Effectiveness and Safety of Resident-Performed Same-Day Bilateral 360-Degree Selective Laser Trabeculoplasty in Patients With Open Angle Glaucoma.

Abstract

Prcis: Resident-performed same-day bilateral selective laser trabeculoplasty are safe and effective for patients with primary open angle glaucoma or ocular hypertension.

Purpose: To assess the efficacy and safety of resident-performed same-day bilateral 360-degree selective laser trabeculoplasty (SLT).

Patients and methods: A retrospective chart review was performed for patients who received bilateral, resident-performed SLT at the University of Chicago from January 1, 2020 to December 31, 2022 under the supervision of 1 glaucoma surgeon (M.Q.). Patients were included in this analysis if they underwent same-day bilateral 360-degree SLT and had at least 6 months of follow-up available. Data were collected on visual acuity, intraocular pressure (IOP), number of IOP-lowering medications, and complications for up to 2 years after the procedure.

Results: There were 48 patients included in this analysis, and the diagnosis was either primary open angle glaucoma (85.4%) or ocular hypertension (14.6%). For patients whose SLT goal was to lower IOP (n=38), the mean baseline IOP in right eyes (OD) was 19.2 mm Hg on 2.1 medications, and in left eyes (OS) was 19.5 mm Hg on 2.1 medications. At the final follow-up (mean 519 d), the mean IOP in the right eyes was 15.8 mm Hg on 2.0 medications, and in the left eyes was 15.8 mm Hg OS on 2.2 medications, resulting in an IOP reduction of 17.6% OD and of 18.8% OS. For patients whose SLT goal was to lower medication number (n=10), the mean baseline IOP in right eyes was 16.7 mm Hg on 2.3 medications, and in left eyes was 16.4 mm Hg OS on 2.3 medications. At the final follow-up (mean 528 d), the mean IOP in the right eye was 17.6 mm Hg on 1.1 medications, and in the left eye was 16.3 mm Hg OS on 1.1 medications, resulting in a medication reduction of 1.1 fewer medications OD and 1.1 fewer medications OS. One patient experienced a 6 mm Hg IOP rise above baseline 4 weeks after SLT, and another developed 2 small, focal areas of peripheral anterior synechiae. Six (12.5%) patients underwent additional IOP-lowering surgery during the chart review period.

Conclusions: Resident-performed same-day bilateral 360-degree SLT was effective and associated with minimal complications, with rates comparable to those of attending-performed SLT in the literature. SLT can be individualized to patients' goals of IOP-lowering or medication reduction. Teaching institutions can consider incorporating this method of education for appropriate patients with primary open angle glaucoma or ocular hypertension.