The Impact of Baseline Intraocular Pressure on Initial Treatment Response in the LiGHT Trial

IF 13.1 1区医学 Q1 OPHTHALMOLOGY

Ophthalmology Pub Date : 2024-07-02 DOI:10.1016/j.ophtha.2024.06.022

Eamonn T. Fahy MB BCh, PhD , Giovanni Montesano MD, PhD , Anurag Garg MD, FRCOphth , Victoria Vickerstaff PhD , Evgenia Konstantakopoulou PhD , Gus Gazzard MD, FRCOphth

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引用次数: 0

Abstract

Purpose

The Laser in Glaucoma and Ocular Hypertension Trial demonstrated the efficacy and safety of selective laser trabeculoplasty (SLT) compared with topical hypotensive medication as first-line therapy for ocular hypertension and open-angle glaucoma. This substudy explored the impact of pretreatment (baseline) intraocular pressure (IOP) on treatment response.

Design

Post hoc analysis of randomized control trial data.

Participants

A total of 1146 eyes from 662 patients were included in this analysis: 559 eyes in the SLT group and 587 in the medication group.

Methods

Intraocular pressure reduction at 8 weeks after treatment with either SLT or prostaglandin analog (PGA) eye drops was assessed at different levels of baseline IOP, and the groups were compared. Differences in absolute and percentage IOP lowering between SLT and PGA groups were tested with a linear mixed-effects model. Differences in the probability of achieving ≥ 20% IOP lowering between SLT and PGA groups, at different levels of baseline IOP, were estimated using a logistic mixed-effects model.

Main Outcome Measure

Intraocular pressure-lowering response to SLT versus PGA eye drops.

Results

Mean IOP was not significantly different between the groups at baseline or 8 weeks after treatment initiation. Both treatments showed greater IOP lowering at higher baseline IOP and less IOP lowering at lower baseline IOP. Selective laser trabeculoplasty tended to achieve more IOP lowering than PGA drops at higher baseline IOP. Prostaglandin analog drops performed better at lower baseline IOP, and the difference compared with SLT, in terms of percentage IOP reduction, was significant at baseline IOP of ≤ 17 mmHg. A significant difference was found in the relationship between baseline IOP and probability of ≥ 20% IOP lowering between the two treatments (P = 0.01), with SLT being more successful than PGA at baseline IOP of more than 22.5 mmHg.

Conclusions

We confirm previous reports of greater IOP lowering with higher baseline IOP for both SLT and PGA drops. In treatment-naïve eyes, at higher baseline IOP, SLT was more successful at achieving ≥ 20% IOP lowering than PGA drops. At lower baseline IOP, a statistically greater percentage, but not absolute, IOP lowering was seen with PGA drops compared with SLT, although the clinical significance of this is uncertain.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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LiGHT试验中基线眼压对初始治疗反应的影响：选择性激光小梁成形术与药物治疗的比较

目的：青光眼和眼压过高症激光治疗（LiGHT）试验表明，选择性激光小梁成形术（SLT）与局部降压药物相比，作为眼压过高症和开角型青光眼的一线疗法，具有良好的疗效和安全性。本子研究探讨了治疗前（基线）眼压（IOP）对选择性激光小梁成形术和药物治疗反应的影响：设计：随机对照试验数据的事后分析：本分析包括 662 名患者的 1146 只眼睛：SLT 组 559 只，药物组 587 只：方法：在不同的基线眼压水平下，对开始使用SLT或前列腺素类似物（PGA）滴眼液治疗8周后的眼压降低情况进行评估，并对两组进行比较。采用线性混合效应模型检验了 SLT 和 PGA 药物在降低眼压的绝对值和百分比方面的差异。使用逻辑混合效应模型估算了在不同基线眼压水平下，SLT 和 PGA 药物降低眼压≥20% 的概率差异。主要结果指标：SLT 与 PGA 滴眼液的降眼压反应：结果：无论是基线还是开始治疗后 8 周，两组的平均眼压均无明显差异。基线眼压较高时，两种疗法的降眼压效果均较好，而基线眼压较低时，降眼压效果较差。在基线眼压较高时，SLT 的降眼压效果往往优于 PGA 滴眼液。在基线眼压较低时，PGA滴眼液的效果更好，与SLT相比，在基线眼压≤17 mmHg时，PGA滴眼液在降低眼压百分比方面的差异显著。两种治疗方法的基线眼压与眼压降低≥20%的概率之间存在显著差异（p = 0.01），在基线眼压> 22.51 mmHg时，SLT比PGA更成功：这些数据证实了之前的报道，即 SLT 和局部降压药的基线眼压越高，降眼压效果越好。在未接受过治疗的眼睛中，当基线眼压较高时，SLT 比 PGA 更能成功地降低≥20% 的眼压。在基线眼压较低的情况下，PGA滴眼液与SLT相比，在统计学上降低眼压的百分比（而非绝对值）更高，但其临床意义尚不确定。

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来源期刊

Ophthalmology 医学-眼科学

CiteScore

22.30

自引率

3.60%

发文量

412

审稿时长

18 days

期刊介绍： The journal Ophthalmology, from the American Academy of Ophthalmology, contributes to society by publishing research in clinical and basic science related to vision.It upholds excellence through unbiased peer-review, fostering innovation, promoting discovery, and encouraging lifelong learning.