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Long-term follow-up of laser trabeculoplasty in multi-treated glaucoma patients
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.ORCID iD: 0000-0002-4102-2455
Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.ORCID iD: 0000-0002-3597-4740
Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden.
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2024 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 102, no 2, p. 179-185Article in journal (Refereed) Published
Abstract [en]

Purpose: To evaluate the long-term effect of laser trabeculoplasty (LTP) in patients randomized to multi-treatment in the Glaucoma Intensive Treatment Study (GITS).

Methods: Patients with untreated newly diagnosed open-angle glaucoma were treated with three intraocular pressure (IOP)-lowering substances for 1 week and then 360 degrees argon or selective LTP was performed. IOP was measured just before LTP and repeatedly during the 60-month study period. Our previous report on 12 months follow-up data revealed no effect of LTP in eyes having an IOP <15 mmHg before the laser treatment.

Results: Before LTP, the mean IOP +/- standard deviation in all 152 study-eyes of 122 multi-treated patients was 14.0 +/- 3.5 mmHg. Three eyes of three deceased patients were lost to follow-up during the 60 months. After exclusion of eyes that received increased therapy during follow-up, the IOP was significantly reduced at all visits up to 48 months in eyes with pre-LTP IOP >= 15 mmHg; 2.6 +/- 3.1 mmHg at 1 month and 1.7 +/- 2.8 mmHg at 48 months, n = 56 and 48, respectively. No significant IOP reduction was seen in eyes with pre-LTP IOP <15 mmHg. Seven eyes, i.e., <13%, with pre-LTP IOP >= 15 mmHg at baseline had required increased IOP-lowering therapy at 48 months.

Conclusion: LTP performed in multi-treated patients may provide a useful IOP reduction that is maintained over several years. This was true on a group level when the initial IOP was >= 15 mmHg, but if the pre-laser IOP was lower than that, chances of LTP success were small.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024. Vol. 102, no 2, p. 179-185
Keywords [en]
ALT, intraocular pressure, laser trabeculoplasty, long-term follow-up, multi-therapy, open-angle glaucoma, pseudoexfoliation glaucoma, SLT
National Category
Clinical Medicine Ophthalmology
Identifiers
URN: urn:nbn:se:umu:diva-206002DOI: 10.1111/aos.15718ISI: 001001069900001PubMedID: 37278271Scopus ID: 2-s2.0-85161487517OAI: oai:DiVA.org:umu-206002DiVA, id: diva2:1745997
Funder
Kronprinsessan Margaretas MinnesfondUmeå UniversityLund UniversityEye FoundationKonung Gustaf V:s och Drottning Victorias FrimurarestiftelseThe Swedish Medical AssociationSwedish Society for Medical Research (SSMF)Västerbotten County Council
Note

Originally included in thesis in manuscript form.

Available from: 2023-03-27 Created: 2023-03-27 Last updated: 2024-05-06Bibliographically approved
In thesis
1. Laser treatment in glaucoma: efficacy and safety
Open this publication in new window or tab >>Laser treatment in glaucoma: efficacy and safety
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Glaucoma is a progressive optic neuropathy and the major cause of irreversible blindness worldwide. Although the pathogenesis of glaucoma is not completely understood, the most important risk factor for development and progression of the disease is an elevated intraocular pressure (IOP). Current glaucoma treatment aims to reduce the IOP in the affected eye. This can be achieved by topical drops, laser therapy or surgery. Laser treatment is used at different stages of the glaucoma disease. Some types of laser procedures are used as first-line treatments or as complement to topical medications or surgery, while other types are used in advanced glaucoma as a last option when other therapies have failed. Although laser therapy has long been used to reduce the IOP in glaucoma, knowledge gaps remain. The aim of this thesis was to evaluate the efficacy and safety, in both a short- and long-term perspective, of two of the most frequently used laser procedures in glaucoma: laser trabeculoplasty (LTP) and transscleral cyclophotocoagulation (TCP).

In the first study, a retrospective analysis, the long-term efficacy and safety of TCP was evaluated in 300 eyes of 300 glaucoma patients in northern Sweden. We found an overall substantial IOP reduction of more than 10 mmHg that was maintained at least 2 years in various types of glaucoma. Following TCP, the patients could reduce their treatment with an average of one substance of topical glaucoma medication in the treated eye. No case of phthisis bulbi, the most feared complication of TCP, was reported. However, a general decline in visual acuity (VA) was noted during the two-year follow up period, and the cause of this finding was difficult to assess due to the retrospective nature of the study.

The short-term effect of TCP on IOP was further investigated in a prospective study of 58 eyes of 58 glaucoma patients. IOP was measured at baseline before TCP and at five additional time-points up to 24 hours after the treatment. The VA was measured before TCP and at the 24 h examination. The results showed a transient IOP spike with a peak at six hours after TCP in approximately 40% of the eyes. Spikes were more common in eyes with pseudoexfoliation glaucoma.

The last two studies of the thesis focused on the short- and long-term efficacy of LTP. One-hundred fifty-two eyes of 122 newly diagnosed glaucoma patients that had been randomized to the multi-treated arm in the Glaucoma Intensive Treatment Study (GITS) were included. All studied eyes were treated with three different IOP-lowering substances and after one week, LTP was performed. We demonstrated that there was an additional IOP-lowering effect of LTP but that this effect was strongly associated with the level of IOP before the laser, where a higher IOP pre-LTP yielded a greater IOP reduction. Eyes with pre-laser IOP ³15 mmHg showed a significant IOP reduction that was maintained during four years of follow-up. However, in eyes with pre-LTP IOP <15 mmHg, the effect of laser treatment was limited.

In summary, this thesis investigated the efficacy and safety of TCP both retrospectively in a longer perspective and prospectively during the first 24 hours after treatment. An overall high efficacy without serious complications was shown, but a possible decline in VA must be considered in the long run. Furthermore, the risk of IOP spikes after TCP implies that additional IOP-lowering treatment should be considered during the first 24 hours, especially in eyes with pseudoexfoliation glaucoma or severe glaucoma damage. Finally, LTP may provide a valuable long-lasting IOP-lowering effect despite medical multi-treatment in eyes with a pre-LTP IOP ³15 mmHg.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2023. p. 60
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2239
Keywords
glaucoma, laser treatment, intraocular pressure, glaucoma treatment, glaukom, laserbehandling, ögontryck, glaukombehandling
National Category
Ophthalmology
Research subject
ophthalmology; ophthalmology
Identifiers
urn:nbn:se:umu:diva-206004 (URN)978-91-8070-013-9 (ISBN)978-91-8070-012-2 (ISBN)
Public defence
2023-04-21, Umeälven, Målpunkt ZA-21, Psykiatrihuset, NUS, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Umeå UniversityKronprinsessan Margaretas MinnesfondEye Foundation
Available from: 2023-03-31 Created: 2023-03-27 Last updated: 2023-03-28Bibliographically approved

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