Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2023; 11(4): 780-787
Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.780
Selective laser trabeculoplasty as adjunctive treatment for open-angle glaucoma vs following incisional glaucoma surgery in Chinese eyes
Jing Zhu, Juan Guo
Jing Zhu, Juan Guo, Department of Ophthalmology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiao Tong University, Affiliated Chengdu Second Clinical College of Chongqing Medical University, Chengdu 610031, Sichuan Province, China
Author contributions: Zhu J collected and analyzed the data; Guo J conceived and supervised the project; All authors have read and approved the article.
Supported by Natural Science Foundation of Sichuan Province of China, No. 2022NSFSC1400, and Youth Innovation Project of Sichuan Medical Association, No. Q15045.
Institutional review board statement: The study was reviewed and approved by the Third People’s Hospital of Chengdu Institutional Review Board (Approval No. [2022]-S-5).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflict of interest to declare. The authors alone are responsible for the content and writing of the paper.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Juan Guo, MD, Chief Physician, Doctor, Department of Ophthalmology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiao Tong University, Affiliated Chengdu Second Clinical College of Chongqing Medical University, NO. 82, Qing Long Street, Chengdu 610031, Sichuan Province, China. guojuan869@163.com
Received: October 15, 2022
Peer-review started: October 15, 2022
First decision: November 16, 2022
Revised: November 30, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: February 6, 2023
ARTICLE HIGHLIGHTS
Research background

Selective laser trabeculoplasty (SLT) is a relatively safe and effective therapy in lowering intraocular pressures (IOP) for glaucoma. SLT could be offered as an initial treatment at decreasing IOP for open-angle glaucoma (OAG) and ocular hypertension. SLT could be used to reduce the IOP of patients who failed to achieve target IOP after receiving maximally tolerated medical therapy. SLT could reduce the uncontrolled intraocular pressure after glaucoma surgery.

Research motivation

To find out whether SLT could reduce IOP in patients with prior glaucoma surgery.

Research objectives

Our aim was to determine the efficacy of SLT as adjunctive treatment in patients with previous incisional glaucoma surgery whose IOP remains or becomes uncontrolled, and the number of medications used up to 3 years.

Research methods

Outpatients who underwent SLT were reviewed retrospectively at the Department of Ophthalmology, Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiao Tong University from September 2016 to January 2020. 75 consecutive eyes of 70 patients (33 male, 37 female) with OAG (n = 36), and PGS (n = 39) were enrolled. The IOP was measured both before and after SLT and followed up to 3 years.

The means and standard deviations of IOP at different time points before and after SLT treatment was calculated. The statistical analysis of the number of medications used were analyzed using the Wilcoxon signed rank test. The comparative evaluation of treatment effects between and within different types of glaucoma after SLT was tested by the analysis of variance. The success rate was calculated with the Kaplan-Meier survival curve analysis.

Research results

The average age of patients receiving SLT was 44.34 ± 16.14 yr (Table 1). The mean IOP before treatment was 22.75 ± 2.08 mmHg in the OAG group and 22.52 ± 2.62 mmHg in the PGS group (Table 3). The average number of medications used before SLT treatment was 3.39 ± 0.69 in the OAG group and 2.97 ± 0.74 in the PGS group (Table 4). 75 eyes were followed up for longer than 1 year, and 58 eyes were followed up for more than 3 years. There was no statistically significant difference between the OAG and PGS groups. The success rates after 1, 3, 6, 12, and 36 mo were 87.13%, 76.81%, 68.27%, 47.66% and 24.96% in the OAG group, and 84.70%, 67.40%, 59.39%, 42.15% and 27.61% in the PGS group, respectively. The number of drugs was gradually reduced 1 wk after being treated by laser and lasted for 36 mo.

Research conclusions

SLT could reduce IOP as an adjunctive treatment both in the OAG and PGS groups. The residual function in the trabecular meshwork pathway still has potential to be modulated in a post-surgical eye, which provided the conditions for the SLT treatment. SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.

Research perspectives

SLT may be efficacious in eyes with prior incisional glaucoma surgery and it provides an effective treatment option to lower IOP to avoid or postpone subsequent incisional glaucoma procedures.