17/2022] Open
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Goldenfeld M, Geyer O, Segev E, Kaplan-Messas A, Melamed S. Selective Laser Trabeculoplasty in Uncontrolled Pseudoexfoliation Glaucoma. Ophthalmic Surg Lasers Imaging Retina 2011; 42:390-3. [DOI: 10.3928/15428877-20110630-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 11/08/2010] [Indexed: 11/20/2022]
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Lee JH, Seong MC, Cho HY, Lee YJ. The Effectiveness of Selective Laser Trabeculoplasty in Steroid-Induced Ocular Hypertension. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.7.876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ju Hyang Lee
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Cheol Seong
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hee Yoon Cho
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yoon Jung Lee
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Tang M, Fu Y, Fu MS, Fan Y, Zou HD, Sun XD, Xu X. The Efficacy of Low-Energy Selective Laser Trabeculoplasty. Ophthalmic Surg Lasers Imaging Retina 2011; 42:59-63. [DOI: 10.3928/15428877-20101124-07] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 09/26/2010] [Indexed: 11/20/2022]
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[Effectiveness and relevance of laser trabeculoplasty: treatment of open-angle glaucoma]. Ophthalmologe 2009; 107:18-21. [PMID: 19844721 DOI: 10.1007/s00347-009-2053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Laser trabeculoplasty is a common glaucoma therapy that is safe and effective for reducing intraocular pressure. It was developed as a treatment for open-angle glaucoma in the 1970s, and larger studies proved its effectiveness in the years that followed. In recent years, through the implementation of newer processes such as selective laser trabeculoplasty, laser trabeculoplasty has experienced further developments. Because it causes less damage to the trabecular meshwork, it should have fewer adverse effects, making it a repeatable treatment. Studies on the indications, contraindications, and effectiveness of this method in lowering intraocular pressure are reviewed.
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