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| |  Antiglaucoma Medications Do Not Adversely or Favourably Affect Selective Laser Trabeculoplasty Success: Presented at COS By Louise Gagnon TORONTO -- June 26, 2009 -- If patients with glaucoma use antiglaucoma medications before selective laser trabeculoplasty (SLT), the outcome of laser treatment will not be compromised regardless of class of drug, according to research presented here at the 72nd Annual Meeting and Exhibition of the Canadian Ophthalmological Society (COS). "We wanted to examine if patients were more likely to have treatment success taking some medications compared with others," explained Evan Martow, University of Western Ontario, London, Ontario, on June 22. "We saw that the treatment works just as well if you use any particular medications." Investigators performed a retrospective chart analysis and gathered data on patients such as their age, sex, corneal thickness, presence of diabetes, and the angle of the anterior chamber. They defined success of treatment as a drop in intraocular pressure (IOP) of at least 20%. One of the motivations for examining the effect of medical therapy before outcome with laser therapy is that some research has suggested that using prostaglandins in combination with SLT is not effective, noted Martow. "It has been thought that prostaglandins might represent a competing pathway," he said. The study cohort consisted of 262 patients, who were divided according to the medical therapies they received: prostaglandins, beta blockers, carbonic anhydrase inhibitors (CAIs), alpha-2 agonists, beta blockers plus CAIs, beta blockers plus alpha-2 agonists, beta blockers plus prostaglandins, and pilocarpine. In univariate analysis, investigators found that IOP before SLT, maximum IOP before SLT, a diagnosis of diabetes, and the use of antiglaucoma medications before SLT were all variables that influenced outcome (P <= .2) On multivariate analysis, the researchers looked at factors such as sex, the angle of pigmentation, and additional antiglaucoma medications. At the 6-month follow-up, multivariate analysis found that just 2 variables, IOP and maximum IOP before SLT, influenced the outcome of SLT. The odds ratio of IOP pre-SLT was 1.320, and the odds ratio for maximum IOP was 0.914. The higher the pre-SLT IOP, the greater the likelihood of success, explained Martow. "The maximum IOPs that were recorded in patients' histories resulted in reduced likelihood of treatment success with SLT." One possible explanation as to why the maximum IOP at the time of SLT influences outcome is that higher maximum IOPs suggest elevated IOPs for a prolonged period. This might affect the trabecular meshwork, thus making it less responsive to laser therapy, noted Martow. Conversely, eyes that had a lower maximum IOP were more likely treatment naïve and thus more responsive to laser therapy. [Presentation title: SLT and Adjunctive Medical Therapy: A Prediction Rule Analysis. Abstract P19]
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