Quality of life in glaucoma patients after selective laser trabeculoplasty

AIM：To compare quality of life and treatment satisfaction between patients who had selective laser trabeculoplasty（SLT） and those on medication.METHODS：A prospective clinical trial on 143 glaucoma patients that received SLT and a control group that continued using anti glaucoma medication was conducted. Tear break-up time（BUT）, punctuate keratitis, need for help, use of artificial tears and the treatment satisfaction survey of intraocular pressure（IOP） were measured at baseline, 6 and 12 mo. RESULTS：SLT was able to reduce the mean number of medications needed from 1.56±0.81 to 0.42±0.66 at six months and to 0.33±0.69 at one year. Punctuate keratitis was observed significantly less often（12.24%） after SLT than before（35.94%; P=0.03）. Use of artificial tears and BUT did not change significantly after SLT（P〉0.05）. At baseline, patients in the SLT group were significantly less convinced of medication effectiveness（P=0.006） and complained more about side effects（P=0.003）. After SLT, these patients had significantly more confidence in their therapy（P〈0.001）, showed less side effects（P=0.006）, complained less about changes in appearance of the eyes（P=0.003） and were less inconvenienced by the use of eye drops（P〈0.001）.CONCLUSION：SLT is able to improve treatment-related quality of life in glaucoma patients.

Selective laser trabeculoplasty in pseudophakic and phakic eyes:a prospective study

AIM：To compare the efficacy of selective laser trabeculoplasty（SLT） in replacing medical therapy in pseudophakic and phakic eyes.METHODS：Subgroup of a prospective randomized clinical trial including patients with primary open angle glaucoma or ocular hypertension controlled with medication.Of 38 pseudophakic eyes were matched with 38 phakic eyes.SLT was offered as a way to decrease medication while maintaining the same low eye pressure.SLT was performed over 360°,at 3ns,spotsize 400 μm,100 spots.Data [intraocular pressure（IOP）,number of medications needed] were measured at 1h,1wk,1,3,6 and 12 mo.An independent-samples t-test was performed to compare baseline characteristics of the phakic and the pseudophakic group and differences in evolution of mean IOP and number of used medications.Chi-squared analysis was performed to investigate proportions of fast,slow and non-responders.RESULTS：The mean IOP measurement was 13.00± 2.88 mm Hg in the phakic group（38 eyes） and 13.51±3.06 mm Hg in the pseudophakic group（38 eyes）（P〉0.05）.This changed little after SLT and IOP lowering effect was comparable between the two groups.Main aim however was to lower the amount of medication needed.In the phakic group medication lowered from 1.29±0.62 at baseline,to 0.15±0.46 after 12mo;a reduction of 88.37%.In the pseudophakic group,used medication changed from 1.71±1.04,to 0.41±0.61;a 76.02% reduction.The differences were not statistically significant at any time point（P〉0.05）.IOP lowering occurred slightly faster in thepseudophakic group（50% of patients after one week） than in the phakic group（68% of patients after more than 4wk）.The difference was not significant（P〉0.05）.CONCLUSION：IOP lowering effect of SLT is comparable between phakic and pseudophakic eyes.

Where does selective laser trabeculoplasty stand now? A review

Background:Chronic treatment of glaucoma can present a challenge in patients who lack the means and/or the discipline to use daily glaucoma medication.We wondered if selective laser trabeculoplasty(SLT)could be a useful alternative.Methods:Inclusion criteria:controlled trials comparing efficacy of SLT in adult patients with any form of open angle glaucoma or ocular hypertension and case reports on side effects of SLT.Two recent meta-analyses identified eight randomized clinical trials(RCTs)comparing the effect of SLT with medication(prostaglandin analogs)and with argon laser trabeculoplasty(ALT).We took these eight RCTs as reference base and calculated their success rates where they were not given.Other articles were added to elaborate on technique and side effects.Results:Mean intraocular pressure(IOP)reduction after SLT was 3.8–8.0 mmHg after 6 months to 1 year.Mean success rate of SLT at 6 months to 1 year is 55–82%.Higher IOP before laser predicts a higher IOP-lowering effect.In terms of mean IOP reduction,reduction in number of medications and treatment success,the effect of SLT was found to show no clinically relevant difference from that of contemporary medication(prostaglandin analogs)and from ALT.Conclusions:The evidence indicates that SLT is an efficacious primary or adjunctive therapy for treating glaucoma.