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Effect of Apraclonidine and Diclofenac on Early Changes in Intraocular Pressure After Selective Laser Trabeculoplasty
摘要： Précis: Adjuvant diclofenac and apraclonidine eye drop given in conjunction with selective laser trabeculoplasty (SLT) do not significantly impact medium-term intraocular pressure (IOP) reduction compared with placebo, but apraclonidine can be used to blunt immediate postlaser pressure spikes. Purpose: There is limited high-grade evidence guiding the choice of eye drops given before and after SLT. The authors chose to measure IOP during the first 24 hours, at 1 week, 6 weeks, and 6 months after SLT, and compare the effect of apraclonidine before SLT and diclofenac after SLT, with placebo. Materials and Methods: In this double-blind, randomized, placebo-controlled trial, patients with open-angle glaucoma or ocular hypertension referred for SLT were recruited between 2016 and 2018. Patients were randomized to receive either apraclonidine pre-SLT with placebo post-SLT, placebo pre-SLT with diclofenac post-SLT, or placebo before and after SLT. Results: Sixty eyes from 35 patients were treated with 360-degree SLT. Twenty-four-hour IOP measurements with patient self-monitoring after SLT demonstrated a moderate IOP spike at 1 hour and 2 hours post-SLT in the placebo and diclofenac study arms (mean = +4.05 ± 0.58 mm Hg and +4.47 ± 0.73, respectively, P < 0.001 vs. pre-SLT IOP), which was prevented by apraclonidine (mean = ?2.41 ± 0.88 mm Hg, P < 0.0001 vs. other study arms post-SLT). There were no significant differences between the 3 arms of the study on the long-term IOP reduction achieved by SLT (6 wk: P = 0.51, 6 mo: P = 0.42). Conclusions: Neither the use of apraclonidine before SLT nor diclofenac after SLT significantly influenced the IOP reduction induced by SLT. Except for a slight and transient reduction in intraocular inflammation, there was no beneficial effect of diclofenac on early IOP changes or the degree of patient discomfort relative to placebo.
关键词： open-angle glaucoma,non–steroidal anti-inflammatory,selective laser trabeculoplasty,intraocular pressure,ocular hypertension
更新于2025-09-23 15:21:01
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Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial
摘要： To compare visual field outcomes of ocular hypertensive and glaucoma patients treated with Medicine-1st against those treated with selective laser trabeculoplasty (SLT, Laser-1st). Secondary analysis of patients from Laser in Glaucoma and Ocular Hypertension (LiGHT), a multicentre randomised controlled trial. 344 patients (588 eyes) treated with Medicine-1st, 344 patients (590 eyes) treated with Laser-1st. Visual fields (VFs) were measured using standard automated perimetry and arranged in series (median length and duration: 9 VFs over 48 months). Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Proportions of points and patients in each treatment group with fast (< -1 dB/y) or moderate (< -0.5 dB/y) progression were compared using log-binomial regression. Pointwise and global progression rates of total deviation (TD) and pattern deviation (PD). A greater proportion of eyes underwent moderate or fast TD progression in the Medicine-1st group compared with the Laser-1st group (26.2% vs. 16.9%; Risk Ratio, RR = 1.55 [1.23, 1.93], P < 0.001). A similar pattern was observed for pointwise rates (Medicine-1st 26.1% vs. Laser-1st 19.0%, RR = 1.37 [1.33, 1.42], P < 0.001). A greater proportion of pointwise PD rates were categorised as moderate or fast in the Medicine-1st group (Medicine-1st 11.5% vs. Laser-1st 8.3%, RR = 1.39 [1.32, 1.46], P < 0.001). There was no statistical difference in the proportion of eyes that underwent moderate or fast PD progression (Medicine-1st 9.9% vs. Laser-1st 7.1%, RR = 1.39 [0.95, 2.03], P = 0.0928). A slightly larger proportion of ocular hypertensive and glaucoma patients treated with Medicine-1st underwent rapid VF progression compared with those treated with Laser-1st.
关键词： Medicine-1st,Laser-1st,Glaucoma,Visual field,Ocular hypertension,Selective laser trabeculoplasty
更新于2025-09-23 15:21:01
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Time course of bilateral microglial activation in a mouse model of laser-induced glaucoma
摘要： Microglial activation is associated with glaucoma. In the model of unilateral laser-induced ocular hypertension (OHT), the time point at which the inflammatory process peaks remains unknown. Different time points (1, 3, 5, 8, and 15 d) were compared to analyze signs of microglial activation both in OHT and contralateral eyes. In both eyes, microglial activation was detected in all retinal layers at all time points analyzed, including: i) increase in the cell number in the outer segment photoreceptor layer and plexiform layers (only in OHT eyes) from 3 d onward; ii) increase in soma size from 1 d onward; iii) retraction of the processes from 1 d in OHT eyes and 3 d in contralateral eyes; iv) increase in the area of the retina occupied by Iba-1+ cells in the nerve fiber layer/ganglion cell layer from 1 d onward; v) increase in the number of vertical processes from 1 d in contralateral eyes and 3 d in OHT eyes. In OHT eyes at 24 h and 15 d, most Iba-1+ cells were P2RY12+ and were down-regulated at 3 and 5 d. In both eyes, microglial activation was stronger at 3 and 5 d (inflammation peaked in this model). These time points could be useful to identify factors implicated in the inflammatory process.
关键词： Microglial activation,retinal layers,glaucoma,inflammation,ocular hypertension
更新于2025-09-23 15:19:57
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Predictors of selective laser trabeculoplasty success in open angle glaucoma or ocular hypertension: does baseline tonography have a predictive role?
摘要： background The determinants of success of selective laser trabeculoplasty (SLT) in treatment- na?ve patients with open angle glaucoma (OAG) and ocular hypertension (OHT) have not been understood fully. Therefore, we have conducted this study to explore the predictors of success. Methods This is a retrospective review of a pre- existing database of patients who had received primary SLT at St Thomas’ Hospital, London, UK. Patients with OAG and OHT who had received primary 360° SLT treatment and had reliable baseline tonographic outflow facility (TOF) with minimum of 1 year of follow- up were included. Univariate and multivariate analyses were performed to find the determinants of success. results One hundred and seventy- four patients between August 2006 and February 2010 had received primary 360° SLT treatment and had baseline TOF measurement. Of these, 72 subjects fulfilled the eligibility criteria. In multivariate regression analysis, the only variable associated with success was baseline intraocular pressure (IOP) (R2=0.32, beta=?0.51, p<0.001, 95% CI ?2.02 to ?0.74). Conclusion To our knowledge, this is the only study investigating the pretreatment TOF (measured with electronic Shi?tz tonography) and IOP as determinants of success 12 month’s post-360° SLT in treatment- na?ve patients with OAG and OHT. This study demonstrated that pretreatment IOP (and not TOF) is the only determinant of success after primary SLT therapy.
关键词： selective laser trabeculoplasty,intraocular pressure,ocular hypertension,tonographic outflow facility,open angle glaucoma
更新于2025-09-19 17:13:59
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Selective laser trabeculoplasty as the primary treatment for open angle glaucoma: time for change?
摘要： Laser trabeculoplasty came to the fore more than 20 years ago when the Glaucoma Laser Trial (GLT) showed that eyes treated initially with argon laser trabeculoplasty (ALT) had lower intraocular pressure (IOP) with better visual field and optic disc status, compared with their fellow eyes initially treated with topical medication [1]. Selective laser trabeculoplasty (SLT) was then introduced in 1995, and has since largely superseded ALT, with less damage to the trabecular meshwork architecture, fewer reported adverse events and potentially better repeatability [2]. Several randomized trials have reported that SLT may provide similar IOP lowering to medical therapy in open angle glaucoma (OAG) and ocular hypertension (OHT) [3]. SLT may also be an alternative treatment option in OAG patients who cannot tolerate medications due to side effects, and unable or unwilling to undergo surgery [4]. However, SLT is currently not widely accepted as a first-line intervention in treatment-naive eyes, despite increasing evidence that it is as efficacious as a prostaglandin analog in lowering IOP for OAG and OHT [5]. The recently published results from the "LiGHT" study support the use of SLT as a primary treatment for OHT and OAG [6]. In this multicentre randomized trial conducted in the United Kingdom (UK), subjects received either initial SLT (laser-first, n = 356) or glaucoma medical therapy (medicine-first, n = 362) [6]. Majority of patients was European white (68.2%) with OHT (31.9%) or mild OAG (50.6%) [7]. Glaucoma progressed in a lower proportion of patients in the laser-first compared with the medicine-first arm (3.8% versus 5.8%). Over the course of 36 months, IOP control was also better in the laser-first arm, with a lower number of glaucoma medications required and no glaucoma surgeries. Due to the significant reduction in the cost of surgery and glaucoma medications, the laser-first approach was also cost-effective in the context of the National Health Service (NHS) in England and Wales, with overall cost savings of ￡451 per patient. However, the treatment arms did not differ significantly in the primary outcome of health-related quality of life assessed using the EQ-5D (difference, 0.012; 95% confidence interval [CI], ?0.007 to 0.031; p = 0.23) [6]. This is not surprising, given that the EQ-5D-5L is a generic questionnaire that is not the most sensitive tool to investigate vision-related quality of life [8].
关键词： open angle glaucoma,LiGHT study,primary treatment,Selective laser trabeculoplasty,ocular hypertension
更新于2025-09-19 17:13:59
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Real-World Outcomes of Selective Laser Trabeculoplasty in the UK
摘要： Objective: Selective laser trabeculoplasty (SLT) is a common treatment option for managing glaucoma and ocular hypertension. We assessed the real-world effectiveness of SLT and baseline factors associated with treatment success in the United Kingdom (UK). Design: Retrospective observational study of de-identified electronic medical records (Medisoft? Glaucoma module) from 5 UK ophthalmology teaching centers. Participants: Adult patients undergoing their first recorded SLT. For bilateral SLT (same day), analyses included one randomly selected eye. Methods: Patient demographics, procedure details and clinical outcomes data were extracted. Factors associated with treatment success were assessed using multivariable Cox regression. Main outcome measures: Change from baseline in intraocular pressure (IOP) and glaucoma medication use at 12?18 and 24?36 months post-SLT. A Kaplan-Meier survival analysis was also conducted. SLT failure was defined as any further glaucoma procedure post-SLT or any of the following at 2 consecutive visits: IOP >21 mmHg, IOP reduction <20% from baseline, or an increase in glaucoma medications from baseline. Results: 831 SLT-treated eyes (mean baseline IOP 22.0 mmHg) of 831 patients were analyzed. At 12?18 and 24?36 months post-SLT, respectively, significant reductions in IOP (?4.2 [95% CI: ?4.7 to ?3.7] and ?3.4 [95% CI: ?4.1 to ?2.7] mmHg; both P<0.0001) and significant increases in the number of glaucoma medications (0.13 [95% CI: 0.04 to 0.23], P=0.007, and 0.20 [95% CI 0.06 to 0.33], P=0.005) were observed. Survival analysis demonstrated treatment success in 70%, 45%, and 27% of eyes at 6, 12, and 24 months post-SLT, respectively. Higher baseline IOP was strongly associated with treatment success (HR 0.64 for baseline IOP >21 mmHg vs ≤21 mmHg, 95% CI: 0.53–0.76; P<0.001). SLT success was not significantly associated with age (P=0.78), baseline visual field mean deviation (P=1.00) or the concurrent use of IOP-lowering medication (P=0.52). Conclusion: Most patients initially responded to SLT, but a majority failed within 1 year. SLT efficacy was better in patients with higher baseline IOP but did not differ by glaucoma severity or by concurrent use of IOP-lowering medication. These findings may help inform which patients are suitable for SLT therapy.
关键词： Selective laser trabeculoplasty,intraocular pressure,glaucoma,real-world outcomes,ocular hypertension
更新于2025-09-12 10:27:22