A Study of Selective Laser Trabeculoplasty as Adjunctive Treatment in Patients Affected by Open Angle Glaucoma for Control of Intraocular Pressure in Indian Eyes

Background: Prospective Interventional Pilot study of selective laser trabeculoplasty as adjunctive treatment in patients affected by open angle glaucoma for control of intraocular pressure in Indian eyes.

Methods: This prospective Interventional pilot study included 29 eyes of 29 patients affected by open angle glaucoma, were treated with Selective laser trabeculoplasty (360 degree trabecular meshwork treated with 100 spots) for IOP control between January 2011 to December 2011. Of these 29 patients, 24 were males, 5 were females. Mean age was 58.96±18.19 years. Primary open Angle Glaucoma was diagnosed in 22 patients, Secondary Open Angle Glaucoma in 6, and Juvenile Open Angle Glaucoma in 1 patient. All patients underwent complete ophthalmic evaluation before SLT and at each follow up. This evaluation included visual acuity, IOP (GAT), slit lamp examination with 90D. The gonioscopy and visual field analysis was done at 6 &12 months. The IOP was measured on day 1, day 7, 1 month, 3 month, 6 month and at 1 year post SLT On GAT.

Results: Main outcome measure was lowering of intraocular pressure on Goldmann Applanation Tonometry. The mean IOP Pre SLT (Selective Laser Trabeculoplasty) was 24.62±6.38, IOP was reduced to 14.20±4.10 mmHg on Day 1 (42.32% reduction), on day 7 it was 15.96±4.731 mmHg (35.17% reduction), at 1 month it was 17.27±4.77 mmHg (29.82% reduction), at 3 months it was 19.41±4.40 mmHg (21.10% reduction), at 6 months it was 16.93±4.03 mmHg (31.23% reduction) and at 1 year it was 16.47±4.04 mmHg (31.3% reduction). After 3 months of follow up, 6 eyes out of 29 eyes, required Trabeculectomy with mitomycin C, for inadequate IOP control post SLT. These patients were considered as failures. In 2 patients topical medications decreased following SLT, remaining patients continued on same antiglaucoma medications. At follow up of 3 months 22 eyes (75.86%) out of 29 eyes maintained atleast 20% reduction from baseline IOP (Pre SLT IOP). At 6 months and 1 year of follow up 22 eyes out of 23 (95.65%), maintained atleast 20% reduction from baseline IOP (Pre SLT IOP). None of our patient had any complication or side effect following SLT.

Conclusion: Selective laser trabeculoplasty is effective and safe as a secondary/adjunctive treatment for lowering IOP in patients of open angle glaucoma not adequately controlled with medical therapy in Indian eyes. SLT has good compliance and affordability.