Effect of Selective Laser Trabeculoplasty in a sub-Saharan Rural Population

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Investigative Ophthalmology & Visual Science




Purpose : Recent studies have demonstrated uniquely high efficacy of selective laser trabeculoplasty (SLT) in glaucoma patients of African heritage in St. Lucia, West Indies and Durban, South Africa. These results are encouraging because both medication and incisional surgery are impractical long-term options in rural sub-Saharan Africa, where glaucoma is the leading cause of permanent blindness, and facilities and financial resources are scarce, with only one opththalmologist per million population. This study assesses the potential utility of SLT among a rural population in one of Africa's most economically deprived regions at the Eyes of Africa Clinic, a facility where wind and solar power provide the only reliable source of electrical power.

Methods : Consenting adult glaucoma patients with inadequate IOP control on a single topical agent were offered the opportunity to undergo SLT treatment in either or both eyes. Baseline IOP values were compared with those obtained at 1-2 wks, 4, 8 & 12 wks by paired t-test. Laser settings were agressive, aiming to elicit champagne bubbles from the trabecular meshwork with each application. The Latina SLT lens was used with the Ellex Tango YAG/SLT. Topical brimonidine and proparacaine were applied prior to treatment, and prednisolone acetate 1% immediately afterward.

Results : 112 eyes of 79 patients on topical monotherapy (102 on timolol; 18F,61M; mean age 61.9(+/-sem2.3) underwent 360 degree SLT with a mean of 106(+/-3) applications at mean 1.65(+/-0.04)mJ. Their mean pre-treatment IOP was 29.6(+/-1.8)mmHg. 1-2 wks post laser mean IOP values were unchanged (29.6(+/-1.8)). By 4 weeks post-SLT mean IOP had decreased to 24.8(+/-1.7)mmHg (P=0.0035). At 8 weeks the mean IOP was 20.4(+/-0.9)mmHg(P

Conclusions : Mean IOP reduction ~10 mmHg (was achieved at 3 months using aggressive SLT settings among the eyes of this central African population already receiving one topical antiglaucoma medication for their substantially elevated eye pressure. This IOP response is commensurate with response levels observed previously in South Africa and the West Indies, and is comparable in its extent to mean % IOP reduction typically associated with incisional glaucoma surgery.


This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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