Ophthalmology. Glaucoma · 2025
Predictors of Selective Laser Trabeculoplasty Efficacy: Results from the Swedish Optimal Selective Laser Trabeculoplasty Multicenter Randomized Controlled Trial.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Dahlgren Tobias, Ayala Marcelo, Zetterberg Madeleine
Аннотация
PURPOSE: To investigate the impact of potential predictor variables on selective laser trabeculoplasty (SLT) efficacy in the Swedish Optimal SLT (OSLT) trial.
DESIGN: Post hoc analysis of a multicenter, masked, randomized controlled trial.
SUBJECTS: Five hundred twelve eyes from 399 patients enrolled in the OSLT trial.
METHODS: 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.
MAIN OUTCOME MEASURES: The mean IOPR 1 to 6 months after SLT.
RESULTS: 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.
CONCLUSIONS: 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.
DESIGN: Post hoc analysis of a multicenter, masked, randomized controlled trial.
SUBJECTS: Five hundred twelve eyes from 399 patients enrolled in the OSLT trial.
METHODS: 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.
MAIN OUTCOME MEASURES: The mean IOPR 1 to 6 months after SLT.
RESULTS: 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.
CONCLUSIONS: 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.