SLT As Effective as Brimonidine Tartrate in Uncontrolled Glaucoma

Selective laser trabeculoplasty (SLT) and brimonidine tartrate/timolol maleate were equally effective adjunct therapy in patients with uncontrolled primary open-angle glaucoma (POAG), according to findings published in the Journal of Ophthalmology & Clinical Research.

Prostaglandin analogs are the standard initial therapy for patients with POAG. However, according to researchers, when this therapy doesn’t adequately control intraocular pressure (IOP), no consensus about the second-line therapy currently exists. Second-line treatments can include additional topical therapy (whether a single agent or combination drop) or laser treatment.

SLT may provide some advantages in certain patients. Researchers compared the intraocular pressure-lowering efficacy of selective laser trabeculoplasty to fixed-combination brimonidine tartrate 0.2%/timolol maleate 0.5% in patients with uncontrolled POAG on only a prostaglandin analog.

In this study, 23 patients were randomized into 2 treatment groups. Group 1 (n=12) received 360 degrees of selective laser trabeculoplasty as an additional treatment, while Group 2 (n=11) was started on brimonidine tartrate. After 8 weeks, both treatment regimens were statistically significant in lowering IOP when used as an adjunct therapy. 

The average IOP reduction for Group 1 and Group 2 was 28.4% (SD=0.17) and 28.2% (SD=0.12) respectively. The incidence of an IOP spike following SLT in this patient population was 8.3%. The investigators report no major complications.

Limitations of this study include the small number of patients, its single-site design, and its relatively short duration. Additionally, randomization wasn’t stratified to ensure both treatment groups had similar demographics.

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

Reference

McWherter I, Lanham M, Peplinski L, et al. Selective laser trabeculoplasty versus brimonidine tartrate 0.2%/timolol maleate 0.5% as adjunct therapy in primary open angle glaucoma: a randomized prospective pilot study. J Ophthalmic Clin Res. Published online January 27, 2021. doi:10.24966/OCR-8887/100075