Selective laser trabeculoplasty for anti-VEGF associated intraocular pressure elevation in steroid-naïve eyes

Selective Laser Trabeculoplasty (SLT) is utilized in cases of primary and certain secondary open-angle glaucoma to decrease intraocular pressure (IOP). SLT effectiveness has been demonstrated in patients with increased IOP secondary to intraocular steroids. In addition to intravitreal steroids, intravitreal anti-vascular endothelial growth factor (VEGF) injections are commonly used in patients with diabetic retinopathy and age-related macular degeneration. Some patients receiving anti-VEGF injections experience increases in IOP. No studies have evaluated the effectiveness of SLT for anti-VEGF-associated glaucoma.

This was a retrospective, single-center study. Anti-VEGF-associated IOP increase was defined as an eye receiving at least one anti-VEGF intravitreal injection prior to SLT. IOP and the number of pressure-lowering drops were measured at 3-, 6-, 9-, and 12-month post-SLT follow-up appointments. Outcomes included changes in IOP, and the number of IOP-lowering drops prescribed.

Twenty-three eyes from 18 patients were included in this study. The IOP was 18.26 ± 3.33 with 2.6 ± 1. drops prescribed at baseline. Two eyes required repeat SLT. Over the study period, IOP was reduced by 3 to 4.5 mm Hg, with all p-values <0.001. Eight eyes in the study were drop-naïve (no IOP-lowering drops prescribed prior to SLT). Of these, 6/8 (75%) remained drop-free at the end of the observation period. At their final clinic visit, 78.3% of patients were controlled on SLT without further surgical or medical intervention.

To the best of our knowledge, this is the first study to demonstrate the long-term effectiveness of SLT in anti-VEGF-associated open-angle glaucoma in steroid-naïve eyes.