title: Efficacy of selective laser trabeculoplasty in primary angle-closure glaucoma: a randomized clinical trial.
abstract: OBJECTIVE
  Selective laser trabeculoplasty (SLT) should be explored as a therapeutic option in eyes with angle closure.
  
  
  OBJECTIVE
  To assess the intraocular pressure (IOP)-lowering efficacy of SLT in eyes with primary angle closure (PAC) and PAC glaucoma (PACG).
  
  
  METHODS
  Randomized clinical trial at tertiary eye care institutions of 100 patients diagnosed as having PAC or PAC glaucoma in which the angles had opened at least 180° (visible posterior trabecular meshwork on gonioscopy) after laser iridotomy. Recruitment and baseline were completed from June 2009 to April 2012 and 6-month follow-up was completed from December 2009 to November 2012.
  
  
  METHODS
  Eligible patients with a baseline IOP greater than 21 mm Hg were randomized to either SLT or prostaglandin analog (PGA; travoprost, 0.004%). The SLT was repeated if the IOP reduction was less than 20.0% from baseline at the 1- or 3-month follow-up visit.
  
  
  METHODS
  The primary outcome measure was the change in IOP from baseline to the final follow-up visit (at 6 months). The frequency of additional postoperative treatments and complications were secondary outcomes.
  
  
  RESULTS
  Fifty patients (96 eyes) were randomized to SLT and 50 patients (99 eyes) to PGA medical therapy. At 6 months, 49 patients in the SLT group and 47 in the PGA group completed follow-up. Analysis was based on intent to treat. At 6 months, IOP decreased by 4.0 mm Hg (95% CI, 3.2-4.8) in the SLT group (P < .001) and by 4.2 mm Hg (95% CI, 3.5-4.9) in the PGA group (P < .001). There were no differences between the SLT and PGA groups in the absolute mean reduction of IOP (4.0 vs 4.2 mm Hg, respectively; P = .78) or in the percentage of reduction in IOP (16.9% vs 18.5%, respectively; P = .52). Complete success (IOP ≤21 mm Hg without medications) was achieved in 60.0% eyes of the SLT group, compared with 84.0% of eyes in the PGA group (P = .008). No patients required glaucoma surgery. Additional medications were required in 22.0% of patients in the SLT group compared with 8.0% in the PGA group (P = .05). One patient in the SLT group (2.0%) had a transient posttreatment IOP spike greater than 5 mm Hg. The mean endothelial cell count showed a significant decrease from baseline in the SLT arm (4.8% decrease; P = .001). No other events such as persistent uveitis or increase in peripheral anterior synechiae were noted in eyes that underwent SLT. Two patients in the PGA group exited owing to drug-related complications (1 patient with uveitis and 1 with allergic conjunctivitis).
  
  
  CONCLUSIONS
  Eyes with PAC or PACG respond to SLT in the short term, but the overall long-term therapeutic effectiveness needs further evaluation.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01004900.
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Arun
authors.initials: A
authors.lastname: Narayanaswamy
authors.affiliation: Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Leung
authors.affiliation: Jakarta Eye Center, Jakarta, Indonesia.
authors.forename: Donny V
authors.initials: DV
authors.lastname: Istiantoro
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Shamira A
authors.initials: SA
authors.lastname: Perera
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Ching-Lin
authors.initials: CL
authors.lastname: Ho
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Monisha E
authors.initials: ME
authors.lastname: Nongpiur
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Mani
authors.initials: M
authors.lastname: Baskaran
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Hla M
authors.initials: HM
authors.lastname: Htoon
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Tina T
authors.initials: TT
authors.lastname: Wong
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Goh
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Su
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore4Goldschleger Eye Research Institute, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Belkin
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore5Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Tin
authors.initials: T
authors.lastname: Aung
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003008:Cloprostenol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods*; D000069557:Travoprost; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D003008:Cloprostenol; D000069557:Travoprost