Long term effects on the lowering of intraocular pressure: selective laser or argon laser trabeculoplasty?

Abstract Objective Selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) are used to lower intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). We report long-term follow-up data comparing SLT to ALT. Design Follow-up of prospective randomized clinical trial. Participants Patients with glaucoma from the practices of three ophthalmologists at the University of Ottawa. Methods We randomized 176 eyes of 152 patients with uncontrolled IOP on maximal tolerated medical therapy (MTMT, with or without previous ALT) to undergo either SLT or ALT. Data were available for 142 eyes at 3 years, 134 eyes at 4 years, and 120 eyes at 5 years. The primary outcome was change in IOP from pretreatment baseline. Results Comparison of baseline parameters was similar in the two groups. Lowering of IOP were similar at 3 years (SLT –6.7 ± 7.1 vs ALT –6.1 ± 5.1); at 4 years (SLT 7.0 ± 7.7 vs ALT –6.3 ± 5.0); and at 5 years (SLT –7.4 ± 7.3 vs ALT –6.7 ± 6.6). There was no statistically significant change in IOP in either of the two groups. Medication changes were equivalent in each group. A number of interventions were required in both groups, cumulatively, over the 5-year follow-up period (49 SLT and 33 ALT). Survival analysis indicated that the time to 50% failure in each group was approximately 2 years. Conclusions The IOP-lowering effect of SLT and ALT was similar over 5 years in this group of patients with open-angle glaucoma on MTMT.