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Clinical outcomes following selective laser trabeculoplasty in Afro-Caribbean patients with glaucoma at high risk for progression
  1. Tony Realini1,
  2. Hazel Shillingford-Ricketts2,
  3. Darra Burt3,
  4. Goundappa K Balasubramani4
  1. 1Ophthalmology and Visual Sciences, School of Medicine, Morgantown, West Virginia, USA
  2. 2Harlsbro Medical Center, Roseau, Dominica
  3. 3Saint Lucia Blind Welfare Association, Castries, Saint Lucia
  4. 4Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Tony Realini, Ophthalmology, West Virginia University Health Sciences Center, Morgantown, WV 26506, USA; realinia{at}wvumedicine.org

Abstract

Aim To characterise clinical outcomes following selective laser trabeculoplasty (SLT) in eyes of Afro-Caribbean patients with open-angle glaucoma (OAG) at high risk for progression.

Methods In a prospective interventional case series, patients meeting high-risk criteria (advanced disease, unilateral glaucoma blindness, inadequate intraocular pressure (IOP) on >2 medications, recent progression on medications, inability to administer, afford or tolerate medications) underwent bilateral 360° SLT and managed based on their subsequent clinical course. Patient-specific indications for SLT—IOP reduction (IOP group) or reduced reliance on medical therapy (MED group)—were recorded before treatment. IOP and medication use were recorded every 3–4 months through up to 24 months of follow-up. Outcomes were analysed separately in the IOP and MED groups.

Results Among 33 right eyes (left eye outcomes were similar) in the IOP group, mean (SD) IOP was significantly reduced from 21.7 (7.5) mm Hg to 16.2–17.1 mm Hg over follow-up (p<0.0177); medication use remained unchanged (p>0.05) at all time points. Among 36 right eyes in the MED group, mean medication use was 1.9 (0.9) at baseline and ranged from 1.2 to 1.4 medications per eye through follow-up (p<0.0033), and mean IOP was significantly reduced at months 1–6 (to 13.1 (2.3) mm Hg, p=0.0013), months 13–18 (to 14.3 (2.8), p=0.0136) and unchanged at other time points. No vision-threatening adverse events occurred.

Conclusions Afro-Caribbean patients with OAG at risk for progression can achieve clinically and statistically significant reductions in IOP or medications through up to 24 months following a single 360° SLT treatment.

Trial registration number NCT02375009.

  • glaucoma
  • treatment lasers
  • intraocular pressure

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors TR and GKB designed the study and analyzed data; TR, HS-R, and DB collected data; all authors made qualifying contributions to this work.

  • Funding Funding for this work was provided by the National Eye Institute of the National Institutes of Health (R01EY023620 (TR)).

  • Competing interests TR: Personal fees from Aerie, Allergan, Asclepix, iStar Medical, New World Medical, Nicox, Notal, Ocular Therapeutix and Sight Sciences. GKB: Personal fees from New World Medical.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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