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Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial
摘要： To compare visual field outcomes of ocular hypertensive and glaucoma patients treated with Medicine-1st against those treated with selective laser trabeculoplasty (SLT, Laser-1st). Secondary analysis of patients from Laser in Glaucoma and Ocular Hypertension (LiGHT), a multicentre randomised controlled trial. 344 patients (588 eyes) treated with Medicine-1st, 344 patients (590 eyes) treated with Laser-1st. Visual fields (VFs) were measured using standard automated perimetry and arranged in series (median length and duration: 9 VFs over 48 months). Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Proportions of points and patients in each treatment group with fast (< -1 dB/y) or moderate (< -0.5 dB/y) progression were compared using log-binomial regression. Pointwise and global progression rates of total deviation (TD) and pattern deviation (PD). A greater proportion of eyes underwent moderate or fast TD progression in the Medicine-1st group compared with the Laser-1st group (26.2% vs. 16.9%; Risk Ratio, RR = 1.55 [1.23, 1.93], P < 0.001). A similar pattern was observed for pointwise rates (Medicine-1st 26.1% vs. Laser-1st 19.0%, RR = 1.37 [1.33, 1.42], P < 0.001). A greater proportion of pointwise PD rates were categorised as moderate or fast in the Medicine-1st group (Medicine-1st 11.5% vs. Laser-1st 8.3%, RR = 1.39 [1.32, 1.46], P < 0.001). There was no statistical difference in the proportion of eyes that underwent moderate or fast PD progression (Medicine-1st 9.9% vs. Laser-1st 7.1%, RR = 1.39 [0.95, 2.03], P = 0.0928). A slightly larger proportion of ocular hypertensive and glaucoma patients treated with Medicine-1st underwent rapid VF progression compared with those treated with Laser-1st.
关键词： Medicine-1st,Laser-1st,Glaucoma,Visual field,Ocular hypertension,Selective laser trabeculoplasty
更新于2025-09-23 15:21:01
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Effect of Apraclonidine and Diclofenac on Early Changes in Intraocular Pressure After Selective Laser Trabeculoplasty
摘要： Précis: Adjuvant diclofenac and apraclonidine eye drop given in conjunction with selective laser trabeculoplasty (SLT) do not significantly impact medium-term intraocular pressure (IOP) reduction compared with placebo, but apraclonidine can be used to blunt immediate postlaser pressure spikes. Purpose: There is limited high-grade evidence guiding the choice of eye drops given before and after SLT. The authors chose to measure IOP during the first 24 hours, at 1 week, 6 weeks, and 6 months after SLT, and compare the effect of apraclonidine before SLT and diclofenac after SLT, with placebo. Materials and Methods: In this double-blind, randomized, placebo-controlled trial, patients with open-angle glaucoma or ocular hypertension referred for SLT were recruited between 2016 and 2018. Patients were randomized to receive either apraclonidine pre-SLT with placebo post-SLT, placebo pre-SLT with diclofenac post-SLT, or placebo before and after SLT. Results: Sixty eyes from 35 patients were treated with 360-degree SLT. Twenty-four-hour IOP measurements with patient self-monitoring after SLT demonstrated a moderate IOP spike at 1 hour and 2 hours post-SLT in the placebo and diclofenac study arms (mean = +4.05 ± 0.58 mm Hg and +4.47 ± 0.73, respectively, P < 0.001 vs. pre-SLT IOP), which was prevented by apraclonidine (mean = ?2.41 ± 0.88 mm Hg, P < 0.0001 vs. other study arms post-SLT). There were no significant differences between the 3 arms of the study on the long-term IOP reduction achieved by SLT (6 wk: P = 0.51, 6 mo: P = 0.42). Conclusions: Neither the use of apraclonidine before SLT nor diclofenac after SLT significantly influenced the IOP reduction induced by SLT. Except for a slight and transient reduction in intraocular inflammation, there was no beneficial effect of diclofenac on early IOP changes or the degree of patient discomfort relative to placebo.
关键词： open-angle glaucoma,non–steroidal anti-inflammatory,selective laser trabeculoplasty,intraocular pressure,ocular hypertension
更新于2025-09-23 15:21:01
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Randomized Prospective Study of the Use of Anti-Inflammatory Drops After Selective Laser Trabeculoplasty
摘要： Purpose: Evaluating the use of Indomethacin, Dexamethasone, and no anti-inflammatory treatment immediately after selective laser trabeculoplasty (SLT). Materials and Methods: Prospective randomized clinical trial of 132 eyes. Both eyes of the patient underwent SLT. One of the eyes was treated with Indomethacin 0.1% or Dexamethasone 0.1% 3 times daily for 1 week; the other eye did not receive any anti-inflammatory treatment. Intraocular pressure (IOP) and inflammatory parameters were recorded at 1 hour, 1 week, 1, 3, and 6 months. Results: Cells in the anterior chamber were present in 57% to 71% of the patients after 1 hour. About 16% to 37% of the patients reported pain/discomfort after 1 hour. Redness was present before SLT in 29% to 34% of the patients, probably due to antiglaucoma medication. After 1 hour, the amount of redness recorded raised to 32% to 42%, but the amount of patients with redness returned to pretreatment levels after 1 week. An IOP peak of >5 mm Hg above baseline IOP 1 hour after laser was present in 3% to 9% of the patients. IOP lowered 11% to 21% compared with IOP at baseline. The number of medications needed changed from 1.45 to 1.49 before, to 0.23 to 0.45 six months after SLT. No differential effects based on the kind of anti-inflammatory treatment or no treatment were found for any of the parameters. Conclusions: SLT induces little inflammation: anti-inflammatory drops do not make a significant difference in pain, redness, cells in anterior chamber, or peak IOP following SLT. The IOP-lowering effect of the SLT is not influenced by the use of Indomethacin or Dexamethasone.
关键词： anti-inflammatory drops,use of steroids,selective laser trabeculoplasty,glaucoma,side effects of SLT
更新于2025-09-23 15:21:01
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Focusing on surgical and laser advances in glaucoma management
摘要： Introduction: Lowering the IOP remains the mainstay treatment to stop the progression of glaucoma. Different modalities can be used to achieve this including IOP lowering medications, laser, and surgeries. Nowadays, minimally invasive glaucoma surgeries and newer lasers are becoming more popular due to their safety profile, and their efficacy, allowing the patients to be less dependent on life long medications and substituting more invasive procedures as trabeculectomy, and shunt operations. Areas covered: This review will go through how lasers and surgery are used to lower the IOP, and the newest techniques, and modalities used to achieve this. Expert opinion: the authors of this review believe that in five years’ time lasers and minimally invasive glaucoma procedures will replace eye drops and surgeries like trabeculectomy and shunt procedures.
关键词： cyclophotocoagulation,trabeculectomy,shunt procedures,minimally invasive glaucoma procedures,non-penetrating glaucoma procedures,laser Trabeculoplasty,Intraocular pressure
更新于2025-09-23 15:19:57
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Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials
摘要： background The only widely accepted, effective treatment for open- angle glaucoma (OAG) is to reduce the intraocular pressure (IOP), with medical therapy being the typical first- line therapy. Notably, an alternative therapy is selective laser trabeculoplasty (SLT), which is safe and effective in lowering the IOP. Nonetheless, whether SLT could replace medication as the first- line therapy for OAG is still under debate. Methods Studies involving randomised controlled trials conducted before August 2019 that compared the efficacy of SLT- related and medication- only treatments for OAG were selected from PubMed, Embase, Cochrane Library and Web of Science. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology was employed to rate the quality of the body of evidence. results 1229 patients in eight trials were included. The overall results revealed no significant differences between SLT- related and medication- only treatments regarding the IOP reduction (mean difference (MD): 0.18, 95% CI ?0.72 to 1.07, p=0.70, I2=73%) and the success rate of IOP control (risk ratio: 1.02, 95% CI 0.99 to 1.04, p=0.74, I2=0%). The SLT- related therapy group required significantly fewer medications compared with the medication- only group (MD: ?1.06, 95% CI ?1.16 to ?0.96, p<0.0000, I2=5%). A quantitative analysis was not performed concerning adverse events and quality of life because of the limited data available. Conclusion SLT is safe and has a lower incidence of ocular side effects. SLT can be the choice of first- line therapy for OAG. However, clinicians should consider the cost- effectiveness, as well as the patient’s characteristics, before deciding on the therapeutic option.
关键词： selective laser trabeculoplasty,intraocular pressure,meta-analysis,medication,open-angle glaucoma
更新于2025-09-23 15:19:57
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Predictors of Success in Selective Laser Trabeculoplasty
摘要： Selective laser trabeculoplasty (SLT) is a common procedure to lower intraocular pressure (IOP) in patients with glaucoma. However, reports are conflicting regarding what factors contribute to SLT success. The purpose of this study was to determine predictors of SLT success. A total of 997 eyes from 677 patients were included in the study. Mean age was 70.2±11.5 years. Selective laser trabeculoplasty success was achieved in 227 eyes (22.8%), whereas 770 eyes (77.2%) did not meet success criteria. Intraocular pressure before SLT was 21.9±5.2 mmHg while taking 2.0±1.2 medications in eyes with successful SLT, compared with 19.0±5.0 mmHg (P < 0.0001) while taking 2.1±1.3 medications (P = 0.52) in eyes with SLT failure. At the 1-year follow-up, mean IOP in eyes with SLT success was 14.7±3.2 mmHg with 2.0±1.2 medications, compared with 16.3±4.7 mmHg (P = 0.008) with a mean of 1.9±1.3 medications (P = 0.37) in eyes with SLT failure. Eyes with SLT success more often showed greater angle pigment (P = 0.03). Age, glaucoma severity, total SLT power, type of glaucoma, severity of glaucoma, visual field mean defect, and retinal nerve fiber layer thickness were not found to correlate with success. No difference was found between the rate of success based on treatments before SLT, whether surgical or medical. In this large cohort of eyes undergoing SLT, greater IOP and angle pigment before SLT correlated positively with SLT success. Age, total SLT power, severity of glaucoma, and prior treatments were not associated with SLT success or failure.
关键词： intraocular pressure,predictors of success,glaucoma,Selective laser trabeculoplasty
更新于2025-09-23 15:19:57
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Hypopyon following selective laser trabeculoplasty
摘要： To report a hypopyon following selective laser trabeculoplasty (SLT). Observations: An 85-year-old woman with primary open-angle glaucoma underwent routine SLT. In the early post-procedural period, she presented with pain and decreased vision, and she was found to have hypopyon, trabeculitis, and corneal edema. The patient was treated with prednisolone acetate and empirically with valacyclovir due to the possibility of herpetic keratouveitis. Work-up for potential etiologies was unrevealing. Her symptoms resolved with treatment, and at eight months follow-up her visual acuity and intraocular pressure had stabilized to her baseline. Conclusions: Though safe, SLT may be associated with rare adverse events requiring intervention. Hypopyon following SLT is extremely rare, and investigation for causes unrelated to the history of SLT should be undertaken as appropriate. Importance: To the best of our knowledge, this is the first report of a hypopyon following SLT in a patient with no history of inflammatory intra-ocular disease.
关键词： Hypopyon,Selective laser trabeculoplasty
更新于2025-09-23 15:19:57
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Selective laser trabeculoplasty: a review of repeatability
摘要： The efficacy of selective laser trabeculoplasty (SLT) to treat open-angle glaucoma (OAG) and ocular hypertension (OHT) has been increasingly substantiated lately. Repeated SLT is usually needed to control intraocular pressure (IOP), be it as primary or adjunctive therapy. We review the studies available, in terms of SLT repeatability; and conclude comparable efficacy, with success rate, duration and complications similar to those in initial SLT.
关键词： glaucoma,Selective laser trabeculoplasty (SLT),repeat,repeatability
更新于2025-09-19 17:13:59
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Predictors of selective laser trabeculoplasty success in open angle glaucoma or ocular hypertension: does baseline tonography have a predictive role?
摘要： background The determinants of success of selective laser trabeculoplasty (SLT) in treatment- na?ve patients with open angle glaucoma (OAG) and ocular hypertension (OHT) have not been understood fully. Therefore, we have conducted this study to explore the predictors of success. Methods This is a retrospective review of a pre- existing database of patients who had received primary SLT at St Thomas’ Hospital, London, UK. Patients with OAG and OHT who had received primary 360° SLT treatment and had reliable baseline tonographic outflow facility (TOF) with minimum of 1 year of follow- up were included. Univariate and multivariate analyses were performed to find the determinants of success. results One hundred and seventy- four patients between August 2006 and February 2010 had received primary 360° SLT treatment and had baseline TOF measurement. Of these, 72 subjects fulfilled the eligibility criteria. In multivariate regression analysis, the only variable associated with success was baseline intraocular pressure (IOP) (R2=0.32, beta=?0.51, p<0.001, 95% CI ?2.02 to ?0.74). Conclusion To our knowledge, this is the only study investigating the pretreatment TOF (measured with electronic Shi?tz tonography) and IOP as determinants of success 12 month’s post-360° SLT in treatment- na?ve patients with OAG and OHT. This study demonstrated that pretreatment IOP (and not TOF) is the only determinant of success after primary SLT therapy.
关键词： selective laser trabeculoplasty,intraocular pressure,ocular hypertension,tonographic outflow facility,open angle glaucoma
更新于2025-09-19 17:13:59
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Selective laser trabeculoplasty as the primary treatment for open angle glaucoma: time for change?
摘要： Laser trabeculoplasty came to the fore more than 20 years ago when the Glaucoma Laser Trial (GLT) showed that eyes treated initially with argon laser trabeculoplasty (ALT) had lower intraocular pressure (IOP) with better visual field and optic disc status, compared with their fellow eyes initially treated with topical medication [1]. Selective laser trabeculoplasty (SLT) was then introduced in 1995, and has since largely superseded ALT, with less damage to the trabecular meshwork architecture, fewer reported adverse events and potentially better repeatability [2]. Several randomized trials have reported that SLT may provide similar IOP lowering to medical therapy in open angle glaucoma (OAG) and ocular hypertension (OHT) [3]. SLT may also be an alternative treatment option in OAG patients who cannot tolerate medications due to side effects, and unable or unwilling to undergo surgery [4]. However, SLT is currently not widely accepted as a first-line intervention in treatment-naive eyes, despite increasing evidence that it is as efficacious as a prostaglandin analog in lowering IOP for OAG and OHT [5]. The recently published results from the "LiGHT" study support the use of SLT as a primary treatment for OHT and OAG [6]. In this multicentre randomized trial conducted in the United Kingdom (UK), subjects received either initial SLT (laser-first, n = 356) or glaucoma medical therapy (medicine-first, n = 362) [6]. Majority of patients was European white (68.2%) with OHT (31.9%) or mild OAG (50.6%) [7]. Glaucoma progressed in a lower proportion of patients in the laser-first compared with the medicine-first arm (3.8% versus 5.8%). Over the course of 36 months, IOP control was also better in the laser-first arm, with a lower number of glaucoma medications required and no glaucoma surgeries. Due to the significant reduction in the cost of surgery and glaucoma medications, the laser-first approach was also cost-effective in the context of the National Health Service (NHS) in England and Wales, with overall cost savings of ￡451 per patient. However, the treatment arms did not differ significantly in the primary outcome of health-related quality of life assessed using the EQ-5D (difference, 0.012; 95% confidence interval [CI], ?0.007 to 0.031; p = 0.23) [6]. This is not surprising, given that the EQ-5D-5L is a generic questionnaire that is not the most sensitive tool to investigate vision-related quality of life [8].
关键词： open angle glaucoma,LiGHT study,primary treatment,Selective laser trabeculoplasty,ocular hypertension
更新于2025-09-19 17:13:59