Selective Laser Trabeculoplasty Can Treat Steroid-Induced Glaucoma

Patients with steroid-induced glaucoma had a superior response to selective laser trabeculoplasty (SLT) compared with patients with primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEX). However, high baseline intraocular pressure (IOP) may be a confounder, according to the findings published in the Canadian Journal of Ophthalmology.

Treating steroid-induced and uveitic glaucoma can be tricky, according to researchers. Successfully managing uveitis prevents damage to the trabecular outflow system, but steroids often increase IOP. 

In a single-center, retrospective, case-control study, investigators compare the response to SLT among patients with uveitic and steroid-induced glaucoma to the more widely studied responses to SLT in POAG and PEX. Patients with uveitic glaucoma, steroid-induced glaucoma, POAG, or PEX who had their first SLT were included. Eyes with POAG or PEX were placed in control groups, while eyes with steroid-induced or uveitic glaucoma were placed in experimental groups. Changes in IOP from baseline, treatment failure, complication rates, and medication use were compared.

In total, 608 eyes of 433 patients were enrolled. Steroid-induced glaucoma eyes had higher mean baseline pressure and a decrease in pressure at 3 to 8 weeks (27.6 to 17.4 mm Hg) than those with PEX (21.7 to 16.5 mm Hg; P <.001) or POAG (18.6 to 14.9 mm Hg; P ≤.025). Failure rates after 2 years were lower in steroid-induced glaucoma (54%) than in PEX (84%; P =.01) or POAG (84%; P =.005). This survival benefit persisted when excluding patients with changes to their steroid dosing (P ≤.03) but showed mixed results when compared with patients with a baseline pressure of 25 mm Hg or greater (P =.020 vs PEX; P =.67 vs POAG). At 18 months, the steroid-induced group decreased ocular hypotensive medication use (3.5-1.9; P =.005); the uveitic group increased medication use (2.7-3.5; P =.02).

Researchers concluded that SLT may decrease ocular hypotensive medication use and prevent a portion of patients from having to undergo filtering or shunting operations. 

Researchers note some limitations with their study, including that data regarding steroid use with not available for all patients, the lack of a standardized definition for steroid-induced glaucoma, the lack of standardized visit schedules, clinical examinations, medication regimens, and patient selection, and the potential for observer bias.

Reference

Zhou Y, Pruet CM, Fang C, et al. Selective laser trabeculoplasty in steroid-induced and uveitic glaucoma. Can J Ophthalmol. Published online June 10, 2021. doi:10.1016/j.jcjo.2021.05.006