Dahlgren Tobias, Ayala Marcelo, Zetterberg Madeleine
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Ophthalmology, NU Hospital Group, Uddevalla, Region Västra Götaland, Sweden.
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Region Västra Götaland, Sweden.
Ophthalmol Glaucoma. 2025 Sep 2. doi: 10.1016/j.ogla.2025.08.008.
To investigate the impact of potential predictor variables on selective laser trabeculoplasty (SLT) efficacy in the Swedish Optimal SLT (OSLT) trial.
Post hoc analysis of a multicenter, masked, randomized controlled trial.
Five hundred twelve eyes from 399 patients enrolled in the OSLT trial.
Patients were randomized to one of 4 SLT variants, differing in treatment extent (180° or 360°), and laser power (standard or high). Analyses were performed with linear mixed models, which allowed optimal use of all the data and applied comprehensive adjustment to the results. A wide selection of potential predictors for SLT efficacy were first analyzed separately regarding their association with intraocular pressure reduction (IOPR). Predictors meeting a threshold of P < 0.1 were then included in a multivariable candidate model, which was refined through manual stepwise backwards selection until only significant variables (P < 0.05) remained. Thereafter, other variables of interest were evaluated in this model.
The mean IOPR 1 to 6 months after SLT.
Selective laser trabeculoplasty performed in 360 degrees, at an energy level giving a 50% to 75% cavitation bubble frequency (the 360/high protocol) remained the most efficacious SLT variant after adjustment for predictors (P < 0.001). The coefficient estimate (CE) of 360/high SLT was 2.0; SLT performed in 360 degrees, at an energy level titrated just below the cavitation bubble threshold (360/standard) CE was 0.9; and SLT performed in 180 degrees, at an energy level giving a 50% to 75% cavitation bubble frequency (180/high) CE was -0.1, with SLT performed in 180 degrees, at an energy level titrated just below the cavitation bubble threshold (180/low) as the reference. Higher baseline IOP was a positive predictor for both absolute IOPR (CE 0.35; P < 0.001) and relative IOPR (CE 0.72; P < 0.001). A larger IOPR from the prior SLT (CE 0.18; P = 0.004), as well as IOPR in the contralateral eye (CE 0.57; P < 0.001), were also highly significant positive predictors. Conversely, the present analyses suggest that SLT efficacy is diminished by pseudoexfoliations (CE -0.69; P = 0.02), the number of prior SLTs (CE -0.54; P = 0.004), and increased corneal thickness (CE -0.01; P < 0.002). Consultants/specialists and residents achieved similar SLT results, but individual surgeon performance mattered (P = 0.003), as well as if the surgeon used the dominant hand (CE 0.35; P = 0.050). However, age, glaucoma medication, cataract surgery, anterior chamber angle pigmentation, inflammatory symptoms, or postoperative anterior chamber flare had no correlation with SLT efficacy.
The 360/high SLT protocol remained the most effective and reliable technique after adjustment for multiple predictors. No evidence was found to advise against 360/high SLT for any particular group of patients.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
在瑞典最佳选择性激光小梁成形术（OSLT）试验中，研究潜在预测变量对选择性激光小梁成形术（SLT）疗效的影响。
一项多中心、设盲、随机对照试验的事后分析。
OSLT试验中399例患者的512只眼。
患者被随机分为4种SLT术式之一，这些术式在治疗范围（180°或360°）和激光功率（标准或高）上有所不同。采用线性混合模型进行分析，该模型能最佳利用所有数据并对结果进行全面调整。首先分别分析多种潜在的SLT疗效预测因素与眼压降低（IOPR）的相关性。然后将P<0.1阈值的预测因素纳入多变量候选模型，通过手动逐步向后选择进行优化，直到仅保留显著变量（P<0.05）。此后，在该模型中评估其他感兴趣的变量。
SLT术后1至6个月的平均IOPR。
在对预测因素进行调整后，360度、能量水平使空化气泡频率达到50%至75%的SLT术式（360/高方案）仍是最有效的SLT术式（P<0.001）。360/高SLT的系数估计值（CE）为2.0；360度、能量水平略低于空化气泡阈值的SLT术式（360/标准）CE为0.9；180度、能量水平使空化气泡频率达到50%至75%的SLT术式（180/高）CE为 -0.1，以180度、能量水平略低于空化气泡阈值的SLT术式（180/低）作为对照。较高的基线眼压是绝对IOPR（CE 0.35；P<0.001）和相对IOPR（CE 0.72；P<0.001）的正向预测因素。前次SLT术后更大的IOPR（CE 0.18；P = 0.004）以及对侧眼的IOPR（CE 0.57；P<0.001）也是高度显著的正向预测因素。相反，本分析表明，假性剥脱（CE -0.69；P = 0.02）、前次SLT的次数（CE -0.54；P = 0.004）以及角膜厚度增加（CE -0.01；P<0.002）会降低SLT疗效。顾问/专家和住院医师取得的SLT结果相似，但外科医生的个人表现很重要（P = 0.003），以及外科医生是否使用优势手（CE 0.35；P = 0.050）也有影响。然而，年龄、青光眼药物治疗、白内障手术、前房角色素沉着、炎症症状或术后前房闪光与SLT疗效无关。
在对多个预测因素进行调整后，360/高SLT方案仍是最有效且可靠的技术。未发现有证据表明对任何特定患者群体不建议采用360/高SLT。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
