SAFELY DELAYING SURGICAL INTERVENTION IN PRE-SURGICAL PRIMARY OPEN ANGLE GLAUCOMA

Selective laser trabeculoplasty (SLT) has been widely used as both a primary and adjunct treatment in glaucoma. We evaluated the safety of SLT as a temporary alternative to delay surgical intervention in pre-surgical primary open angle glaucoma (POAG).

This retrospective study was conducted at the ophthalmology department of New Cross Hospital, Wolverhampton.

This study included 104 patients who had a diagnosis of POAG and received SLT treatment, with at least 1 year follow-up. Primary outcomes included: reduction in intraocular pressure (IOP), and number of glaucoma medications (NGM). The endpoint was defined as time to be listed for glaucoma surgery. All eyes that had progressive or advanced visual fields and were on 2 or more medications were included. Eyes with previous glaucoma filtration surgery or argon laser trabeculoplasty, diagnosed with normal tension glaucoma or that had significant angle closure disease (peripheral anterior synechiae >180) were excluded.

The IOP reduction was 3.7 ± 5.8 mmHg (14.5%, p<0.01) at 12 months follow-up, 3.4 ± 4.7 mmHg (15.5%, p<0.01) at 24 months follow-up, 3.7 ± 5.2mmHg (15.2%, p<0.01) at 36 months follow-up and 2.5 ± 5.9 mmHg (10.1%, p=0.04) at 48 months follow-up. No surgical intervention was needed in 96.1% (100/104) of eyes within the first year of SLT, 87.5% (84/96) of eyes within the first 2 years, and 82% (73/88) of eyes within the first 3 years.

With the current limitation of surgical capacities of eye hospitals especially following the Covid-19 pandemic, SLT can safely delay the need for glaucoma surgery for at least 3 years in more than 80% of POAG patients. This is particularly useful in elderly patients or those poorly compliant to medical therapy. In addition, this could increase ophthalmology clinic capacity by reducing the number of post-operative follow ups.