Selective laser trabeculoplasty as replacement therapy in controlled glaucoma patients
2 oktober 2017
UAntwerp, Campus Drie Eiken, Building Q, Promotiezaal - Universiteitsplein 1 - 2610 WILRIJK (route: UAntwerpen, Campus Drie Eiken
Myrjam De Keyser
Prof V. De Groot, Prof J.-P. Bogers
PhD defence Myrjam De Keyser - Faculty of Medicine and Health Sciences
We examined selective laser trabeculoplasty (SLT) as a replacement therapy for medically controlled glaucoma patients.
1, Does the use of anti-inflammatory drops influence the intraocular pressure (IOP) lowering effect or the side effects of SLT?
2, Can structural variations of the eye, like corneal thickness, influence the outcome of SLT?
3, Does previous lens extraction influence the effect of SLT?
4, Can SLT be used in normal tension glaucoma?
5, Does SLT significantly improve quality of life in glaucoma patients?
A prospective randomized interventional clinical trial on 143 glaucoma patients. Patients were randomized to either receiving SLT or to the control group that continued on pressure lowering medication. Data were recorded 1 hour, 1 week, 1, 3, 6, 12 and 18 months after SLT. Primary outcome was number of medications at 12 and 18 months while maintaining a pre-determined target (IOP).
SLT reduced the number of medications from a mean of 1.5 at baseline to 0.35 after 12 months and 0.29 after 18 months. Meanwhile, SLT achieved more than 20% IOP lowering in 95% of eyes and more than 30% IOP lowering in 86% of eyes after 18 months. 77% of our eyes no longer needed any medication after SLT at 18 months.
1, We used Dexamethasone or Indomethacin in one eye and no post laser treatment in the other eye. This made no significant difference in inflammatory signs, nor in the IOP lowering effect of the SLT (p <0,05).
2, Thin corneas (< 550 μm) did not significantly influence outcome of SLT (p <0,05).
3, SLT efficiency was comparable in phakic and pseudophakic eyes (p <0,05).
4, SLT efficacy was not inferior in normal tension glaucoma patients compared to ocular hypertension or other open angle glaucoma patients (p <0,05).
5, SLT lowered the number of medications needed drastically. After SLT, the need for help from others to instil drops, lowered. Ocular surface disease improved significantly after SLT compared tot the control group. Patient reported quality of life improved. Perceived effectiveness rose after SLT, unintended treatment effects decreased, convenience of the therapy augmented.
SLT enabled a reduction in number of medications while maintaining good IOP control. SLT was able to completely replace medical therapy in 77% of eyes after 18 months. SLT as replacement therapy may reduce local and systemic side effects and prevent adherence issues.