Adjunctive micropulse laser trabeculoplasty : analysis of treatment efficacy based on disease stage

Abstract EN

Objectives: To determine (a) the efficacy and safety of micropulse laser trabeculoplasty (MLT) as an adjunctive therapy in patients with medically uncontrolled mild, moderate, and severe primary open angle glaucoma (POAG) and (b) the influence of ocular and systemic characteristics on MLT outcomes.

Methods: One hundred and twenty consecutive patients who received MLT between April 2015 and November 2017 were reviewed in this retrospective study.

One eye was randomly selected per patient.

Variables collected included: age, sex, race, cup-to-disc ratio (C/D), complications, additional glaucoma treatments, and intraocular pressure (IOP).

Success was defined as ≥10% reduction of IOP or final pressure of ≤18 mmHg, whichever was lower, at one year.

Failure was defined as not meeting IOP goals or requiring additional laser or surgical glaucoma treatments.

Statistical analyses included Chi-square, one-way ANOVA, and Univariate and multivariate binary logistic regression.

Results: Average IOP reduction for all patients at one-year post-MLT (n=55, 46%) was 11.15%, while reduction in those with mild moderate and severe glaucoma was 9.53%, 15.93%, and 7.63% respectively (p<0.05).

At one year, MLT was successful in forty (43.0%) patients.

Four cases (3.3%) had transient IOP spikes between 5 and 10 mmHg while two (1.7%) reported pain.

Variables found to be significantly correlated with failure were higher pre-op: IOP (OR=0.866), number of medications (OR=0.077), and C/D ratio (OR=0.086).

Conclusion: Our study found adjunctive MLT to be an efficacious and safe treatment in patients with POAG who were not adequately controlled.

Patients with mild to moderate glaucoma responded better to MLT than those with severe glaucoma.

Systemic patient characteristics did not appear to affect outcomes.