Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia

Abstract

Objective: To evaluate the efficacy of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma in an African-derived population in the developing world.

Methods: Sixty-one subjects from St. Lucia with medically treated primary open-angle glaucoma underwent a 30-day washout, followed by bilateral 360° SLT. Intraocular pressure (IOP) was measured 1 hour; 1 week; and 1, 3, 6, 9, and 12 months after SLT.

Results: Mean (SD) IOP with medical therapy was 17.3 (5.0) mm Hg and 17.5 (4.0) mm Hg in the right and left eyes, respectively, and increased to 21.4 (3.6) mm Hg and 21.1 (3.5) mm Hg, respectively, after washout. Both eyes demonstrated a prompt and sustained IOP response to SLT therapy. Intraocular pressure dropped significantly by the first week and remained in the range of 13 to 14 mm Hg without medical therapy through 12 months in patients deemed successful. The mean IOP reductions from baseline ranged from 7.3 to 8.3 mm Hg (34.1%-38.8%) in right eyes and from 7.6 to 8.2 mm Hg (36.0%-38.9%) in left eyes through 12 months. The 12-month Kaplan-Meier survival rate (≥10% IOP reduction from postwashout baseline) was 77.7%, and 93% of successful subjects experienced IOP levels less than with-medication values. Most subjects reported moderate photophobia for 2 to 3 days after SLT; only 1 received anti-inflammatory therapy. Five eyes of 3 subjects had IOP spikes between 5 and 10 mm Hg that resolved without treatment.

Conclusions: The magnitude and duration of IOP reduction are clinically relevant in individuals from St. Lucia of African descent. If repeatable, SLT could be a powerful tool for reducing glaucoma-related blindness in this population.