Clinical Outcomes of Selective Laser Trabeculoplasty in Thai Glaucoma Patients Across Initial, Adjunctive, and Replacement Therapy
Year: 2025
Type: article
Study design: Observational Study
Abstract: Purpose: To evaluate the outcomes of selective laser trabeculoplasty (SLT) in Thai glaucoma patients across three treatment groups–initial, adjunctive, and replacement therapy–and to identify predictors of treatment response and durability. Methods: This retrospective study included glaucoma patients who underwent SLT and were classified into initial, adjunctive, and replacement therapy groups. Treatment durability was analyzed using Kaplan–Meier survival methods. Predictors of non-response and shortened effects were identified using multivariable logistic regression and Cox proportional hazards models. Results: A total of 254 eyes from 123 patients were included: 76 eyes in the initial group, 117 in adjunctive therapy, and 61 in replacement therapy. Overall, 61.1% of eyes achieved a laser response, with significant variation among groups (initial 78.9%, replacement 68.9%, adjunctive 45.3%; p < 0.001). The mean effective duration of SLT was 1.5 years, with cumulative success of 67.2% at 1 year and 14.7% at 3 years, without significant intergroup differences ( p = 0.448). Retreatment with SLT was associated with a reduced risk of non-response (adjusted OR = 0.328, p = 0.023). Independent predictors of non-response included higher baseline IOP (adjusted OR = 1.118, p = 0.004), greater number of medications (adjusted OR = 1.371, p = 0.013), and acetazolamide use (adjusted OR = 5.531, p = 0.033). Shortened treatment effect within 1 year was predicted by older age (adjusted HR = 1.029, p = 0.002), higher baseline IOP (adjusted HR = 1.070; p = 0.001), and greater number of medications (adjusted HR = 1.179, p = 0.036). Conclusion: SLT is effective and repeatable in Thai patients, particularly as initial or replacement therapy. While adjunctive therapy provides some benefit, patients with higher baseline IOP, heavier medication burden are more likely to experience non-response or shortened efficacy. Individualized selection and timely retreatment may optimize outcomes. Plain Language Summary: Glaucoma is a disease that can lead to vision loss if not treated. It is usually treated by lowering eye pressure using topical glaucoma eye drop, laser treatment, or surgery. Selective laser trabeculoplasty (SLT) is a laser treatment that helps reduce eye pressure by improving fluid drainage from the eye. It can be used as the first treatment, alongside medications, or as a replacement when medications are insufficient or intolerant. This study looked at the effectiveness of SLT in Thai patients with glaucoma. We reviewed records from 123 patients (254 eyes). Overall, about 61.1% of eyes responded to the laser treatment, with the highest success in patients receiving SLT as their first treatment. On average, the treatment worked for around 1.5 years. We also found factors that affected treatment success. Patients who received a second SLT treatment were more likely to respond successfully. Higher eye pressure, current use of more medications, and older age were linked to a lower chance of good response or shorter duration of effect. In summary, SLT is a safe, effective, and repeatable treatment for Thai glaucoma patients, especially when used as the first or replacement therapy. Considering each patient’s age, eye pressure, and medication burden can help doctors choose the best timing for treatment and retreatment to achieve optimal results. Keywords: retreatment, medication burden, asian, efficacy, predictive factor
Source: Clinical ophthalmology
DOI: 10.2147/opth.s568406
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,320
OpenAlex ID: W4416937231