Selective laser trabeculoplasty in steroid-induced and uveitic glaucoma.

Abstract

OBJECTIVE:

To compare primary selective laser trabeculoplasty (SLT) response in uveitic, steroid-induced, primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEX).

DESIGN:

Single-centre retrospective case-control study.

PARTICIPANTS:

Patients with uveitic glaucoma, steroid-induced glaucoma, POAG, or PEX who had their first SLT.

METHODS:

Eyes with POAG or PEX were in control groups. Eyes with steroid-induced or uveitic glaucoma were in experimental groups. Change in intraocular pressure from baseline, treatment failure, complication rates, and medication use were compared using rank-sum and log-rank tests.

RESULTS:

Six-hundred and eight eyes of 433 patients were enrolled. Steroid-induced glaucoma eyes had higher mean baseline pressure and a decrease in pressure at 3-8 weeks (27.6-17.4 mm Hg) than those with PEX (21.7-16.5 mm Hg; p < 0.001) or POAG (18.6-14.9 mm Hg; p ≤ 0.025). Failure rates after 2 years were lower in steroid-induced glaucoma (54%) than in PEX (84%; p = 0.01) or POAG (84%; p = 0.005). This survival benefit persisted when excluding patients with changes to their steroid dosing (p ≤ 0.03) but showed mixed results when compared with patients with a baseline pressure of 25mm Hg or greater (p = 0.020 vs PEX; p = 0.67 vs POAG). At 18 months, the steroid-induced group decreased ocular hypotensive medication use (3.5-1.9; p = 0.005); the uveitic group increased medication use (2.7-3.5; p = 0.02).

CONCLUSIONS:

SLT is an effective treatment for steroid-induced glaucoma, with greater response and a lower failure rate than in PEX and primary POAG, although high baseline intraocular pressure may be a confounder. Judicious use of SLT can be considered in uveitic glaucoma.

• Authors: Yujia Zhou, Christopher M Pruet, Chengbo Fang, Cheryl L Khanna
• Journal: Canadian journal of ophthalmology. Journal canadien d'ophtalmologie (Can J Ophthalmol) Vol. 57 Issue 4 Pg. 277-283 (08 2022) ISSN: 1715-3360 [Electronic] England
• PMID: 34119463 (Publication Type: Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier Inc.

Chemical References

• Steroids

Topics

• Case-Control Studies
• Glaucoma (chemically induced, surgery)
• Glaucoma, Open-Angle (chemically induced, diagnosis, surgery)
• Humans
• Intraocular Pressure
• Laser Therapy (methods)
• Lasers
• Retrospective Studies
• Steroids (adverse effects)
• Trabeculectomy (methods)
• Treatment Outcome