Effect of Anti-Inflammatory Regimen on Selective Laser Trabeculoplasty Outcomes: A Randomized Controlled Trial

Patients in the prednisolone acetate 1% group post-SLT had higher treatment success rates comparing with other anti-inflammatory drugs.

To investigate the effect of different anti-inflammatory regimens on selective laser trabeculoplasty (SLT) outcomes.

A prospective randomized controlled trial. We included newly diagnosed primary open angle glaucoma (POAG) patients that underwent a primary SLT session. Patients were randomly divided into 3 groups (prednisolone acetate 1%, prednisolone acetate 0.12%, and ketorolac tromethamine 0.5%). After SLT, intraocular pressure (IOP) data were collected at different time points: days 7 and 30, and at 3, 6, and 12 months post-SLT. The main outcome measure was the comparison of success rates (Kaplan-Meier survival analysis) between groups (log-rank test).

We included a total of 134 eyes from 134 newly diagnosed POAG patients (mean age: 62.64±13.86 y) with a mean follow-up of 287±104 days. We observed a significant IOP reduction following SLT treatment in all groups at 12 months (baseline IOP 19.57±3.78 vs. final IOP: 14.39±2.29 mm Hg, P <0.001). Patients in the acetate prednisolone 1% group presented higher survival rates (83.7%) comparing with the other groups (prednisolone acetate 0.12%=63.9%; ketorolac tromethamine 0.5%=67.0%) at 12 months ( P =0.003). Patients in the acetate prednisolone 1% group had higher chances of treatment success [hazard ratio (HR) 0.30; 95% CI: 0.13-0.68, P =0.004], as well as younger patients (HR: 1.03; 95% CI: 1.00-1.05, P =0.005) and those with higher baseline IOP (HR: 0.78; 95% CI: 0.72-0.85 P <0.001). In the multivariable analysis, patients in the acetate prednisolone 1% group remained with higher chances of treatment success (HR: 0.37; 95% CI: 0.15-0.91, P =0.031). No sight-threatening adverse events was reported during follow-up in all groups.

In summary, when evaluating the effect of different anti-inflammatory regimens on SLT outcomes in newly diagnosed POAG patients, we found higher success rates in patients treated with prednisolone acetate 1% after SLT. In addition, higher baseline IOP appears to positively influence postoperative outcomes.