10-year outcomes of first-line selective laser trabeculoplasty (SLT) for primary open-angle glaucoma (POAG).

ABSTRACT

BACKGROUND: To evaluate long-term efficacy of selective laser trabeculoplasty (SLT) in treatment-naive early primary open-angle glaucoma (POAG) eyes. METHODS: Retrospective study, 108 treatment-naïve eyes of 54 early POAG patients followed up for a mean (± standard deviation (SD)) of 83(27) months. Eyes treated with 360° SLT. Energy levels ranged from 0.6 to 1.4 mJ per pulse. Success of treatment defined as achieving at least 20% reduction of intraocular pressure (IOP) and IOP <19 mmHg. MAIN OUTCOME MEASURE: proportion of eyes achieving success. SECONDARY OUTCOME MEASURES: average time to re-treatment and change in visual field mean deviation (MD) over the follow-up period. RESULTS: Baseline IOP (±SD) was 22.2 (± 4.9). Baseline MD (±SD) of standard automated perimetry was - 1.28 (± 2.36). Decrease in IOP was 6.5 (±3.6) mmHg at 1 year (n=108), 5.2 (±4.6) mmHg at 5 years (n=84) and 3.8 (±2.7) mmHg at 10 years (n=18). Treatment success rate 98% at year 1, 89% at year 5 and 72% at year 10. Failure most common after the third year. Median time to re-treatment 81 months (CI 60-100 months), with 60% needing re-treatment by 10 years. Higher baseline IOP associated with an increased risk of re-treatment. Treatment changed to drops in 4 eyes, but no cases needed glaucoma surgery. Change in visual field MD for the whole group averaged - 0.2 dB per annum. CONCLUSIONS: Treatment of early POAG with first-line SLT, with re-treatments as required, is an effective strategy lasting a period of several years. 60% required re-treatments in the long-term with effective control of IOP and visual field loss remaining at an early stage. The potential for economic benefits in avoiding medications, and simultaneously improving quality of life in these cases is substantial.