Selective Laser Trabeculoplasty after Failed Trabeculectomy in Open Angle Glaucoma

Abstract

Objective: To determine the efficacy of selective laser trabeculoplasty (SLT) for uncontrolled open angle glaucoma (OAG) on maximal tolerated medical therapy and with a history of previously failed trabeculectomy. Methods: This was a prospective, non-randomized, interventional case series. Participants included 22 eyes of 20 consecutive glaucoma patients with a previously failed trabeculectomy and medically uncontrolled intraocular pressure, unable or unwilling to undergo further incisional surgery. A single SLT treatment was performed over 270° to 360°, and participants were followed for a minimum of 12 months. Success was defined in two separate analyses as 1) absolute IOP reduction ≥ 3 mm Hg and 2) percentage IOP reduction of 20% or 15% without additional laser or surgical intervention. Results: The mean IOP dropped from 20.8 mm Hg to 16.3 mm Hg 12 months after SLT. The mean reduction in IOP was 19.5% or 4.5 mm Hg (95% confidence interval, 1.06-7.92, p<0.001). The cumulative success rate at 12 months (3 mmHg IOP reduction) was 16%. There was no statistically significant change in the number of medications (2.2 ± 0.8 to 2.0 ± 1.1). Conclusions: In the short- and intermediate-term, SLT had mild to moderate success in achieving lower IOP in individuals with medically uncontrolled OAG with previously failed trabeculectomy.