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Editors Selection IGR 10-3

Medical Treatment: Round-the-clock effects of SLT and travoprost

Comment by Norbert Pfeiffer on:

71469 The effects of selective laser trabeculoplasty and travoprost on circadian intraocular pressure fluctuations: A randomized clinical trial, Kiddee W; Atthavuttisilp S, Medicine, 2017; 96: e6047

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This paper compares the efficacy of IOP reduction by either travoprost or selective laser trabeculoplasty in terms of mean IOP reduction and IOP fluctuation over a 24 hour period in 58 eyes that were randomized to either treatment. In brief, both travoprost and SLT treatment lowered IOP significantly by -4.1 and -3.7 mmHg, respectively with no statistically significant difference between both treatments.

Travoprost effect seemed to be present during day and night, while the SLT effect was significant only during nighttime

IOP fluctuations were < 3 mmHg over a 24 hour diurnal measurement period in 100% of travoprost and 87% of SLT eyes. Percentages were similar for eyes with normal tension glaucoma (96% and 82%, respectively). However, the travoprost effect seemed to be present during day and night, while the SLT effect was significant only during nighttime.

Travoprost effect seemed to be present during day and night, while the SLT effect was significant only during nighttime This study addresses the important question whether patients may be better controlled on medical of laser therapy. The strengths of the study include a randomization with comparable groups, a 24 hour IOP measurement before and after treatment and a clear definition of success. However, the sample size was small (16/14 eyes for POAG and 14/16 eyes for NTG. Masking could have been better with sham laser treatment and placebo given to the laser group. Also, an untreated control group what help to understand a possible effect of regression to the mean which might account for at least some of the effects shown here. Yet, the very popular use of SLT warrants studies like these to better understand the efficacy of laser treatment.

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