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

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

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...

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Main Authors: Tomoko Naito, Kazuyuki Hirooka, Toru Nakazawa, Masaki Tanito, Shiro Mizoue, Katsuyoshi Suzuki, Keiji Yoshikawa, Itaru Kimura, Yasushi Ikuno, Takako Miki, Kazuhisa Sugiyama, Tairo Kimura, Akiko Narita, Tadashi Nakano, Tomoyuki Watanabe, Koji Nitta, Kae Sugihara, Maki Katai, Takuji Matsuda, Hiroaki Ozaki, Kaori Komatsu, Yoshiaki Saito, Takeshi Sagara, Aika Tsutsui, Akiko Ishida, Satoru Tsuda, Toyoaki Tsumura, Naoki Tojo, Naoto Tokuda, Kenji Nakamoto, Naka Shiratori, Mami Nanno, Naoya Nezu, Yoshitaka Tasaka, Shigeru Mori, Shigeki Yamabayashi, Kimihito Konno, Miyuki Domoto
Format: Article
Language:English
Published: BMJ Publishing Group 2024-08-01
Series:BMJ Open Ophthalmology
Online Access:https://bmjophth.bmj.com/content/9/1/e001563.full
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Summary: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).
ISSN:2397-3269

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