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Primary Selective Laser Trabeculoplasty for Open Angle Glaucoma and Ocular Hypertension: Clinical Outcomes, Predictors of Success and Safety from the Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial

Garg, A; Vickerstaff, V; Nathwani, N; Garway-Heath, D; Konstantakopoulou, E; Ambler, G; Bunce, C; ... LiGHT Trial Study Group, ; + view all (2019) Primary Selective Laser Trabeculoplasty for Open Angle Glaucoma and Ocular Hypertension: Clinical Outcomes, Predictors of Success and Safety from the Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial. Ophthalmology 10.1016/j.ophtha.2019.04.012. (In press). Green open access

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Abstract

PURPOSE: To report clinical efficacy, predictors of success and safety of primary selective laser trabeculoplasty (SLT) used in treatment-naïve open-angle glaucoma (OAG) or ocular hypertension (OHT) patients. DESIGN: Post-hoc analysis of a multicentre prospective randomized-controlled-trial. PARTICIPANTS: Treatment-naïve OAG or OHT patients. METHODS: Patients randomized to SLT or topical medication and treated to pre-defined target IOPs requiring ≥20% IOP reduction from baseline for all disease severity levels. OUTCOME MEASURES: Initial ("early") absolute IOP-lowering at 2-months. Achievement of "drop-free disease-control": meeting target IOP without disease progression or need for additional topical medication over 36-months following SLT. Predictors of early absolute IOP-lowering and drop-free "disease-control" after single initial SLT. Frequency of laser-related complications. RESULTS: 611 eyes (195 OHT & 416 OAG) of 355 patients received SLT and 622 eyes (185 OHT & 437 OAG) of 362 patients received topical medication at baseline. Early absolute IOP-lowering following SLT was no different between OHT and OAG eyes (adjusted mean difference = -0.05mmHg; 95% confidence interval (CI) -0.6 to 0.5mmHg; p=0.85). No difference was noted in early absolute IOP-lowering between topical medication and primary SLT (adjusted mean difference = -0.1mmHg; 95% CI, -0.6 to 0.4mmHg; p=0.67). Early absolute IOP-lowering with primary SLT was positively associated with baseline IOP (Coefficient 0.59; 95% CI, 0.54 to 0.64; p<0.001) and negatively with female gender (Coefficient -0.63; 95% CI, -1.23 to -0.02; p=0.04). At 36-months, 536 eyes (87.7% of 611 eyes) of 314 patients (88.5% of 355 patients) were available for analysis. 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free "disease-control" at 36-months; 58.2% (312 eyes) following single SLT. Total SLT power and 2-month IOP were predictors of drop-free "disease-control" at 36-months following single SLT. 6 eyes of 6 patients experienced immediate post-laser IOP spike (>5mmHg from pre-treatment IOP) with 1 eye requiring treatment. CONCLUSION: Primary SLT achieved comparable early absolute IOP-lowering in OHT vs OAG eyes. Drop-free "disease-control" was achieved in ∼75% eyes at 36-months following 1 or 2 SLTs; the majority of these following single SLT. These analyses are exploratory, but support primary SLT to be effective and safe in treatment-naïve OAG and OHT eyes.

Type: Article
Title: Primary Selective Laser Trabeculoplasty for Open Angle Glaucoma and Ocular Hypertension: Clinical Outcomes, Predictors of Success and Safety from the Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ophtha.2019.04.012
Publisher version: https://doi.org/10.1016/j.ophtha.2019.04.012
Language: English
Additional information: This is an Open Access article published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence (https://creativecommons.org/licenses/by-nc-nd/4.0/).
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Applied Health Research
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Statistical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10074112
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