Selective laser trabeculoplasty in Korean eyes with medically uncontrolled pseudoexfoliation glaucoma Su Chan Lee1, Jung Hyun Lee1, Mi Jin Kim2, Hye Jin Chung1, Yun Suk Chung1, Jin Young Choi1, Mi Jeung Kim1 1Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea 2Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea Introduction Results Selective laser trabeculoplasty (SLT) Widely used as a primary or adjunctive therapy for lowering intraocular pressure (IOP). IOP reduction (≥12 months) in pseudoexfoliative glaucoma (PXFG) ranged from 11% to 32%.1 Few studies reported the efficacy of SLT in medically uncontrolled PXFG.2 However, there has been no report in Korean populations. IOP lowering efficacy of SLT might be affected by ethnicity.3 Comparisons of baseline characteristics between 1year success and failure group Baseline characteristics of PXFG eyes PXFG eyes (n=23) Age (years) 72.2 ± 8.8 Sex ; Male : Female (No.) 12 : 11 IOP (mmHg) 27.7 ± 4.9 Number of medications 3.6 ± 0.7 Phakic : Pseudophakic (No.) 11 : 12 VF index MD (dB) - 18.4 ± 9.7 PSD (dB) 7.7 ± 4.1 Success (n=12) Failure (n=11) P-value Age (years) 74.4 ± 8.7 69.8 ± 8.6 0.260* Sex ; Male : Female (No.) 6 : 6 6 : 5 1.000† IOP (mmHg) 26.4 ± 5.1 29.1 ± 4.5 0.151* Number of medications 3.6 ± 0.7 0.833* Phakic : Pseudophakic 5 : 6 VF index MD (dB) -18.0 ± 11.2 -18.3 ± 8.2 0.786* PSD (dB) 6.5 ± 4.6 8.5 ± 3.2 0.169* VF, visual field; MD, mean deviation; PSD, pattern standard deviation Purpose *Mann-Whitney test; † Fisher’s exact test To assess the efficacy of SLT in Korean eyes with medically uncontrolled PXFG Survival Analysis of medically uncontrolled PXFG eyes (n=23) No significant differences in the baseline characteristics between two groups (all P > 0.05) Correlation analysis between IOP decrement and VF in 1 year success group Patients and Methods IOP decrement (mmHg) Rho (P-value*) vs MD vs PSD 1 day 8.4 ±10.7 -0.186 (>0.05) -0.263 (>0.05) 1 week 10.8 ± 5.4 0.153 (>0.05) -0.153 (>0.05) 1 months 9.7 ± 6.1 0.232 (>0.05) -0.239 (>0.05) 3 months 12.0 ± 6.4 0.728 (0.007) -0.007 (>0.05) 6 months 10.4 ± 4.6 0.376 (>0.05) 0.359 (>0.05) 1 year 10.5 ± 6.0 0.439 (>0.05) 0.130 (>0.05) Retrospective Observational study Patients 23 eyes of 23 PXFG patients who had undergone first-time SLT : followed up ≥ 12 months after SLT : enrolled from Glaucoma Clinic of HanGil Eye Hospital and Kim’s Eye Hospital from August 2013 to March 2016 Inclusion criteria : (1) Age ≥ 18 years old (2) Open angle on gonioscopic exam (3) Pseudoexfoliation (4) IOP ≥ 21 mmHg despite of topical maximum tolerated medical treatment Exclusion criteria (1) History of uveitis, trauma and other ocular diseases (2) History of laser or surgical therapy for glaucoma SLT procedure : Q-switched frequency-doubled 532nM Nd:YAG laser started at 0.6 mJ and increased by 0.2 mJ until cavitation bubbles were visible ( <1.2 mJ ) 360° treated with contiguous laser spots topical medication adjustments at the physician's discretion Ophthalmologic examinations including visual acuity, fundoscopy, slit-lamp biomicroscopy and Goldmann applanation tonometry baseline & followed at 1 hour, 1 day, 1 week, 1, 3, 6 months and 1 year after SLT IOP spike : defined as IOP rise of ≥ 10 mmHg than baseline in 1 day after SLT Kaplan-Meier survival analysis Criteria for treatment success / failure Success : ≥ 20% IOP reduction from baseline without additional anti glaucomatous interventions (systemic medications, laser, and incisional glaucoma surgery) Failure < 20% IOP reduction from baseline at 2 consecutive follow ups or (2) additional anti glaucomatous interventions regardless of the degree of IOP reduction Fig.1. Kaplan-Meier survival curve of 23 PXFG eyes * Spearman correlation analysis During 1 year follow up, IOP decrements at each time intervals were not associated with the severity of glaucoma except at 3 months follow-up in success group. Cumulative probability of failure after SLT at 1year was 47.8% (11 eyes) < 20% IOP reduction from baseline in 9 eyes (39.1%) Additional interventions despite of ≥ 20% IOP reduction from baseline in 2 eyes (8.7%) IOP decrement of phakic and pseudophakic eyes in 1year success group No significant differences in the IOP decrement between phakic and pseudophakic eyes at all follow-up points (all P > 0.05) Mean IOP following SLT in PXFG eyes Adverse events IOP spike : 2 eyes (8.7%) → Filtering surgery No other significant adverse events except transient conjunctival hyperemia Number available* Mean IOP (mmHg) P-value† Pre-SLT Post-SLT Baseline 23 - 27.7 ± 4.9 1 day 22 27.2 ± 4.5 20.7 ± 9.5 0.005 1 week 21 27.1 ± 4.5 15.8 ± 3.4 <0.001 1 months 18 27.1 ± 4.9 17.3 ± 3.6 3 months 15.5 ± 2.8 6 months 17 27.0 ± 5.0 17.0 ± 4.2 1 year 12 26.4 ± 5.1 15.8 ± 2.6 0.002 Conclusions About half (52.2%) of medically uncontrolled Korean PXFG eyes showed overall 1-year IOP lowering efficacy (≥ 20% IOP reduction from baseline without additional interventions). 45% of failure was observed in the early phase (within 3 months). ; This suggests that prognosis is not worse if IOP is controlled for more than 3 months. IOP lowering efficacy of SLT does not seem to be affected by the severity of glaucoma and prior cataract surgery. No significant adverse events except 2 eyes (8.7%) of IOP spike. → SLT might be considered as one of the treatment modality in medically refractory PXFG eyes, that is effective in some part. * Included in the analysis until failure, then removed from subsequent follow-up † Wilcoxon signed–rank test for analyzing changes in IOP from pre-SLT values References Wong MO, et al. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol. 2015;60:36-50. 2. Goldenfeld M, et al. Selective laser trabeculoplasty in uncontrolled pseudoexfoliation glaucoma. Ophthalmic Surg Lasers Imaging. 2011;42:390-393. 3. Goosen E, et al. Racial Differences in Selective Laser Trabeculoplasty Efficacy. J Curr Glaucoma Pract. 2017 ;11:22-7 Fig. 2. Change of IOP in 1 year success group (n=12) * Wilcoxon signed–rank test: all P < 0.05 Success at 1year group (n=12) Mean IOP reduction : 10.5 ± 6.0 mmHg (39.8 % reduction from pre-SLT value) Number of medications was decreased but it was not statistically significant. (3.6 ± 0.7 → 3.4 ± 0.7, Wilcoxon signed–rank test : p = 0.317) • Conflicts of Interest : We have no financial interests or relationships to disclose. • E-mail : mjkim01@gmail.com