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.