Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma
iStent implantation is thought to augment the trabecular outflow channel in the anterior segment of the eye. We hypothesized that iStent with subsequent selective laser trabeculoplasty (SLT) would better control the intraocular pressure (IOP) compared to standalone SLT in patients with primary open-...
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doaj-c5d05596f904493a92228e88a09e1ab82021-08-26T13:58:01ZengMDPI AGJournal of Personalized Medicine2075-44262021-08-011179779710.3390/jpm11080797Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle GlaucomaAdam R Siedlecki0Patrice M Hicks1Benjamin Haaland2Margaret M DeAngelis3Sandra F Sieminski4Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14214, USADepartment of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USADepartment of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84108, USADepartment of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14214, USADepartment of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Engineering, SUNY-University at Buffalo, Buffalo, NY 14214, USAiStent implantation is thought to augment the trabecular outflow channel in the anterior segment of the eye. We hypothesized that iStent with subsequent selective laser trabeculoplasty (SLT) would better control the intraocular pressure (IOP) compared to standalone SLT in patients with primary open-angle glaucoma (POAG). We, therefore, determined if the presence of an iStent combined with SLT was statistically associated with IOP lowering compared to standalone SLT. Through retrospective electronic medical record review, records of 824 eyes from 440 patients who received primary SLT without a history of iStent were considered. Additionally, 42 eyes from 28 patients who received SLT after combined phacoemulsification and iStent implantation that failed to control intraocular pressure (IOP) and/or the progression of the disease were retrospectively reviewed. IOP and number of medications, which were tracked in each patient for up to 12 months post laser, were also examined. Successful outcome was defined as a statistically significant reduction in IOP or number of medications at 6 months. As defined in univariate analysis <i>(p</i> ≤ 0.01), multivariate analysis included iStent, age, sex, race, and initial IOP as variables. IOP reduction was statistically associated with patients pre-SLT IOP (<i>p</i> < 0.001) but not with patients with iStent (<i>p</i> = 0.222). Medication reduction was statistically associated with the pre-SLT number of medications (<i>p</i> < 0.001) and iStent (<i>p</i> < 0.001). In eyes that received SLT, iStent was not statistically associated with a greater reduction in IOP compared to controls, but was associated with a higher reduction in the overall number of medications used 6 months after receiving SLT. The work presented should guide clinicians to consider SLT as an effective therapy after iStent implantation, in terms of glaucoma medication reduction in iStent patients, but clinicians should know that the presence of an iStent does not necessarily make subsequent SLT more effective at lowering IOP.https://www.mdpi.com/2075-4426/11/8/797glaucomaiStentSLT |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Adam R Siedlecki Patrice M Hicks Benjamin Haaland Margaret M DeAngelis Sandra F Sieminski |
spellingShingle |
Adam R Siedlecki Patrice M Hicks Benjamin Haaland Margaret M DeAngelis Sandra F Sieminski Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma Journal of Personalized Medicine glaucoma iStent SLT |
author_facet |
Adam R Siedlecki Patrice M Hicks Benjamin Haaland Margaret M DeAngelis Sandra F Sieminski |
author_sort |
Adam R Siedlecki |
title |
Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma |
title_short |
Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma |
title_full |
Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma |
title_fullStr |
Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma |
title_full_unstemmed |
Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma |
title_sort |
efficacy of selective laser trabeculoplasty after istent implantation in primary open-angle glaucoma |
publisher |
MDPI AG |
series |
Journal of Personalized Medicine |
issn |
2075-4426 |
publishDate |
2021-08-01 |
description |
iStent implantation is thought to augment the trabecular outflow channel in the anterior segment of the eye. We hypothesized that iStent with subsequent selective laser trabeculoplasty (SLT) would better control the intraocular pressure (IOP) compared to standalone SLT in patients with primary open-angle glaucoma (POAG). We, therefore, determined if the presence of an iStent combined with SLT was statistically associated with IOP lowering compared to standalone SLT. Through retrospective electronic medical record review, records of 824 eyes from 440 patients who received primary SLT without a history of iStent were considered. Additionally, 42 eyes from 28 patients who received SLT after combined phacoemulsification and iStent implantation that failed to control intraocular pressure (IOP) and/or the progression of the disease were retrospectively reviewed. IOP and number of medications, which were tracked in each patient for up to 12 months post laser, were also examined. Successful outcome was defined as a statistically significant reduction in IOP or number of medications at 6 months. As defined in univariate analysis <i>(p</i> ≤ 0.01), multivariate analysis included iStent, age, sex, race, and initial IOP as variables. IOP reduction was statistically associated with patients pre-SLT IOP (<i>p</i> < 0.001) but not with patients with iStent (<i>p</i> = 0.222). Medication reduction was statistically associated with the pre-SLT number of medications (<i>p</i> < 0.001) and iStent (<i>p</i> < 0.001). In eyes that received SLT, iStent was not statistically associated with a greater reduction in IOP compared to controls, but was associated with a higher reduction in the overall number of medications used 6 months after receiving SLT. The work presented should guide clinicians to consider SLT as an effective therapy after iStent implantation, in terms of glaucoma medication reduction in iStent patients, but clinicians should know that the presence of an iStent does not necessarily make subsequent SLT more effective at lowering IOP. |
topic |
glaucoma iStent SLT |
url |
https://www.mdpi.com/2075-4426/11/8/797 |
work_keys_str_mv |
AT adamrsiedlecki efficacyofselectivelasertrabeculoplastyafteristentimplantationinprimaryopenangleglaucoma AT patricemhicks efficacyofselectivelasertrabeculoplastyafteristentimplantationinprimaryopenangleglaucoma AT benjaminhaaland efficacyofselectivelasertrabeculoplastyafteristentimplantationinprimaryopenangleglaucoma AT margaretmdeangelis efficacyofselectivelasertrabeculoplastyafteristentimplantationinprimaryopenangleglaucoma AT sandrafsieminski efficacyofselectivelasertrabeculoplastyafteristentimplantationinprimaryopenangleglaucoma |
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1721192198323568640 |