Angle Recession, Uveitis Increase Laser Trabeculoplasty Failure Risk

Laser trabeculoplasty (LTP) can prolong medication-free intraocular pressure (IOP) management in some patients, according to researchers who analyzed nearly 80,000 eyes that had undergone the procedure. However, the Journal of Glaucoma study also shows that angle recession and uveitis can increase the risk of LTP failure.

The Intelligent Research in Sight (IRIS) Registry includes electronic health record data of more than 17 million unique patient entries collected from more than 2300 USophthalmology practices. Researchers analyzed the outcomes of patients in the IRIS database who had initially responded to LTP treatment. The team excluded eyes treated with IOP-lowering medications or additional procedures, and those patients who had reached the end of the follow-up period. Only the first eye of patients who were treated bilaterally was included.

Of the 79,332 patients included in the study, 53.2% were women and 64.5% were White. The cohort’s mean age was 71.5 years, and most — 71.2% — were diagnosed with primary open-angle glaucoma (POAG). The mean baseline IOP was 21.6±5.3 mm Hg and they used a mean 2.1±1.5 medications.

Patients who had initially responded to LTP treatment enjoyed a median of 385 days before experiencing failure. More specifically, 84.2% survived 1 year, while 59.2% survived 2 years. The investigators found that eyes with high baseline IOP (>24 mm Hg) had a higher survival rate than eyes with lower baseline IOP. Overall failure at 0, 6, 12, 18 and 24 months was 0.2%, 6.1%, 16.8%, 29.1%, and 40.8%, respectively. Angle recession and uveitis increased the risk of failure, according to the team’s analysis. However, patients who weren’t not taking IOP-lowering medications at the time of baseline measurements remained medication-free for a median of 197 days.

“Overall, this data supports offering LTP to medication-free eyes as a means of obviating medication burden,” researchers report. “The ability to identify factors associated with different response durations in LTP responders is crucial in planning follow-up and setting treatment expectations.”

There are several limitations to this study. First, because of the especially large sample size, many statistically significant associations may not necessarily be clinically significant. In addition, the study is limited by its retrospective cohort design and variations in coding glaucoma type, stage, and other clinical features.

Reference

Chang TC, Vanner EA, Fujino D, et al. Factors associated with laser trabeculoplasty response duration: analysis of a large clinical database (IRIS Registry). J Glaucoma. Published online August 9, 2021. doi:10.1097/IJG.0000000000001918