Development of a prediction rule to estimate the probability of acceptable intraocular pressure reduction after selective laser trabeculoplasty in open-angle glaucoma and ocular hypertension.

PURPOSE: To develop and validate a prediction rule to estimate the probability of acceptable intraocular pressure (IOP) reduction after selective laser trabeculoplasty (SLT) in ocular hypertension and open-angle glaucoma. PATIENTS AND METHODS: The study population was derived from a cohort of 220 patients with ocular hypertension, open-angle glaucoma, or normal tension glaucoma. A > or =20% reduction in IOP (mm Hg) from the baseline IOP at 6 months after SLT was considered treatment success. Logistic multivariate regression modeling was performed to develop a prediction rule. RESULTS: In multivariate logistic regression analyses, pre-SLT IOP and maximum IOP were identified as independent predictors for > or =20% IOP reduction at 6 months with adjusted odds ratios of 1.3 and 0.9, respectively, controlling for sex, diagnosis, pigment of anterior chamber, and washout of eye drops. The area under receiver operator characteristic curve was 0.716. Calibration of this prediction rule showed good agreement between predicted and observed probabilities of acceptable IOP reduction. If a probability of acceptable IOP reduction of 50% or greater is used as the minimal clinical threshold for treatment, the prediction rule had a sensitivity and specificity of 91.3% and 30.4%, respectively. CONCLUSIONS: SLT efficacy is positively associated with IOP elevation before SLT treatment and adversely associated with the maximum IOP ever recorded in history. Pigmentation of the anterior chamber angle, diagnosis, washout of eye drops, and sex are not associated with SLT treatment efficacy. This prediction rule should be further validated with a comparable prospective clinical study cohort.

Internal glaucoma drainage device tube fenestration for uncontrolled postoperative intraocular pressure.

PURPOSE: To describe a novel approach to early postoperative intraocular pressure (IOP) control after glaucoma drainage device (GDD) implantation. METHODS: Two patients with elevated IOP after GDD implantation underwent internal GDD tube fenestration using a 30-gauge needle to perforate the GDD tube. RESULTS: IOP was lowered in each case by over 50% without complication. CONCLUSIONS: Transanterior chamber internal GDD tube fenestration is a novel, straightforward approach to early IOP control after GDD implantation. This procedure adds to our armamentarium of methods for controlling IOP during the early postoperative period.

Ocular massage for intraocular pressure control after Ahmed valve insertion.

BACKGROUND: To investigate the immediate and longer-term effect of ocular massage on intraocular pressure (IOP) after Ahmed valve insertion. METHODS: A retrospective chart review was undertaken of the effects of ocular massage in patients with inadequately controlled IOP after Ahmed valve surgery. During a 20-month period between January 2004 and August 2005, 20 of 52 patients underwent a course of ocular massage. They were compared on IOP and the number of ocular hypotensive medications required with the 32 patients whose IOP was satisfactory after surgery. RESULTS: The mean time to initiation of massage was 29 days (range 8-141 days), and the mean total duration of massage was 127 days (range 18-273 days). At the initiation of massage, the mean IOP was 19.2 mm Hg, significantly higher than at any other postoperative visit (p = 0.001-0.02). Immediately following massage, the IOP was reduced by 40% to 11.6 mm Hg (p < 0.001). When compared with those patients not requiring massage, there were no differences in IOP at any subsequent visit (p = 0.1-0.9). There were also no differences in final absolute IOP reduction (11.1 [SD 5.9] for the massage group vs. 10.64 [SD 8.0] mm Hg for those not requiring massage, p = 0.8), percentage IOP reduction (46% vs. 40%, p = 0.5), or number of glaucoma medications required at 1 year (2.9 vs. 2.6, p = 0.4), respectively. The massage group was receiving more medications than the group not requiring massage at 3 months (3.1 vs. 1.9) and 6 months (3.5 vs. 2.2). No complications arose due to ocular massage. INTERPRETATION: This is the first report to document that ocular massage is a safe and effective manoeuvre for the management of elevated IOP after Ahmed valve insertion. Massage resulted in an immediate reduction of IOP, and, despite initial higher postoperative IOP in the massage group, there were no differences between groups at 1 year with regard to IOP reduction or requirements for medications.

Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma.

PURPOSE: To investigate the efficacy and safety of selective laser trabeculoplasty as an initial treatment for newly diagnosed open-angle glaucoma, and its role as adjunctive therapy. PATIENTS AND METHODS: A prospective multicenter nonrandomized clinical trial was performed. Patients with newly diagnosed open-angle glaucoma or ocular hypertension were assigned to the primary (selective laser trabeculoplasty) treatment group or the control (latanoprost) group according to patient choice. Both groups were followed up at 1, 3, 6, and 12 months. A secondary treatment group was also included to study the efficacy of selective laser trabeculoplasty for patients intolerant of medical therapy or in whom such therapy was unsuccessful, with or without a history of previous argon laser trabeculoplasty. RESULTS: One hundred eyes (61 patients) were enrolled, 74 in the primary treatment group and 26 in the control group. The average absolute and percent reductions in intraocular pressure for the primary treatment group were 8.3 mm Hg or 31.0%, compared with 7.7 mm Hg or 30.6% for the control group (P = 0.208 and P = 0.879). The responder rates (20% pressure reduction) were 83% and 84% for the primary and control groups, respectively. There were no differences in intraocular pressure lowering with selective laser trabeculoplasty on the basis of angle pigmentation. A modest contralateral effect was observed in the untreated fellow eyes of patients undergoing selective laser trabeculoplasty. CONCLUSIONS: Selective laser trabeculoplasty was found to be equally efficacious as latanoprost in reducing intraocular pressure in newly diagnosed open-angle glaucoma and ocular hypertension over 12 months, independent of angle pigmentation. Nonsteroidal antiinflammatory therapy had similar efficacy to steroids after laser therapy. These findings support the consideration of selective laser trabeculoplasty as a first-line treatment for newly diagnosed open-angle glaucoma or ocular hypertension.