Treatment Outcomes and Prognostic Factors of Selective Laser Trabeculoplasty for Open-angle Glaucoma Receiving Maximal-tolerable Medical Therapy.

Purpose

To evaluate the efficacy of selective laser trabeculoplasty (SLT) for patients with open-angle glaucoma receiving maximal-tolerable medical therapy.

Patients and methods: Consecutive patients with open-angle glaucoma who were followed up for at least 1 year after SLT were retrospectively evaluated. The effectiveness was assessed using Kaplan-Meier survival analysis with 2 criteria for failure: (1) intraocular pressure (IOP) equal to or more than baseline; and (2) <20% reduction from baseline, on 2 consecutive visits. Those 2 failure criteria also included loss of light perception, reoperation of SLT, and glaucoma surgery. Influence of baseline factors on success were assessed using mixed-effects Cox proportional hazard models.

Results

Seventy-five eyes [39 primary open-angle glaucoma, 23 exfoliation glaucoma, and 13 secondary open-angle glaucoma (SOAG)] of 59 patients (21 females) aged 65.5±15.9 (mean±SD) were included. Preoperative mean IOP was 23.3±6.5 mm Hg with 3.4±1.3 IOP lowering medications. The overall success ratio at the end of study period was 45.3% by criterion 1 and 14.2% by criterion 2. The success ratio by criterion 1 and 2 was 61.1% and 21.7% in primary open-angle glaucoma, 29.3% and 14.5% in exfoliation glaucoma, and 15.4% and 7.7% in SOAG, respectively. Higher preoperative IOP and diagnosis of SOAG were significantly associated with treatment failure (P<0.01 and 0.04, respectively).

Conclusions

One-year efficacy of SLT in controlling IOP was very limited in patients with maximal-tolerable medical therapy. Types of glaucoma and preoperative IOP were significant prognostic factors for treatment success.