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Real-World Outcomes of Selective Laser Trabeculoplasty in the United Kingdom.
Ophthalmology ( IF 13.1 ) Pub Date : 2019-11-26 , DOI: 10.1016/j.ophtha.2019.11.017
Anthony P Khawaja 1 , Joanna H Campbell 2 , Nicholas Kirby 3 , Hitesh S Chandwani 4 , Ian Keyzor 5 , Mousam Parekh 6 , Andrew I McNaught 7 ,
Affiliation  

PURPOSE Selective laser trabeculoplasty (SLT) is a common treatment option for managing glaucoma and ocular hypertension. We assessed the real-world effectiveness of SLT and baseline factors associated with treatment success in the United Kingdom. DESIGN Retrospective observational study of de-identified electronic medical records (Medisoft Glaucoma module [Medisoft Ltd, Leeds, UK]) from 5 UK ophthalmology teaching centers. PARTICIPANTS Adult patients undergoing their first recorded SLT. For bilateral SLT (same day), analyses included 1 randomly selected eye. METHODS Patient demographics, procedure details, and clinical outcomes data were extracted. Factors associated with treatment success were assessed using multivariable Cox regression. MAIN OUTCOME MEASURES Change from baseline in intraocular pressure (IOP) and glaucoma medication use at 12 to 18 and 24 to 36 months post-SLT. A Kaplan-Meier survival analysis was also conducted. Failure of SLT was defined as any further glaucoma procedure post-SLT or any of the following at 2 consecutive visits: IOP >21 mmHg, IOP reduction <20% from baseline, or increase in glaucoma medications from baseline. RESULTS A total of 831 SLT-treated eyes (mean baseline IOP 22.0 mmHg) of 831 patients were analyzed. At 12 to 18 and 24 to 36 months post-SLT, respectively, significant reductions in IOP (-4.2 [95% confidence interval {CI}, -4.7 to -3.7] and -3.4 [95% CI, -4.1 to -2.7] mmHg; both P < 0.0001) and significant increases in the number of glaucoma medications (0.13 [95% CI, 0.04-0.23], P = 0.007, and 0.20 [95% CI, 0.06-0.33], P = 0.005) were observed. Survival analysis demonstrated treatment success in 70%, 45%, and 27% of eyes at 6, 12, and 24 months post-SLT, respectively. Higher baseline IOP was strongly associated with treatment success (hazard ratio [HR], 0.67 for baseline IOP >21 mmHg vs. ≤21 mmHg, 95% CI, 0.57-0.80; P < 0.001). Selective laser trabeculoplasty success was not significantly associated with age (P = 0.78), baseline visual field mean deviation (P = 1.00), or concurrent use of IOP-lowering medication (P = 0.52). CONCLUSIONS Most patients initially responded to SLT, but the majority failed within 1 year. Efficacy of SLT was better in patients with higher baseline IOP but did not differ by glaucoma severity or concurrent use of IOP-lowering medication. These findings may help inform which patients are suitable for SLT therapy.

中文翻译:

英国选择性激光小梁成形术的真实结果。

目的 选择性激光小梁成形术 (SLT) 是治疗青光眼和高眼压症的常见治疗选择。我们评估了英国 SLT 的实际有效性和与治疗成功相关的基线因素。设计 来自 5 个英国眼科教学中心的去识别电子病历(Medisoft Glaucoma 模块 [Medisoft Ltd, Leeds, UK])的回顾性观察研究。参与者首次接受 SLT 记录的成年患者。对于双侧 SLT(同一天),分析包括 1 只随机选择的眼睛。方法 提取患者人口统计资料、程序细节和临床结果数据。使用多变量 Cox 回归评估与治疗成功相关的因素。主要结果测量 SLT 后 12 至 18 个月和 24 至 36 个月眼压 (IOP) 和青光眼药物使用与基线相比的变化。还进行了 Kaplan-Meier 生存分析。SLT 失败定义为 SLT 后任何进一步的青光眼手术或连续 2 次就诊时出现以下任何情况:眼压 > 21 mmHg,眼压从基线降低 <20%,或青光眼药物从基线增加。结果 对 831 名患者的 831 只接受 SLT 治疗的眼睛(平均基线 IOP 22.0 mmHg)进行了分析。分别在 SLT 后 12 至 18 个月和 24 至 36 个月,眼压显着降低(-4.2 [95% 置信区间 {CI},-4.7 至 -3.7] 和 -3.4 [95% CI,-4.1 至 -2.7 ] mmHg;P < 0.0001)和青光眼药物数量显着增加(0.13 [95% CI,0.04-0.23],P = 0.007 和 0.20 [95% CI,0.06-0.33],P = 0。005) 被观察到。生存分析表明,在 SLT 后 6、12 和 24 个月分别有 70%、45% 和 27% 的眼睛治疗成功。较高的基线 IOP 与治疗成功密切相关(基线 IOP >21 mmHg 与 ≤21 mmHg 的风险比 [HR] 为 0.67,95% CI,0.57-0.80;P < 0.001)。选择性激光小梁成形术的成功与年龄(P = 0.78)、基线视野平均偏差(P = 1.00)或同时使用降低眼压的药物(P = 0.52)没有显着相关性。结论 大多数患者最初对 SLT 有反应,但大多数在 1 年内失败。SLT 在基线眼压较高的患者中效果更好,但在青光眼严重程度或同时使用降低眼压的药物方面没有差异。这些发现可能有助于告知哪些患者适合 SLT 治疗。生存分析表明,在 SLT 后 6、12 和 24 个月分别有 70%、45% 和 27% 的眼睛治疗成功。较高的基线 IOP 与治疗成功密切相关(基线 IOP >21 mmHg 与 ≤21 mmHg 的风险比 [HR] 为 0.67,95% CI,0.57-0.80;P < 0.001)。选择性激光小梁成形术的成功与年龄(P = 0.78)、基线视野平均偏差(P = 1.00)或同时使用降低眼压的药物(P = 0.52)没有显着相关性。结论 大多数患者最初对 SLT 有反应,但大多数在 1 年内失败。SLT 在基线眼压较高的患者中效果更好,但在青光眼严重程度或同时使用降低眼压的药物方面没有差异。这些发现可能有助于告知哪些患者适合 SLT 治疗。生存分析表明,在 SLT 后 6、12 和 24 个月分别有 70%、45% 和 27% 的眼睛治疗成功。较高的基线 IOP 与治疗成功密切相关(基线 IOP >21 mmHg 与 ≤21 mmHg 的风险比 [HR] 为 0.67,95% CI,0.57-0.80;P < 0.001)。选择性激光小梁成形术的成功与年龄(P = 0.78)、基线视野平均偏差(P = 1.00)或同时使用降低眼压的药物(P = 0.52)没有显着相关性。结论 大多数患者最初对 SLT 有反应,但大多数在 1 年内失败。SLT 在基线眼压较高的患者中效果更好,但在青光眼严重程度或同时使用降低眼压的药物方面没有差异。这些发现可能有助于告知哪些患者适合 SLT 治疗。
更新日期:2019-11-26
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