Effect of Anti-Inflammatory Regimen on Selective Laser Trabeculoplasty Outcomes: A Randomized Controlled Trial.

Abstract

Precis: Patients in the prednisolone acetate 1% group post-SLT had higher treatment success rates comparing to other anti-inflammatory drugs.

Purpose: To investigate the effect of different anti-inflammatory regimens on selective laser trabeculoplasty (SLT) outcomes.

Patients and methods: Prospective randomized controlled trial. We included newly diagnosed primary open angle glaucoma (POAG) patients that underwent a primary SLT session. Patients were randomly divided into 3 groups (prednisolone acetate 1%, prednisolone acetate 0.12% and ketorolac tromethamine 0.5%). After SLT, intraocular pressure (IOP) data were collected at different time points: days 7 and 30, and at 3, 6 and 12 months post-SLT. Main outcome measure was the comparison of success rates (Kaplan Meier survival analysis) between groups (log-rank test).

Results: We included a total of 134 eyes from 134 newly diagnosed POAG patients (mean age: 62.64±13.86 y) with a mean follow-up of 287±104 days. We observed a significant IOP reduction following SLT treatment in all groups at 12 months (baseline IOP 19.57±3.78 vs. final IOP: 14.39±2.29 mmHg, P<0.001). Patients in the acetate prednisolone 1% group presented higher survival rates (83.7%) comparing to the other groups (prednisolone acetate 0.12%=63.9%; ketorolac tromethamine 0.5%=67.0%) at 12 months (P=0.003). Patients in the acetate prednisolone 1% group had higher chances of treatment success (hazard ratio [HR] 0.30; 95% CI: 0.13-0.68, P=0.004), as well as younger patients (HR 1.03; 95% CI: 1.00-1.05, P=0.005) and those with higher baseline IOP (HR 0.78; 95% CI: 0.72-0.85 P<0.001). In the multivariable analysis, patients in the acetate prednisolone 1% group remained with higher chances of treatment success (HR 0.37; 95% CI: 0.15-0.91, P=0.031). No sight-threatening adverse events was reported during follow-up in all groups.

Conclusions: In summary, evaluating the effect of different anti-inflammatory regimens on SLT outcomes in newly diagnosed POAG patients, we found had higher success rates in patients treated with prednisolone acetate 1% after SLT. In addition, higher baseline IOP seem to positively influence post-operative outcomes.