Acceptance of Selective Laser Trabeculoplasty as a First-Line Treatment for Primary Open-Angle Glaucoma in Saudi Arabia.

PURPOSE: Glaucoma is the second leading cause of blindness worldwide. Early detection and timely treatment are crucial to reducing disease progression. Selective laser trabeculoplasty (SLT) has proven efficacious as a primary treatment for primary open-angle glaucoma. This study aims to evaluate the acceptance among Saudi ophthalmologists of using SLT as a primary treatment for glaucoma. METHODS: This cross-sectional study enrolled 128 ophthalmologists practicing in Saudi Arabia. Data collection was conducted using a structured online questionnaire, which evaluated sociodemographic data, current glaucoma practice, the technology acceptance model (TAM), and potential barriers to incorporating SLT as the primary treatment for glaucoma. RESULTS: The mean age of the participants was 40 ± 9.6 years, with 65.6% being male. Almost one-third were glaucoma specialists, and 89% followed the American Academy of Ophthalmology recommendations for managing glaucoma patients. The majority (96.1%) used medical treatment as the initial therapy, 72.7% agreed that SLT is safe, and 59.4% agreed that it rapidly controls intraocular pressure. Nearly half of the participants were willing to use SLT as the primary treatment, yet only 42.2% considered themselves experienced enough to do so. The most reported barriers were inadequate training (47.7%), non-availability of SLT equipment (41.4%), and low efficacy as reported by 27.3% of participants. CONCLUSION: Despite the good overall acceptance of SLT as a first-line treatment for glaucoma, most participants still preferred medical therapy as the primary treatment. To overcome the barriers to incorporating SLT, Saudi ophthalmologists require more training and access to equipment to effectively implement this modality in their practices.

Outcomes of selective laser trabeculoplasty in corticosteroid-induced ocular hypertension and glaucoma.

PURPOSE: To report the outcomes of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced ocular hypertension and glaucoma. METHODS: A retrospective chart review of patients who underwent SLT for steroid-induced ocular hypertension or glaucoma between January 2014 and October 2018. Success of SLT was defined as ⩾20% IOP reduction from baseline without further medical or surgical intervention and/or a reduction in the number of glaucoma medications by ⩾1 from baseline while maintaining the target IOP. Main outcome measures were change in IOP from baseline and reduction in the number of medications post-laser. RESULTS: A total of 25 eyes of 17 patients were included in the study. The mean duration of follow-up was 18.8 ± 4.5 months. IOP decreased from 23.7 ± 6.7 mmHg pre-laser to 14.4 ± 3.2 mmHg post-laser, at the last follow-up visit (p < 0.001). The mean number of medications was 1.8 ± 1.6 medications pre-laser and 1.4 ± 1.3 medications post-laser (p = 0.262). The overall success rate at 12 months was 72%. No visually significant complications were encountered during the whole duration of follow-up. CONCLUSION: SLT is a safe and effective procedure that can result in well-controlled IOP in patients with steroid-induced ocular hypertension and glaucoma.

Chloral Hydrate Administered by a Dedicated Sedation Service Can Be Used Safely and Effectively for Pediatric Ophthalmic Examination.

PURPOSE: To determine safety and efficacy of oral chloral hydrate sedation (CHS) for outpatient pediatric ophthalmic procedures. DESIGN: Prospective, interventional case series. METHODS: Setting: King Khaled Eye Specialist Hospital. SUBJECTS: Children aged 1 month to 5 years undergoing CHS for ocular imaging/evaluation. PROCEDURES: Details on chloral hydrate dose administered, sedation achieved, vital signs, and adverse events were recorded. OUTCOME MEASURES: Primary outcome was percentage of patients with a sedation level ≥ 4 at 45 minutes post chloral hydrate administration. Secondary outcomes were time from sedation to discharge and adverse events, including changes in vital signs following chloral hydrate administration. RESULTS: A total of 324 children were recruited with a mean age of 2.2 (SD: 1.3) years and mean weight of 10.9 (SD: 3.3) kg. Adequate sedation was obtained with a mean chloral hydrate first dose of 77.4 (SD: 14.7) mg/kg in 306 (94.4%) patients, with an additional 6 patients (1.9%) achieving adequate sedation with a second dose (overall adequate sedation: 96.3%). Mean reductions in heart rate, respiratory rate, and oxygen (O2) saturation from pre-sedation to 25 minutes post-sedation were 11.7 (SD: 14.3) beats per minute, 1.2 (SD: 2.4) breaths per minute, and 0.81% (SD: 1.2%), respectively (P < .001 for all). In multivariable regression, odds of remaining sedated 45 minutes after chloral hydrate administration were 2.53 times higher for American Society of Anesthesiologists (ASA) class II or III patients than for ASA class I (95% confidence interval [CI]: 1.11-5.78, P = .03), 1.03 times higher per mg increase in initial dose of chloral hydrate (95% CI: 1.01-1.06, P = .006), and 2.70 times higher per unit increase in number of planned procedures (95% CI: 1.63-4.47, P < .001). Three patients developed minor adverse events: 2 cases of O2 desaturation and 1 paradoxical reaction, none requiring significant intervention. Patients were discharged a median of 90 minutes after chloral hydrate administration. CONCLUSION: Chloral hydrate administered by a dedicated sedation service, as in this prospective assessment, can be used safely and effectively for outpatient pediatric ophthalmic procedures.

Selective Laser Trabeculoplasty in Primary Angle-closure Glaucoma After Laser Peripheral Iridotomy: A Case-Control Study.

PURPOSE: To evaluate the outcomes of selective laser trabeculoplasty (SLT) in patients with primary angle closure (PAC/PACG) following a YAG peripheral laser iridotomy (PI) compared with primary open-angle glaucoma (POAG). METHODS: A case-control study compared the effectiveness of SLT in PAC/PACG to POAG. Data from patients who underwent SLT after a successful PI for PAC/PACG (PAC/PACG group) with an opening of the angle for at least 180 degrees were compared with a POAG group that was randomly matched to the PAC/PACG group for age, baseline intraocular pressure (IOP), and severity of glaucoma. Data were collected on the change in IOP from baseline and reduction in number of medications following SLT in both groups. SLT was considered successful when IOP decreased by ≥20% of the baseline IOP without further medical or surgical intervention or a reduction in glaucoma medications by ≥1 from the baseline number while maintaining the target IOP. RESULTS: In the PAC/PACG group, 59 eyes with persistent IOP elevation after successful PI underwent SLT in areas where the angle was open for at least 180 degrees; 41% (n=24) of PAC/PACG had scattered peripheral anterior synechiae (PAS) of ≤180 degrees. In the POAG group, 59 eyes underwent SLT. Fifty-nine percent in the PAC/PACG group and 85% in POAG group had 360-degree treatment, with 74 and 78 shots at 0.53 and 0.62 mJ per laser application, respectively. In the PAC/PACG group, IOP was 19.3±6.5 mm Hg at baseline and 15±3.5 mm Hg10 months after SLT, and the number of medications decreased from 2.3 at baseline to 1.4 at 10 months postoperatively. In the POAG group, IOP was 19.6±5.6 mm Hg at baseline, and 16.1±3.7 mm Hg 11 months after SLT and the glaucoma medications decreased from 2.3 to 1.1. The postoperative IOP reduction in the PAC/PACG and POAG was not significantly different (P=0.66). The success rate of achieving clinically significant IOP reduction of 20% or more from baseline, or discontinuation of one or more of glaucoma medications was 84.7% in the PAC/PACG group and 79.6% in the POAG group (P=0.47). An IOP spike occurred in 10% (n=6) in PACG/PAC and 5% (n=3) in POAG and was controlled with topical medications (P=0.49). CONCLUSION: The safety and efficacy of SLT was equivalent in PAC/PACG and POAG.