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Selective Laser Trabeculoplasty Protects Glaucoma Progression in the Initial Primary Open-Angle Glaucoma and Angle-Closure Glaucoma after Laser Peripheral Iridotomy in the Long Term
摘要： Purpose. To compare the ability of SLT in preventing glaucoma progression in the initial primary angle-closure glaucoma (PACG) after laser peripheral iridotomy and primary open-angle glaucoma (POAG) in the long term. Methods. 60 patients with the initial stage of PACG after laser peripheral iridotomy and 64 initial POAG patients were recruited in a prospective study. Complete success of selective laser trabeculoplasty (SLT) was de?ned as a 20% intraocular pressure (IOP) reduction with topical hypotensive medications without any hypotensive intervention. Pre-SLT rate of progression and post-SLT rate of progression (ROP) was detected in the both groups by means of the trend and the event analysis of perimetry, the Guided Progression Analysis, and the optical coherence tomography- (OCT-) based negative trend for either the thickness of the peripapillary retinal nerve ?ber layer (RNFL) or ganglion cell complex (GCC). Results. IOP decreased signi?cantly after SLT in both the groups. 30% in PACG and 19% in POAG had the progression according to perimetry and 49% in PACG and 40% in POAG had the progression, respectively, according to OCT. After SLT, ROP was reduced from ? 0.14 ± 0.39 dB/year to ? 0.08 ± 0.48 dB/year, p ? 0.034, in PACG and from ? 0.09 ± 0.36 dB/year to ? 0.04 ± 0.43 dB/year, p ? 0.021, in POAG. According to RNFL trend analysis, ROP was reduced from ? 1.86 ± 2.9 μm/year to ? 1.38 ± 2.2 μm/year, p ? 0.039, and from ? 1.24 ± 2.23 μm/year to ? 0.76 ± 1.73 μm/year, p ? 0.037, in PACG and POAG, and according to GCC, ROP was reduced from ? 1.88 ± 2.9 μm/year to ? 1.34 ± 2.0 μm/year, p ? 0.040, and from ? 1.35 ± 2.16 μm/year to ? 0.91 ± 1.86 μm/year, p ? 0.040, in PACG and POAG, respectively. ROP was signi?cantly faster in PACD than in POAG between 2 and 6 years after SLT: ? 0.15 ± 0.46 dB/year and 0.02 ± 0.38 dB/year (p ? 0.042). However, it did not di?er signi?cantly according to OCT. Conclusion. SLT is an e?ective treatment for initial PACG after LPI and POAG that can prevent functional and structural deterioration in the long term.
关键词： Ganglion Cell Complex,Laser Peripheral Iridotomy,Optical Coherence Tomography,Primary Angle-Closure Glaucoma,Selective Laser Trabeculoplasty,Intraocular Pressure,Retinal Nerve Fiber Layer,Primary Open-Angle Glaucoma,Glaucoma Progression
更新于2025-09-16 10:30:52
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Factors Associated with Interventions after Laser Peripheral Iridotomy for Primary Angle-Closure Spectrum Diagnoses
摘要： To assess factors associated with receipt of subsequent medical, laser, or surgical interventions after laser peripheral iridotomy (LPI). Design: Retrospective review. Participants: A total of 1271 eyes in 692 subjects with narrow angles (NAs) that were treated with LPI. Methods: Demographic and clinical factors associated with primary angle-closure (PAC) or PAC glaucoma (PACG) versus PAC suspect (PACS) diagnosis and use of glaucoma medications at the time of LPI, as well as factors predictive of subsequent addition of glaucoma medications, and receipt of selective laser trabeculoplasty (SLT), cataract surgery, and glaucoma surgery were assessed using logistic regression with generalized estimating equations. Kaplan-Meier curves and Cox proportional-hazards regression analysis were used to assess baseline factors affecting the time to SLT, cataract surgery, or glaucoma surgery. Main Outcome Measures: Diagnosis of PAC/PACG and medical, laser, or surgical interventions after LPI. Results: African Americans (odds ratio [OR], 2.12; P < 0.001) were significantly more likely than whites to have PAC/PACG than PACS and to already be taking glaucoma medications (OR, 2.25, P < 0.001) at the time of LPI. In multivariable logistic regression analysis, African Americans were significantly more likely to be prescribed additional glaucoma medications after LPI (OR, 1.73; P = 0.025) and receive glaucoma surgery (OR, 2.7; P = 0.007), but were less likely to receive SLT (OR, 0.37; P = 0.009). In multivariate Cox proportional-hazards regression analysis, African Americans had longer time to SLT than whites (hazard ratio [HR], 0.41; P = 0.022), but a shorter time to glaucoma surgery (HR, 2.57; P = 0.004). There was no significant association between race and the likelihood of cataract surgery or time to cataract surgery (P > 0.10). Conclusions: African Americans were more likely than whites to carry a diagnosis of PAC or PACG at the time of LPI and were significantly more likely to be prescribed additional glaucoma medications and require glaucoma surgery after LPI. Improved screening methods that target African Americans with NAs are needed so that preventive interventions such as LPI can be performed earlier to decrease the risk of progression.
关键词： selective laser trabeculoplasty,primary angle-closure glaucoma,laser peripheral iridotomy,African Americans,glaucoma surgery
更新于2025-09-16 10:30:52
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Evaluation of the effects of selective laser trabeculoplasty on anterior segment parameters by anterior segment optical coherence tomography
摘要： To prospectively examine the effects of selective laser trabeculoplasty (SLT) on the anterior chamber angle (ACA) and its related parameters using anterior segment-optic coherence tomography (AS-OCT). Fifty eyes of 50 patients with primary open angle glaucoma (POAG) and ocular hypertension were included in the study. AS-OCT was performed before SLT application, immediately after and at 1 day and 1 month. Intraocular pressure (IOP), central corneal thickness (CCT) and anterior chamber depth (ACD) were also recorded and evaluated. No statistically significant difference was determined in ACA and other AS-OCT parameters (AOD, angle opening distance at 500 and 750 mm; TISA, trabecular-iris space area at 500 and 750 mm) before and 1 day after SLT application (p > 0.05). However, a statistically significant increase was determined in both the temporal and nasal ACA, AOD and TISA values between the baseline and day 30 (p < 0.001). No statistically significant change was observed in the CCT or ACD values (p > 0.05). SLT resulted in an increase in ACA, AOD and TISA when evaluated using AS-OCT. We think that this study provides a different perspective concerning the effects of SLT in the angle region and the involved mechanism.
关键词： Selective laser trabeculoplasty,Glaucoma,Anterior segment optical tomography
更新于2025-09-16 10:30:52
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West Indies Glaucoma Laser Study (WIGLS)—2
摘要： To identify factors associated with intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) in Afro-Caribbean people with primary open-angle glaucoma (POAG). Design: This was a prospective stepped-wedge study. Methods: Data were drawn from 72 Afro-Caribbean subjects with POAG participating in the ongoing West Indies Glaucoma Laser Study. Multivariable mixed-model analysis was utilized to develop a predictive model for percent IOP reduction 12 months following SLT. Putative factors (age, sex, site, baseline IOP, prior use of prostaglandin therapy, number of prewashout IOP-lowering medications, central corneal thickness, severity of glaucoma, duration of follow-up, and signs of acute postoperative inflammation) were evaluated in bivariate analysis. Factors significant at P ≤ 0.2 were included in the final model. Right and left eye data were modeled separately. Results: At month 12 following SLT, mean IOP reductions in the West Indies Glaucoma Laser Study were 6.2 to 6.5 mm Hg (29.7% to 31.0%) in right and left eyes. The only factor significant in both eyes (P = 0.0005 in right eyes and P < 0.0001 in left eyes) was time, with IOP reductions being greatest at month 3 and declining slightly over time through month 12. Vertical cup-disc ratio (P = 0.006) and prior prostaglandin therapy (P = 0.004) were significant only in right eyes, and central corneal thickness (P = 0.014) was significant only in left eyes. Factors significant only unilaterally did not approach significance in fellow eyes, suggesting the possibility that these represent type 1 errors. Site (St. Lucia vs. Dominica) was not a significant factor, establishing generalizability of these treatment outcomes to a broader population of African-derived people. Conclusions: This analysis did not identify any subject-specific factors consistently predictive of therapeutic response to SLT. Of note, no factors predicted a suboptimal response. These findings favorably position SLT for broad application as primary therapy in African-derived people with POAG.
关键词： selective laser trabeculoplasty,intraocular pressure,glaucoma,low-income and middle-income countries
更新于2025-09-16 10:30:52
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SALT Trial: Steroids after Laser Trabeculoplasty
摘要： This study examined whether short-term use of topical nonsteroidal anti-inflammatory drug (NSAID) or steroid therapy affected the efficacy of selective laser trabeculoplasty (SLT). Design: Double-masked, randomized, placebo-controlled, dual-center, multisurgeon trial. Participants: Patients older than 18 years with intraocular pressure (IOP) of more than 18 mmHg for whom the clinician decided SLT was the appropriately indicated therapy were randomized to 1 of 3 groups in a ratio of 1:1:1 as follows: ketorolac 0.5%, prednisolone 1%, or saline tears. Methods: After SLT, patients randomized into each group were instructed to use an unmarked drop 4 times daily starting the day of SLT and continuing for 4 additional days. The Kruskal-Wallis test and Wilcoxon rank-sum test were used for continuous variables when comparing 2 or 3 treatment groups, respectively. The Fisher exact test was used for categorical variables. Main Outcome Measures: The primary outcome of this study was IOP at 12 weeks. Secondary outcome measures included IOP at 1 and 6 weeks, patient-reported pain, and detectable anterior chamber inflammation. Results: Ninety-six eyes of 85 patients fit inclusion criteria and were enrolled between the 2 sites. The NSAID, steroid, and placebo groups were similar in baseline demographics and baseline IOP (mean, 23.3±3.9 mmHg; P = 0.57). There was no statistically significant difference in IOP decrease among groups at week 6. Both the NSAID and steroid groups showed a statistically significantly greater decrease in IOP at week 12 compared with the placebo group (mean, -6.2±3.1 mmHg, -5.2±2.7 mmHg, and -3±4.3 mmHg, respectively; P = 0.02 [analysis of variance] and P = 0.002 [t test] for NSAID vs. placebo groups; P = 0.02 for steroid vs. placebo groups). Conclusions: Significantly better IOP reduction at 12 weeks was measured in eyes treated with steroid or NSAID drops after SLT. Short-term postoperative use of NSAID or steroid drops may improve IOP reduction after SLT. Longer-term follow-up studies are indicated.
关键词： steroid,NSAID,SLT,selective laser trabeculoplasty,anti-inflammatory,IOP,intraocular pressure
更新于2025-09-16 10:30:52
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Towards Automatically Controlled Dosing for Selective Laser Trabeculoplasty
摘要： Purpose: Selective laser trabeculoplasty (SLT) is a treatment option for open-angle glaucoma; however, it lacks an instant evidence for successful irradiation. So far ophthalmologists use the visible appearance of permanent champagnelike bubbles (macro bubbles) as an indicator for appropriate pulse energy. We hypothesize that micro bubbles, which start energetically far below the appearance of macro bubbles, already trigger the therapeutic benefit. Here we present two methods to capture the onset of these micro bubbles. Methods: The trabecular meshwork of freshly enucleated porcine eye globes was irradiated with a series of 15 pulses with a pulse duration of 1.7 ls and with increasing energy at a repetition rate of 100 Hz per each spot of 200 lm in diameter. An optical and an optoacoustic method have been developed and appropriate algorithms investigated towards the real-time detection of the onset of micro bubbles. Results: Both observation methods are capable of detecting micro bubble nucleation. Threshold radiant exposures were found at 310 6 137 mJ/cm2. By combination of both methods a sensitivity and specificity of 0.96 was reached. Conclusions: In case that the therapeutically demanded pressure reduction is already achieved with these micro bubbles, which needs to be proven clinically, then the methods presented here can be used in an automatic feedback loop controlling the laser irradiation. This will unburden the clinicians from any dosing during SLT. Translational Relevance: Automatic real-time pulse energy dosing based on the formation of micro bubbles in SLT significantly improves and facilitates the treatment for the physician.
关键词： dosimetry,selective laser trabeculoplasty,ophthalmology,micro bubble detection,ophthalmic optics and device
更新于2025-09-12 10:27:22
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Crystalline lens changes after selective laser trabeculoplasty in Afro-Caribbean patients with open-angle glaucoma; report 4 of the West Indies Glaucoma Laser Study (WIGLS)
摘要： To characterize changes in nuclear, cortical, and posterior subcapsular lens opacities after selective laser trabeculoplasty (SLT) in Afro-Caribbean eyes with primary open-angle glaucoma (POAG).
关键词： SLT,lens opacities,Afro-Caribbean,open-angle glaucoma,selective laser trabeculoplasty
更新于2025-09-12 10:27:22
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Real-World Outcomes of Selective Laser Trabeculoplasty in the UK
摘要： Objective: Selective laser trabeculoplasty (SLT) is a common treatment option for managing glaucoma and ocular hypertension. We assessed the real-world effectiveness of SLT and baseline factors associated with treatment success in the United Kingdom (UK). Design: Retrospective observational study of de-identified electronic medical records (Medisoft? Glaucoma module) from 5 UK ophthalmology teaching centers. Participants: Adult patients undergoing their first recorded SLT. For bilateral SLT (same day), analyses included one randomly selected eye. Methods: Patient demographics, procedure details and clinical outcomes data were extracted. Factors associated with treatment success were assessed using multivariable Cox regression. Main outcome measures: Change from baseline in intraocular pressure (IOP) and glaucoma medication use at 12?18 and 24?36 months post-SLT. A Kaplan-Meier survival analysis was also conducted. SLT failure was defined as any further glaucoma procedure post-SLT or any of the following at 2 consecutive visits: IOP >21 mmHg, IOP reduction <20% from baseline, or an increase in glaucoma medications from baseline. Results: 831 SLT-treated eyes (mean baseline IOP 22.0 mmHg) of 831 patients were analyzed. At 12?18 and 24?36 months post-SLT, respectively, significant reductions in IOP (?4.2 [95% CI: ?4.7 to ?3.7] and ?3.4 [95% CI: ?4.1 to ?2.7] mmHg; both P<0.0001) and significant increases in the number of glaucoma medications (0.13 [95% CI: 0.04 to 0.23], P=0.007, and 0.20 [95% CI 0.06 to 0.33], P=0.005) were observed. Survival analysis demonstrated treatment success in 70%, 45%, and 27% of eyes at 6, 12, and 24 months post-SLT, respectively. Higher baseline IOP was strongly associated with treatment success (HR 0.64 for baseline IOP >21 mmHg vs ≤21 mmHg, 95% CI: 0.53–0.76; P<0.001). SLT success was not significantly associated with age (P=0.78), baseline visual field mean deviation (P=1.00) or the concurrent use of IOP-lowering medication (P=0.52). Conclusion: Most patients initially responded to SLT, but a majority failed within 1 year. SLT efficacy was better in patients with higher baseline IOP but did not differ by glaucoma severity or by concurrent use of IOP-lowering medication. These findings may help inform which patients are suitable for SLT therapy.
关键词： Selective laser trabeculoplasty,intraocular pressure,glaucoma,real-world outcomes,ocular hypertension
更新于2025-09-12 10:27:22
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Long-Term Outcomes and Predictive Factors for Success of Selective Laser Trabeculoplasty
摘要： Purpose: To investigate long-term outcomes and predictive success factors for selective laser trabeculoplasty (SLT). Methods: This retrospective chart review included 66 eyes of 66 glaucoma or ocular hypertension patients who underwent SLT between 2004 and 2011. All patients were followed-up for at least 2 years after the procedure. The intraocular pressure (IOP) was measured before the treatment, at postoperative 1 week, 1 month and every 3 months thereafter. Success was defined as an IOP decrease ≥ 3 mm Hg or ≥ 20% of the pretreatment IOP. The success rate was determined based on the Kaplan-Meier survival analysis. The predictive success factors were analyzed using the Cox proportional hazard model. Results: The mean follow-up period was 4.78 ± 1.98 (2-8) years. The mean pretreatment IOP was 23.79 ± 2.83 mm Hg. The mean IOP reduction was 6.64 ± 3.21 mm Hg. The success rates were 80%, 75%, 69%, 63%, 50%, 45%, and 42% after 1, 2, 3, 4, 5, 6, and 7 years, respectively. Only high pretreatment IOP was significantly correlated with success (p = 0.044). Conclusions: SLT was an effective tool for lowering IOP in glaucoma patients. Higher pretreatment IOP was a predictive success factor.
关键词： Success rate,Predictive factor,Glaucoma,Intraocular pressure,Selective laser trabeculoplasty (SLT)
更新于2025-09-12 10:27:22
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Effect of a single session of micropulse laser trabeculoplasty on corneal endothelial parameters
摘要： Background: To evaluate the effect of a single session of micropulse laser trabeculoplasty on the cornea in eyes with primary open-angle glaucoma and pseudoexfoliation glaucoma. Methods: This single-centre, prospective, case series enrolled patients with primary open-angle and pseudoexfoliation glaucoma under treatment with glaucoma agents that required additional intraocular pressure reduction. Eyes underwent 360 degrees treatment with 532 nm micropulse laser trabeculoplasty. Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-ef?cient of variation of endothelial cells were measured before micropulse laser trabeculoplasty and at one, three and six months after treatment. Results: Twenty eyes of 20 patients (mean age 67.6 (cid:1) 8.0 years) with primary open-angle glaucoma and 18 eyes of 18 patients (mean age 71.44 (cid:1) 6.43 years) with pseudoexfoliation glaucoma were included in the study. Treatment with micropulse laser trabeculoplasty resulted in statistically signi?cantly lower intraocular pressure compared to baseline in both primary open-angle and pseudoexfoliation glaucoma eyes (p < 0.0001 at both comparisons). Central corneal thickness, endothelial cell count, hexagonal cell ratio and co-ef?cient of variation of the endothelial cell size showed no signi?cant change between baseline and six months after micropulse laser trabeculoplasty in both primary open-angle and pseudoexfoliation glaucoma eyes. Conclusion: A single session of micropulse laser trabeculoplasty did not affect central corneal thickness and corneal endothelium parameters in eyes with primary open-angle and pseudoexfoliation glaucoma.
关键词： micropulse laser trabeculoplasty,corneal endothelium,hexagonal cell ratio,pseudoexfoliation,glaucoma
更新于2025-09-11 14:15:04