Selective laser trabeculoplasty following failed combined phacoemulsification cataract extraction and excimer laser trabeculotomy can control intraocular pressure for a limited time

Int Ophthalmol. 2022 Mar;42(3):739-746. doi: 10.1007/s10792-021-02039-x. Epub 2022 Feb 3.

Abstract

Purpose: To assess the efficacy of selective laser trabeculoplasty (SLT) following failed phacoemulsification cataract extraction combined with excimer laser trabeculotomy (phaco-ELT).

Methods: Retrospectively, the medical records of patients with primary or secondary open-angle glaucoma or ocular hypertension who underwent SLT between January 2001 and February 2015 by one surgeon at a single center after a failed phaco-ELT were evaluated. Exclusion criteria were: angle-closure glaucoma, optic nerve atrophy due to disease other than glaucoma, and additional glaucoma procedures between phaco-ELT and SLT. The main outcome measures were time to failure and Kaplan-Meier survival. Complete success was defined as a reduction of intraocular pressure (IOP) of > 3 mmHg and > 20% compared to baseline, and the number of AGM ≤ baseline.

Results: A total of 23 eyes of 21 subjects were included. Baseline IOP was 19.7 (range, 19.1-22.7) mmHg, and the number of AGM at baseline was 2.5 (range, 1.9-2.9). Median time to failure after SLT was 7.2 (range, 6.6-7.8) months. The number of antiglaucoma medications did not change during that time.

Conclusions: In eyes in which the IOP is no longer controlled following phaco-ELT, SLT could be an option to slow disease progression or prolong time until incisional filtration surgery. However, time to failure after SLT is limited. Thus, close follow-up visits are necessary in order to not delay an incisional surgery.

Keywords: Cataract; Excimer laser trabeculotomy; Glaucoma; Minimally invasive glaucoma surgery; Selective laser trabeculoplasty.

MeSH terms

  • Cataract Extraction*
  • Glaucoma, Open-Angle* / surgery
  • Humans
  • Intraocular Pressure
  • Laser Therapy* / methods
  • Lasers, Excimer / therapeutic use
  • Phacoemulsification* / methods
  • Retrospective Studies
  • Trabeculectomy* / methods
  • Treatment Outcome