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Long-Term Outcomes of Selective Laser Trabeculoplasty on Intraocular Pressure Control and Visual Field Progression
Kwanghyun Lee1, Esteban Morales2, Joseph Caprioli2
1From the Glaucoma Division (K.L., E.M., J.C.), David Geffen School of Medicine, Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (K.L.), National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea.
Purpose:
To evaluate the long-term outcomes of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) control and visual field (VF) progression, and to identify factors associated with them.
Design:
Retrospective case-control study.
Subjects, Participants, And/Or Controls:
A total of 500 eyes from 500 patients who underwent SLT between 2002 and 2021, with a mean follow-up of 9.6 years. Inclusion required at least 5 years of follow-up and 4 reliable perimetry examinations for VF analysis.
Methods:
Kaplan-Meier survival analysis and multivariable Cox regression were used to evaluate time to treatment failure, defined as failure to achieve ≥20% IOP reduction or IOP ≥21 mmHg, need for medication escalation, or additional glaucoma surgery. Multivariable logistic regression was used to identify predictors of VF progression, defined by concordant progression on at least 2 of 3 methods (mean deviation slope, pointwise linear regression, and glaucoma rate index) at 5 years after SLT.
Main Outcome Measures:
Time to IOP-based treatment failure and VF progression at 5 years after SLT.
Results:
Median time to failure was 4.6 years for initial SLT and 2.7 years for repeat SLT. In multivariable analysis, repeat SLT (HR 1.49, P = .008), prior glaucoma surgery (HR 2.33, P < .001), asthma (HR 1.40, P = .032), and moderate-to-advanced glaucoma (HR 1.54, P < .001) were associated with a higher risk of failure, whereas higher energy intensity was associated with a lower risk (HR 0.91, P < .001). Among 302 eyes with sufficient VF data, VF progression at 5 years was associated with pre-SLT medications (OR 1.57, P = .006), higher energy intensity (OR 1.48, P = .004), and lower central corneal thickness (OR 0.90, P = .028).
Conclusions:
Outcomes were less favorable in eyes undergoing repeat SLT, with asthma, prior glaucoma surgery, more advanced disease, or lower laser energy intensity. Higher pre-SLT medication burden and lower corneal thickness were associated with a greater risk of VF progression. These findings identify clinical and treatment-related factors associated with long-term SLT outcomes and may help inform patient selection and post-SLT monitoring.
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