Swain David L, Eliassi-Rad Babak
Department of Ophthalmology, Boston University School of Medicine, Boston, MA, United States.
Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States.
Front Med (Lausanne). 2023 Jan 12;9:1039195. doi: 10.3389/fmed.2022.1039195. eCollection 2022.
Studies have shown the efficacy of selective laser trabeculoplasty (SLT) to lower intraocular pressure (IOP) as adjuvant therapy during short-term follow-up. However, few studies have assessed the long-term efficacy of SLT on preventing worsening Humphrey visual field (HVF) parameters and thinning of the retinal nerve fiber layer (RNFL) with continued medical therapy.
A retrospective chart review was conducted of 51 eyes of 39 patients with glaucoma treated with SLT at Boston Medical Center between 2012 and 2016 with 3- and 5-year follow-up. Outcome measures included IOP, visual acuity, number of glaucoma medications, number of months to subsequent surgical intervention. HVF outcome measures included mean deviation (MD) and pattern standard deviation (PSD). Optical coherence tomography (OCT) outcome measures included RNFL mean thickness, and superior and inferior thicknesses.
Twenty-five eyes received subsequent surgical intervention (mean time to intervention = 33.6 ± 20.0 months). In the eyes that did not receive another intervention, mean IOP was significantly decreased by 3.2 and 3.5 mmHg at 3- and 5-year after SLT, respectively. Mean number of glaucoma medications was significantly increased at 5-year (2.7 ± 1.6; = 0.04), compared to pre-SLT (2.0 ± 1.1). Mean HVF MD was significantly higher at 5-year (-7.64 ± 6.57 dB) compared to pre-SLT (-5.61 ± 3.90 dB). Mean PSD significantly increased at 3-year (5.30 ± 2.91 dB) and 5-year (6.84 ± 2.62 dB), compared to pre-SLT (4.63 ± 2.70 dB; = 0.04 and ≤0.01, respectively). On OCT, inferior quadrant RNFL thickness decreased significantly at 5-year (88.5 ± 19.3 μm), compared to pre-SLT (94.0 ± 23.2 μm).
Although 51% of eyes had IOP controlled at 5-year post-SLT, mean number of glaucoma medications was significantly higher. Also, there was progression of MD and PSD on HVF and inferior quadrant thinning on OCT at 5-year. We found a significant association between age at SLT and risk of subsequent surgical intervention over 5-year follow-up. Our study adds to our understanding of long-term outcomes of adjuvant SLT for glaucoma patients receiving medical therapy.
研究表明，选择性激光小梁成形术（SLT）作为辅助治疗在短期随访期间可有效降低眼压（IOP）。然而，很少有研究评估SLT在持续药物治疗情况下对预防汉弗莱视野（HVF）参数恶化和视网膜神经纤维层（RNFL）变薄的长期疗效。
对2012年至2016年在波士顿医疗中心接受SLT治疗的39例青光眼患者的51只眼睛进行回顾性图表审查，并进行3年和5年随访。观察指标包括眼压、视力、青光眼药物使用数量、至后续手术干预的月数。HVF观察指标包括平均偏差（MD）和模式标准偏差（PSD）。光学相干断层扫描（OCT）观察指标包括RNFL平均厚度以及上方和下方厚度。
25只眼睛接受了后续手术干预（平均干预时间 = 33.6 ± 20.0个月）。在未接受其他干预的眼睛中，SLT后3年和5年时平均眼压分别显著降低3.2 mmHg和3.5 mmHg。与SLT前（2.0 ± 1.1）相比，5年时青光眼药物平均使用数量显著增加（2.7 ± 1.6；P = 0.04）。与SLT前（-5.61 ± 3.90 dB）相比，5年时平均HVF MD显著更高（-7.64 ± 6.57 dB）。与SLT前（4.63 ± 2.70 dB；P分别为0.04和≤0.01）相比，3年时（5.30 ± 2.91 dB）和5年时（6.84 ± 2.62 dB）平均PSD显著增加。在OCT上，与SLT前（94.0 ± 23.2 μm）相比，5年时下方象限RNFL厚度显著降低（88.5 ± 19.3 μm）。
尽管51%的眼睛在SLT后5年眼压得到控制，但青光眼药物平均使用数量显著更高。此外，5年时HVF上MD和PSD出现进展，OCT上下方象限变薄。我们发现在5年随访期间，SLT时的年龄与后续手术干预风险之间存在显著关联。我们的研究增进了我们对接受药物治疗的青光眼患者辅助性SLT长期结果的理解。
