Download PDF
Klin Monbl Augenheilkd 2022; 239(10): 1239-1244
DOI: 10.1055/a-1668-0145
Klinische Studie

Five-Year Long-Term Follow-Up of Selective Laser Trabeculoplasty in Open-Angle Glaucoma

5-Jahres-Langzeitnachbeobachtung der selektiven Lasertrabekuloplastik beim Offenwinkelglaukom
Christina Gack
Augenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
,
Robert Laemmer
Augenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
,
Bettina Hohberger
Augenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Purpose Selective laser trabeculoplasty (SLT) is known as a safe laser therapy for an effective reduction in intraocular pressure (IOP). The aim of this study was to examine the therapeutic success of SLT in open-angle glaucoma (OAG) patients with a long-term follow-up of 5 years.

Methods Forty-six eyes of forty OAG patients, some with previous intraocular surgery, underwent SLT (24 males, 16 females). Therapeutic success was categorized as: category (I) – IOP reduction ≤ 21 mmHg and > 20% compared to baseline IOP with additional glaucoma medication; category (II) – IOP reduction ≤ 18 mmHg and > 30% compared to baseline IOP with additional glaucoma medication; category (III) – IOP reduction ≤ 18 mmHg without any additional glaucoma medication at all follow-ups. Therapeutic failure was defined as the necessity of any further glaucoma surgery (IV).

Results (1) SLT was well tolerated in all eyes, and no severe side effects or complications were recorded. (2) After 1-year follow-up, therapeutic success was 27% (I), 30% (II), and 3% (III). The therapeutic failure rate was 40% (IV). (3) After 2 years follow-up, therapeutic success was 7% (I), 10% (II), and 0% (III). The therapeutic failure rate was 83% (IV). (4) After 3 years follow-up, the therapeutic failure rate increased up to 100% (IV).

Conclusion SLT seemed to be effective in lowering IOP in the first year in the present cohort, however, the long-term effect is low and additional local therapy or surgical interventions are necessary.

Zusammenfassung

Hintergrund Die selektive Lasertrabekuloplastik (SLT) ist als sichere Lasertherapie zur effektiven Senkung des Augeninnendrucks (IOD) bekannt. Ziel dieser Studie war es, den therapeutischen Erfolg der SLT bei Patienten mit Offenwinkelglaukom (OWG) in einem Langzeit-Follow-up von 5 Jahren zu untersuchen.

Methoden 46 Augen von 40 OWG-Patienten mit teilweise vorheriger intraokularer Operation wurden einer SLT unterzogen (24 Männer, 16 Frauen). Der Therapieerfolg wurde wie folgt kategorisiert: Kategorie (I) – IOD-Senkung ≤ 21 mmHg und > 20% im Vergleich zum Ausgangsdruck mit zusätzlicher Glaukommedikation; Kategorie (II) – IOD-Senkung ≤ 18 mmHg und > 30% im Vergleich zum Ausgangsdruck mit zusätzlicher Glaukommedikation; Kategorie (III) – IOD-Senkung ≤ 18 mmHg ohne zusätzliche Glaukommedikation bei allen Nachuntersuchungen. Als Therapieversagen wurde die Notwendigkeit einer weiteren Glaukomoperation definiert (IV).

Ergebnisse (1) Die SLT wurde in allen Augen gut vertragen und es wurden keine schweren Nebenwirkungen oder Komplikationen festgestellt. (2) Nach 1 Jahr Nachbeobachtung betrug der Therapieerfolg 27% (I), 30% (II) und 3% (III). Die Rate der Therapieversager lag bei 40% (IV). (3) Nach 2 Jahren Nachbeobachtung betrug der Therapieerfolg 7% (I), 10% (II) und 0% (III). Die Rate der Therapieversager lag bei 83% (IV). (4) Die Rate der Therapieversager stieg auf 100% nach 3 Jahren Nachbeobachtung (IV).

Schlussfolgerung Die SLT scheint bei der Senkung des IOD im 1. Jahr in der vorliegenden Kohorte wirksam zu sein, der Langzeiteffekt ist jedoch gering und es sind zusätzliche lokale Therapien oder chirurgische Eingriffe erforderlich.

Key words

selective laser trabeculoplasty - SLT - intraocular pressure - IOP - glaucoma

Schlüsselwörter

selektive Lasertrabekuloplastik - SLT - IOD - Glaukom


Publication History

Received: 12 June 2021

Accepted: 05 October 2021

Article published online:
17 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Quigley HA. Glaucoma. Lancet 2011; 377: 1367-1377
    CrossrefPubMedGoogle Scholar
  • 2 Lichter PR, Musch DC, Gillespie BW. et al. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 2001; 108: 1943-1953
    CrossrefPubMedGoogle Scholar
  • 3 Heijl A, Leske MC, Bengtsson B. et al. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol 2002; 120: 1268-1279
    CrossrefPubMedGoogle Scholar
  • 4 Leske MC, Heijl A, Hyman L. et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology 2007; 114: 1965-1972
    CrossrefPubMedGoogle Scholar
  • 5 The AGIS Investigators. The Advanced Glaucoma Intervention Study: 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators. Am J Ophthalmol 2000; 130: 429-440
    CrossrefPubMedGoogle Scholar
  • 6 Wise JB, Witter SL. Argon laser therapy for open-angle glaucoma. A pilot study. Arch Ophthalmol 1979; 97: 319-322
    CrossrefPubMedGoogle Scholar
  • 7 Barkana Y, Belkin M. Selective laser trabeculoplasty. Surv Ophthalmol 2007; 52: 634-654
    CrossrefPubMedGoogle Scholar
  • 8 Latina MA, Sibayan SA, Shin DH. et al. Q-switched 532-nm Nd : YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology 1998; 105: 2082-2088
    CrossrefPubMedGoogle Scholar
  • 9 Kramer TR, Noecker RJ. Comparison of the morphologic changes after selective laser trabeculoplasty and argon laser trabeculoplasty in human eye bank eyes. Ophthalmology 2001; 108: 773-779
    CrossrefPubMedGoogle Scholar
  • 10 Damji KF, Bovell AM, Hodge WG. et al. Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial. Br J Ophthalmol 2006; 90: 1490-1494
    CrossrefPubMedGoogle Scholar
  • 11 Liu Y, Birt CM. Argon versus selective laser trabeculoplasty in younger patients: 2-year results. J Glaucoma 2012; 21: 112-115
    PubMedGoogle Scholar
  • 12 Wong MO, Lee JW, Choy BN. et al. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol 2015; 60: 36-50
    CrossrefPubMedGoogle Scholar
  • 13 Birt CM. Selective laser trabeculoplasty retreatment after prior argon laser trabeculoplasty: 1-year results. Can J Ophthalmol 2007; 42: 715-719
    CrossrefPubMedGoogle Scholar
  • 14 Russo V, Barone A, Cosma A. et al. Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with uncontrolled open-angle glaucoma. Eur J Ophthalmol 2009; 19: 429-434
    CrossrefPubMedGoogle Scholar
  • 15 Katz LJ, Steinmann WC, Kabir A. et al. Selective laser trabeculoplasty versus medical therapy as initial treatment of glaucoma: a prospective, randomized trial. J Glaucoma 2012; 21: 460-468
    CrossrefPubMedGoogle Scholar
  • 16 Latina MA, Park C. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and CW laser interactions. Exp Eye Res 1995; 60: 359-371
    CrossrefPubMedGoogle Scholar
  • 17 Van Buskirk EM. Pathophysiology of laser trabeculoplasty. Surv Ophthalmol 1989; 33: 264-272
    CrossrefPubMedGoogle Scholar
  • 18 Stein JD, Challa P. Mechanisms of action and efficacy of argon laser trabeculoplasty and selective laser trabeculoplasty. Curr Opin Ophthalmol 2007; 18: 140-145
    CrossrefPubMedGoogle Scholar
  • 19 Gracner T, Falez M, Gracner B. et al. Long-term follow-up of selective laser trabeculoplasty in primary open-angle glaucoma. Klin Monbl Augenheilkd 2006; 223: 743-747
    PubMedGoogle Scholar
  • 20 Melamed S, Ben Simon GJ, Levkovitch-Verbin H. Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study. Arch Ophthalmol 2003; 121: 957-960
    CrossrefPubMedGoogle Scholar
  • 21 McIlraith I, Strasfeld M, Colev G. et al. Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma. J Glaucoma 2006; 15: 124-130
    CrossrefPubMedGoogle Scholar
  • 22 European Glaucoma Society. Terminology and Guidelines for Glaucoma 2021. 5th ed. Accessed December 1, 2020 at: https://www.eugs.org/eng/guidelines.asp
    PubMedGoogle Scholar
  • 23 Gazzard G, Konstantakopoulou E, Garway-Heath D. et al. Selective laser trabeculoplasty vs. drops for the treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet 2019; 393: 1505-1516
    CrossrefPubMedGoogle Scholar
  • 24 Gracner T. Intraocular pressure response of capsular glaucoma and primary open-angle glaucoma to selective Nd : YAG laser trabeculoplasty: a prospective, comparative clinical trial. Eur J Ophthalmol 2002; 12: 287-292
    CrossrefPubMedGoogle Scholar
  • 25 Harasymowyc PJ, Papamatheakis DG, Latina M. et al. Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks. Am J Ophthalmol 2005; 139: 1110-1113
    CrossrefPubMedGoogle Scholar
  • 26 Miki A, Kawashima R, Usui S. et al. Treatment Outcomes and Prognostic Factors of Selective Laser Trabeculoplasty for Open-angle Glaucoma Receiving Maximal-tolerable Medical Therapy. J Glaucoma 2016; 25: 785-789
    CrossrefPubMedGoogle Scholar
  • 27 Best UP, Domack H, Schmidt V. Long-term results after selective laser trabeculoplasty – a clinical study on 269 eyes. Klin Monbl Augenheilkd 2005; 222: 326-331
    PubMedGoogle Scholar
  • 28 Kim DY, Singh A. Severe iritis and choroidal effusion following selective laser trabeculoplasty. Ophthalmic Surg Lasers Imaging 2008; 39: 409-411
    CrossrefPubMedGoogle Scholar
  • 29 Lee JW, Chan JC, Chang RT. et al. Corneal changes after a single session of selective laser trabeculoplasty for open-angle glaucoma. Eye (Lond) 2014; 28: 47-52
    CrossrefPubMedGoogle Scholar
  • 30 Izzotti A, Longobardi M, Cartiglia C. et al. Trabecular meshwork gene expression after selective laser trabeculoplasty. PLoS One 2011; 6: e20110
    CrossrefPubMedGoogle Scholar
  • 31 Alvarado JA, Katz LJ, Trivedi S. et al. Monocyte modulation of aqueous outflow and recruitment to the trabecular meshwork following selective laser trabeculoplasty. Arch Ophthalmol 2010; 128: 731-737
    CrossrefPubMedGoogle Scholar
  • 32 Alvarado JA, Murphy CG. Outflow obstruction in pigmentary and primary open angle glaucoma. Arch Ophthalmol 1992; 110: 1769-1778
    CrossrefPubMedGoogle Scholar
  • 33 Kagan DB, Gorfinkel NS, Hutnik CM. Mechanisms of selective laser trabeculoplasty: a review. Clin Exp Ophthalmol 2014; 42: 675-681
    CrossrefPubMedGoogle Scholar
  • 34 Bradley JM, Anderssohn AM, Colvis CM. et al. Mediation of laser trabeculoplasty-induced matrix metalloproteinase expression by IL-1beta and TNFalpha. Invest Ophthalmol Vis Sci 2000; 41: 422-430
    PubMedGoogle Scholar
  • 35 Lee JY, Kagan DB, Roumeliotis G. et al. Secretion of matrix metalloproteinase-3 by co-cultured pigmented and non-pigmented human trabecular meshwork cells following selective laser trabeculoplasty. Clin Exp Ophthalmol 2016; 44: 33-42
    CrossrefPubMedGoogle Scholar
  • 36 Gracner T. Intraocular pressure response to selective laser trabeculoplasty in the treatment of primary open-angle glaucoma. Ophthalmologica 2001; 215: 267-270
    CrossrefPubMedGoogle Scholar
  • 37 Realini T. Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia. JAMA Ophthalmol 2013; 131: 321-327
    CrossrefPubMedGoogle Scholar