Multi-Therapy Plus Laser Trabeculoplasty Can Provide Long-Term IOP Control

A multi-therapy plus laser trabeculoplasty (LTP) approach may provide useful intraocular pressure (IOP) reduction that can persist for several years, according to research published in Acta Ophthalmologica. The study shows that the treatment’s pressure-lowering effect and duration is highly dependent on the patient’s pretreatment IOP.

Researchers analyzed the long-term effect of multi-therapy plus laser trabeculoplasty based on 5-year data from the Glaucoma Intensive Treatment Study (GITS).

After exclusions, the analysis included 152 eyes of 122 participants (mean age, 68.7±5.8 years; range, 40 to 78 years) who were recently diagnosed with primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PEXG) in at least 1 eye. Patients were randomly selected for multi-therapy plus laser trabeculoplasty. This regimen involved IOP-lowering eyedrops from 3 drug classes, followed in 1 week by 360° argon laser trabeculoplasty (ALT) or selective laser trabeculoplasty (SLT).

The initial cohort exhibited average IOP of 14.0±3.5 mm Hg immediately before LTP. Eyes with a pre-laser treatment IOP of 15 mm Hg or higher showed significantly lower IOP at every timepoint until 48 months; including 56 eyes with mean 2.6±3.1 mm Hg reduction after 1 month.

However, patients who underwent multi-therapy plus laser trabeculoplasty who had a pre-LTP IOP that was lower than 15 mm Hg did not experience any notable benefit from LTP.

“The IOP reduction of almost 2 mm Hg after 48 months that was seen in the eyes with pre-LTP IOP ≥15 mm Hg was not only statistically significant but can also be considered clinically significant,” the study authors explain.

Fewer than 13% of individuals with pre-laser IOP of 15 mm Hg or greater required additional medical therapy or other intervention at 48 months. After 60 months, 74% of all eyes did not need greater or fewer number of eyedrops. From 12 to 60 months, no large differences arose in IOP reduction between the patients who received multi-therapy plus laser trabeculoplasty with ALT or SLT. No major contrasts were noted among POAG or PEXG — with the exception that participants with PEXG showed higher IOP at 60 months (P =.025).

The GITS clinical trial was not originally planned to address long-term impact of multi-therapy plus laser trabeculoplasty and lacked a multi-treated arm not undergoing LTP, which can be seen as a limitation. Also, selection bias may have been possible — a number of eyes received added treatment during the study period. Strengths involved uniform LTP procedure, long follow-up, and 98% attendance at the 5-year visit.

Disclosures: Multiple study authors have declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.