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Selective laser trabeculoplasty: adverse effects of prior topical anti-glaucoma medication

Eye (2026)Cite this article

Subjects

Abstract

Objectives

To determine the long-term effect of the administration of topical anti-glaucoma medications on Selective Laser Trabeculoplasty (SLT) efficacy and to identify other potential risk factors for failure of SLT.

Methods

A single-centre, observational cohort study of 264 SLT procedures performed on 127 patients over a 10-year period. Data collected included the absolute number of anti-glaucoma drops administered, intraocular pressure (IOP) and the number of anti-glaucoma medications at each visit. A Cox’s proportional hazards regression analysis was performed to analyse various risk factors. A multivariate logistic regression model for failure in the first 12 months was constructed to adjust for potential confounders, including age, pre-SLT IOP, treatment duration, disease duration, total number of pre-SLT drops administered and SLT energy delivered.

Results

A greater number of pre-SLT drop administrations was identified as a risk factor for failure of SLT. At 12 months, the complete success rate of SLT for eyes unexposed to drops was 62%, for those to a moderate number of drops, 36–41% and for those to a high number of drops, only 2%. Other statistically significant risk factors included duration of drop therapy, exposure to drop preservatives, disease duration, age, previous cataract surgery, lower pre-SLT IOP and a lower SLT energy level.

Conclusions

Long-term exposure to topical anti-glaucoma medication (especially if preserved), longer duration of disease and therapy, together with older age and prior cataract surgery, may all have a significant adverse effect on SLT outcome.

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Fig. 1: Calculation of drop exposure and effect on SLT outcome.

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Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

References

  1. Quigley HA. Glaucoma. Lancet. 2011;377:1367–77.

    Article  PubMed  Google Scholar 

  2. Damji KF, Shah KC, Rock WJ, Bains HS, Hodge WG. Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial. Br J Ophthalmol. 1999;83:718–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Sherwood KA, Murray S, Kurban AK, Tan OT. Effect of wavelength on cutaneous pigment using pulsed irradiation. J Investig Dermatol. 1989;92:717–20.

    Article  CAS  PubMed  Google Scholar 

  4. Alvarado JA, Katz LJ, Trivedi S, Shifera AS. Monocyte modulation of aqueous outflow and recruitment to the trabecular meshwork following selective laser trabeculoplasty. Arch Ophthalmol. 2010;128:731–7.

    Article  PubMed  Google Scholar 

  5. Kagan DB, Gorfinkel NS, Hutnik CM. Mechanisms of selective laser trabeculoplasty: a review. Clin Exp Ophthalmol. 2014;42:675–81.

    Article  PubMed  Google Scholar 

  6. Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial [published correction appears in Lancet. Lancet. 2019;393:1505–16.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gazzard G, Konstantakopoulou E, Garway-Heath D, Adeleke M, Vickerstaff V, Ambler G, et al. Laser in glaucoma and ocular hypertension (LiGHT) trial: six-year results of primary selective laser trabeculoplasty versus eye drops for the treatment of glaucoma and ocular hypertension. Ophthalmology. 2023;130:139–51.

    Article  PubMed  Google Scholar 

  8. NICE. Selective laser therapy recommended to treat glaucoma and ocular hypertension. Available from: https://www.nice.org.uk/news/article/selective-laser-therapy-recommended-to-treat-glaucoma-and-ocular-hypertension.

  9. Murdoch IE, Morris SS, Cousens SN. People and eyes: statistical approaches in ophthalmology. Br J Ophthalmol. 1998;82:971–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Hamard P, Debbasch C, Blondin C, Brignole F, Loison-Dayma K, Warnet JM, et al. Apoptose et cellules trabéculaires humaines: évaluation in vitro de l’effet du bétaxolol avec ou sans conservateur [Human trabecular cells and apoptosis: in vitro evaluation of the effect of betaxolol with or without preservative]. J Fr Ophtalmol. 2002;25:777–84.

    CAS  PubMed  Google Scholar 

  11. Baudouin C, Denoyer A, Desbenoit N, Hamm G, Grise A. In vitro and in vivo experimental studies on trabecular meshwork degeneration induced by benzalkonium chloride (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2012;110:40–63.

    PubMed  PubMed Central  Google Scholar 

  12. Hamard P, Blondin C, Debbasch C, Warnet JM, Baudouin C, Brignole F. In vitro effects of preserved and unpreserved antiglaucoma drugs on apoptotic marker expression by human trabecular cells. Graefes Arch Clin Exp Ophthalmol. 2003;241:1037–43.

    Article  CAS  PubMed  Google Scholar 

  13. Alvarado J, Murphy C, Polansky J, Juster R. Age-related changes in trabecular meshwork cellularity. Investig Ophthalmol Vis Sci. 1981;21:714–27.

    CAS  Google Scholar 

  14. Lee JW, Wong MO, Liu CC, Lai JS. Optimal selective laser trabeculoplasty energy for maximal intraocular pressure reduction in open-angle glaucoma. J Glaucoma. 2015;24:e128–e131.

    Article  PubMed  Google Scholar 

  15. Radcliffe N, Gazzard G, Samuelson T, Khaw P, Sun X, Aung T, et al. Energy dose-response in selective laser trabeculoplasty: a review. J Glaucoma. 2022;31:e49–e68.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sacks Z, Katz LJ, Gazzard G, Van Tassel SH, Blumenthal EZ, Lerner F, et al. A Proposal for the use of a fixed low-energy selective laser trabeculoplasty for open-angle glaucoma. J Glaucoma. 2024;33:1–7.

    Article  PubMed  Google Scholar 

  17. Fahy ET, Montesano G, Garg A, Konstantakopoulou E, Gazzard G. The impact of baseline intraocular pressure on initial treatment response in the LiGHT Trial. Ophthalmology. 2024;131:1366–76.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to all the patients for taking part in the study.

Author information

Authors and Affiliations

  1. Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK

    Toby S. Al-Mugheiry & David C. Broadway

  2. Norwich Medical School, University of East Anglia, Norwich, UK

    Ian Nunney

  3. School of Pharmacy, University of East Anglia, Norwich, UK

    David C. Broadway

Authors
  1. Toby S. Al-Mugheiry
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  2. Ian Nunney
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  3. David C. Broadway
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Contributions

DCB was responsible for study design and conceptualisation; data collection; editing and finalisation of the manuscript. TA carried out data analysis, drafting, editing and finalisation of the manuscript. IN carried out full statistical analyses and editing of the manuscript. All authors reviewed and approved the final manuscript.

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Correspondence to Toby S. Al-Mugheiry.

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Al-Mugheiry, T.S., Nunney, I. & Broadway, D.C. Selective laser trabeculoplasty: adverse effects of prior topical anti-glaucoma medication. Eye (2026). https://doi.org/10.1038/s41433-026-04273-y

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