Success predictors of selective laser trabeculoplasty in primary angle-closure glaucoma: a long-term follow-up

Purpose. To evaluate the effectiveness and the factors predictive of long-term failure of selective laser trabeculoplasty (SLT) in patients with the initial stage of primary angle-closure (PACG) and primary open angle glaucoma (POAG).Materials and methods. 65 PACG patients (65 eyes) and 65 POAG patients (65 eyes) were observed for 6 years. SLT was considered to be successful if its hypotensive effect consisted in an IOP decrease ³ 20 % achieved without any additional hypotensive treatment by antiglaucoma drop instillations or any hypotensive intervention (repeated SLT, antiglaucoma surgery, cataract phacoemulsification). The effectiveness was assessed using the Kaplan — Meier survival analysis. To determine the factors predictive of SLT, one-factor Cox proportional hazards regression analysis was used. Results. The hypotensive effect of SLT achieved was, for PACG and POAG, respectively, (1) 82 and 84 % one year after surgery; (2) 62 and 68 % two years thereafter, (3) 59 and 63 %, three years thereafter, (4) 34 and 42 %, four years thereafter, (5) 26 and 38 %, five years thereafter, (6) 4 and 8 % thereafter (log rank test, p = 0.234). The predictors of SLT failure were common for both forms of glaucoma in Cox regression analysis, namely: initial IOP > 24 mm Hg (OR = 1.184, p = 0.029 for PACG and OR = 1.156, p = 0.010 for POAG), corneal hysteresis < 9,5 mm Hg (OR = 1.441, р = 0.022 for PACG and OR = 1.486, р = 0.030 for POAG), corneal thickness < 540 μm (OR = 1.586, р=0.021 for PACG and OR =1.648, p =0.030 for POAG), reduced thickness of the retinal nerve fiber layer < 90 μm (OR = 1.231, p = 0.014 for PACG and OR =1.194, p = 0.027 for POAG) and age > 68 years (OR = 1.162, p = 0.040 for PACG and OR = 1.167, p = 0.000 for POAG). The additional failure predictors for PACG were the span of exposure to SLT < 180 0 (OR = 1.686, p = 0.004) and lens thickness > 4.86 mm (OR = 4.841, p = 0.001). Hypertension, diabetes mellitus, trabecular pigmentation degree and the type of antiglaucoma drugs taken before SLT were not found to be significant predictors of SLT effectiveness.Conclusion. SLT is an effective method of treating initial POAG and PACG after laser iridotomy. The long-term effect of SLT in both forms of glaucoma is affected by the initial IOP, glaucoma stage, and the patient’s age. The most important role in PACG is played by the span of SLT exposure and the size of the lens.

Efficacy of Selective Laser Trabeculoplasty in Primary Angle-Closure Glaucoma after peripheral iridotomy: a long-term follow-up

Purpose. To evaluate an efficiency of selective laser trabeculoplasty (SLT) in treatment of patients with primary angle closure glaucoma (PACG) following a YAG laser peripheral iridotomy (PI) compared with primary open angle glaucoma (POAG) in long-term follow-up period.Material and methods. The SLT hypotensive efficiency was evaluated in 68 eyes with the initial PACG after PI performed not earlier than one month before SLT and in 74 eyes with initial POAG. The quantity of necessary hypotensive medication to decrease IOP ≤21 mm was also considered. Rate of progression (ROP) of glaucoma optic neuropathy was assessed using the MD index, RNFL and GCC thickness. Follow-up period lasted 6 years.Results. The IOP was decreased significantly after SLT in both groups in long-term period. However, hypotensive effect was more pronounced in PACG – 41.18% compared to POAG – 28.38%. After 6 years, a significantly less quantity of hypotensive eye drops was required to achieve a hypotensive efficacy in PACG than in POAG: 0.68±0.92 and 1.18±0.75, respectively (р=0.035). There was no significant difference in ROP between PACG and POAG: -0.06±0.65 dB/year and -0.14±0.48 dB/year, respectively for MD (р=0.461); -0.57±1.82 μm/year and -0.62±1.59 μm/year for RNFL (р=0.372); -0.60±2.36 μm/year and -0.71±1.98 μm/ year for GCC (р=0.292).Conclusion. The SLT is a safe and effective laser treatment method for the initial stage of PACG after peripheral laser iridotomy. Hypotensive effect of SLT in case of PACG is higher than in POAG, especially 2 and 6 years after the procedure. The SLT in the initial stages of POAG and PACG allows to stabilize glaucoma optic neuropathy

Glaucoma Optic Neuropathy Progression: the Results of Long-Term Follow-Up

Purpose: to investigate the average speed and risk factors for the glaucomatous optic neuropathy (GON) progression during longterm observation. Patients and methods. The 10-year data of 750 patients were analyzed. The average GON progression rate was calculated on the basis of perimetry and optical coherent tomography data. Further, according to inclusion and exclusion criteria 128 patients were included into the group of retrospective analysis. Resultes. The following risk factors were established: initial cornealcompensated IOP (IOPcc) > 23.6 mm Hg (AUC 0.7), IOPcc after 5 years > 19.8 mm Hg (AUC 0.83), age > 69.5 years (AUC 0.6), corneal hysteresis < 9.9 mm Hg (AUC 0.6) and retinal nerve fiber layer < 92 μm (AUC 0.6). Patients with pseudoexfoliation syndrome, and patients taking systemic calcium channel blockers (p = 0.01) also had the higher risk of GON progression. Its rate was lower in patients with arterial hypertension (p = 0.015), and in patients who received prostaglandin analogues (risk was 5 times reduced, p = 0.04) and fixed combinations (risk was 2 times reduced, p = 0.018). IOPcc of higher than 17.6 mm Hg in the long-term period is the most pronounced risk factor for the progression of GON. It was determined that the average ROP of glaucoma progression among the patients was 0.6 dB/year for ROP1, 0.62 ± 1.09 μm/year for ROP2 and 0.95 ± 3.28 μm/year for ROP3, also each 1 dB/year decrease in photosensitivity (in group with glaucoma progression) was associated with further loss of RNFL (3.9 µm/year). Conclusion. The use of prostaglandin analogues and fixed combinations reduces this risk