Preoperative intraocular pressure as a predictor of selective laser trabeculoplasty efficacy.
Pillunat Karin R, Spoerl Eberhard, Elfes Greta, Pillunat Lutz E
AI Summary
This study found preoperative IOP best predicts SLT efficacy; higher initial IOP leads to greater reduction, suggesting limited benefit for patients with pre-SLT IOP below 14 mmHg.
Abstract
Purpose
To identify predictors of intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) in patients with high- and low-pressure primary open-angle glaucoma, who are already taking maximally tolerated IOP-lowering medication and need further IOP reduction.
Methods
In this prospective interventional case series, 157 eyes of 157 open-angle glaucoma patients who were assigned for SLT for further IOP reduction were included. Each patient had diurnal IOP measurements taken before and on average 6 months following SLT. The mean of six IOP measurements was compared. The following parameters were analysed for their association with SLT success: age, gender, spherical equivalent, high-pressure or normal-pressure open-angle glaucoma, number and type of pressure-lowering medications, lens status, pre-SLT IOP, IOP at the time of diagnosis, duration of glaucoma, visual field stage and central corneal thickness.
Results
The only parameter that was predictive for absolute and relative mean diurnal IOP reduction after SLT was the preoperative mean diurnal IOP. One hundred per cent of the patients with a mean diurnal preoperative IOP of more than 18 mmHg had an IOP reduction after SLT. With mean diurnal preoperative values of 14-18 mmHg, 83.1% of the patients, and with values below 14 mmHg only 64% of the patients, showed an IOP reduction. This difference was statistically significant (>18 compared to 14-18: p = 0.002; >18 compared to <14: p = 0.001; 14-18 compared to <14: p = 0.030).
Conclusions
The pressure-lowering effect of SLT can best be predicted by the individual IOP level before treatment. Patients with mean diurnal IOP levels below 14 mmHg might not benefit from the procedure at all.
MeSH Terms
Shields Classification
Key Concepts4
The only parameter predictive for absolute and relative mean diurnal intraocular pressure (IOP) reduction after selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma was the preoperative mean diurnal IOP.
One hundred percent of patients with a mean diurnal preoperative intraocular pressure (IOP) of more than 18 mmHg had an IOP reduction after selective laser trabeculoplasty (SLT) for primary open-angle glaucoma.
Among patients with primary open-angle glaucoma undergoing selective laser trabeculoplasty (SLT), 83.1% of those with mean diurnal preoperative intraocular pressure (IOP) values of 14-18 mmHg showed an IOP reduction, compared to 64% of those with values below 14 mmHg. This difference was statistically significant (14-18 mmHg compared to <14 mmHg: p = 0.030).
Patients with mean diurnal intraocular pressure (IOP) levels below 14 mmHg might not benefit from selective laser trabeculoplasty (SLT) for primary open-angle glaucoma.
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