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).
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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.
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