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Multicenter Study
. 2024 Apr 15;9(1):e001563.
doi: 10.1136/bmjophth-2023-001563.

Efficacy and safety of first-line or second-line selective laser trabeculoplasty for normal-tension glaucoma: a multicentre cohort study

Koji Nitta  1 , Kae Sugihara  2 , Akiko Narita  3 , Tomoko Naito  4 , Takako Miki  4 , Maki Katai  5 , Shiro Mizoue  6 , Keiji Yoshikawa  7 , Masaki Tanito  8 , Kazuhisa Sugiyama  9 ; FSS Study group
Collaborators, Affiliations
Multicenter Study

Efficacy and safety of first-line or second-line selective laser trabeculoplasty for normal-tension glaucoma: a multicentre cohort study

Koji Nitta et al. BMJ Open Ophthalmol. .

Abstract

Background/aims: This study aimed to investigate and compare the efficacy and safety of first-line and second-line selective laser trabeculoplasty (SLT) in Japanese patients with normal-tension glaucoma (NTG).

Methods: 100 patients with NTG were enrolled in this study. Patients were treated with SLT as a first-line or second-line treatment for NTG. Main outcome measures were intraocular pressure (IOP) reduction rate, outflow pressure improvement rate (ΔOP), success rate at 1 year and complications. Success was defined as ΔOP≥20% (criterion A) or an IOP reduction ≥20% (criterion B) without additional IOP-lowering eye-drops, repeat SLT or additional glaucoma surgeries. The incidence of transient IOP spike (>5 mm Hg from the pretreatment IOP), conjunctival hyperaemia, inflammation in the anterior chamber and visual impairment due to SLT were assessed.

Results: A total of 99 patients (99 eyes) were initially enrolled in this study, including 74 eyes assigned to the first-line SLT group and 25 eyes to the second-line SLT group. The mean IOP of 16.3±2.1 mm Hg before SLT decreased by 17.1%±9.5% to 13.4±1.9 mm Hg at 12 months after SLT in the first-line group (p<0.001), and the mean IOP of 15.4±1.5 mm Hg before SLT decreased by 12.7%±9.7% to 13.2±2.0 mm Hg at 12 months after SLT (p=0.005) in the second-line group. Both groups showed significant reductions in IOP. Higher pre-SLT IOP and thinner central corneal thickness were associated with greater IOP reduction. The success rate at 1 year was higher in the first-line compared with the second-line group, with lower pretreatment IOP and the use of IOP-lowering medication before SLT being associated with treatment failure. Most post-treatment complications were minor and transient.

Conclusions: SLT may be an effective and safe treatment option for NTG, as either a first-line or second-line treatment.

Trial registration number: The study was registered in the UMIN-CTR (UMIN Test ID: UMIN R000044059).

Keywords: Glaucoma; Intraocular pressure; Treatment Lasers.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Changes in intraocular pressure (IOP) before and after selective laser trabeculoplasty (SLT). The mean IOP of 16.3±2.1 mm Hg before SLT decreased by 17.1%±9.5% to 13.4±1.9 mm Hg at 12 months in the first-line group (p<0.001), and the mean IOP of 15.4±1.5 mm Hg before SLT decreased by 12.7%±9.7% to 13.2±2.0 mm Hg at 12 months (p=0.005) in the second-line group.
Figure 2
Figure 2
Success rates for criteria A, B according to Kaplan-Meier survival analyses. The success rate for criterion A was 83.8% (A) and that for criterion B was 19.2% (B) at 12 months. Comparing the two groups at 12 months, the success rate for criterion A was 89.2% in the first-line group and 68.0% in the second-line group (C), and the success rate for criterion B was 23.0% in the first-line group and 8.0% in the second-line group (D). The success rate was greater in the first-line group compared with the second-line group for both criteria (p=0.011, 0.046, respectively) (C, D).
See this image and copyright information in PMC

References

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