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Editors Selection IGR 11-4
Surgical Therapy: IOP reduction with SLT after medical treatment
Comment by Jay Katz on:
46847 Comparison of selective laser trabeculoplasty success in patients treated with either prostaglandin or timolol/dorzolamide fixed combination, Kara N; Altan C; Satana B et al., Journal of Ocular Pharmacology and Therapeutics, 2011; 27: 339-342
In a retrospective study, Kara et al. (1576) evaluated the intraocular pressure (IOP) reduction with selective laser trabeculoplasty (SLT) in two populations: one on a prostaglandin analog (PG) and the other on a fixed combination of timolol and dorzolamide (FC). All patients were followed for at least one year. A successful response was defined as a 20% IOP reduction at one year. They reported a 50% success for the PG group and 78% for the FC group with a mean IOP reduction of 4.7 mmHg and 6.5 mmHg respectively. Conceptually the results fit the notion that SLT lowers IOP by improving outflow akin to PG drugs which may limit their additivity whereas the FC has two drugs that are aqueous suppressants and may be more additive to SLT. However, there are several concerns with the study and the interpretation of the results. 1) The sample size was small with only 35 patients total with 48 eyes enrolled. Four patients had both eyes enrolled in the PG group but nine in the FC group had both eyes included. This may have biased the results in favor of a better outcome in the FC group with the second eye more likely to be treated if there had been a favorable result in the first eye. 2) Only 180 degrees of the angle was treated with SLT with an unknown number of spots applied. One may argue that this was only a partial treatment and if 360 treatment was utilized the results may have differed. 3) There is no mention of how the patients ended up on PG vs FC. Had they failed other prior medical therapy? Which drugs had been previously tried? The authors have tried to answer a difficult question regarding the different additivity of SLT with current glaucoma drugs but the definitive answer remains elusive.
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