Selective laser trabeculoplasty for primary open-angle glaucoma patients younger than 40 years

Objective: To evaluate the efficacy of selective laser trabeculoplasty (SLT) among patients with juvenile-onset primary open-angle glaucoma (JOAG). Methods: Patients diagnosed with JOAG who were not controlled on medical therapy were offered a trial of SLT. The patients were followed up prospectively for 1, 3, 6, and 12 months postlaser to evaluate the efficacy of SLT as second-line therapy. Success was defined as an intraocular pressure (10P) reduction of >= 20% at 12 months without the need for further medication, laser, or surgery. Factors associated with success/failure, prelaser 10P, age, and angle dysgenesis on gonioscopy were analysed. Results: The average prelaser 10P in these JOAG eyes (n = 30) was 25.3 +/- 6.5 mm Hg, which reduced to 17.3 +/- 5.8 mm Hg at 12 months (p = 0.01). All patients were of Indian ethnicity. Out of 30 eyes, at 12 months post-SLT, 13 (43%) eyes had at least a 20% reduction in IOP. In the eyes that achieved success, the average reduction of 10P was 37.6%. There was no difference in the prelaser 10P between those with success (25.5 +/- 5.6 mm Hg) and those that failed (25.1 +/- 8 mm Hg; p = 0.8), nor was there a difference in the mean age between successful cases (34.4 +/- 9.4 years) and failures (31.6 +/- 8.9 years; p = 0.4). However, those without angle dysgenesis were 4 times (CI 1.1-15.2) more likely to succeed with SLT than those with angle dysgenesis (p = 0.03). Conclusions: A significant proportion of patients with JOAG can benefit from an 10P reduction after SLT. Those with gonioscopically normal-appearing angles are more likely to respond to SLT.