Abstract

Volume.117 Number.4

Original article : Clinical science

Results of Selective Laser Trabeculoplasty (SLT) as Initial Treatment for Normal Tension Glaucoma
Koji Nitta1,2, Kazuhisa Sugiyama2, Yoshiro Mawatari3, Toshiro Tanahashi1
1 Department of Ophthalmology, Fukui-ken Saiseikai Hospital
2 Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science
3 Department of Ophthalmology, Keiju General Hospital

Purpose: A 3-year prospective study was performed to evaluate treatment outcomes following selective laser trabeculoplasty (SLT) used as initial treatment for normal tension glaucoma (NTG).
Subjects and methods: SLT was performed as initial treatment in 42 NTG patients (42 eyes). Thirty-seven of the patients were untreated and 5 patients had discontinued antiglaucoma medications. Two patients were excluded because they did not visit our clinic during the study period. The study was conducted on the remaining subjects (40 eyes of 40 patients).
Results: The intraocular pressure (IOP) was 15.8±1.8 mmHg before SLT, 13.2±1.9 mmHg after one year, 13.5±1.9 mmHg after two years, and 13.5±1.9 mmHg after three years. The IOP after SLT was significantly lower than that before SLT. One month after SLT, the outflow pressure was improved at least 20% (ΔOP) in 92.5% of the patients. The success rate for the effect of IOP reduction at three years after SLT was 40.0% by Kaplan-Meier survival analysis. 27.5% of the patients who had two consecutive ΔOP less than 20%, 25.0% of the patients who had begun antiglaucoma ophthalmic solution, and 15.0% of the patients who had undergone repeated SLT were judged to have reached the endpoint. Kaplan-Meier survival analysis revealed that the success rate for the visual field at three years after SLT was 82.4%(the visual field loss progression was judged to have reached its endpoint when a significant sensitivity loss was first detected in two consecutive points of the same adjacent test points of at least 3 points in the Glaucoma Progressive Analysis for the Humphrey Visual Field Analyzer). Complications included conjunctival hyperemia(52.5%), eye discomfort (12.5%), visual disturbance (blurry vision and photophobia)(10.0%), and eye pain (5.0%). These complications resolved within a few days, and there were no severe complications such as increased IOP or iritis.
Conclusion: Our results suggest that SLT is an effective initial treatment for NTG.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 117: 335-343, 2013.

Key words
Normal-tension glaucoma, Initial treatment, Selective laser trabeculoplasty, Treatment of intraocular pressure reduction
Reprint requests to
Koji Nitta, M.D.　Department of Ophthalmology, Fukui-ken Saiseikai Hospital. 7-1 Funabashi, Wadanaka-machi, Fukui-shi 918-8503, Japan
Received: 18 June 2012. Accepted in revised form: 28 September 2012.
Nihon Ganka Gakkai Zasshi 117: 335-343,2013