25429421
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 .
METHODS	Recruitment and baselinewere 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 % ) .
METHODS	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 ) .
METHODS	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 .
RESULTS	At 6 months , 49 patients in the SLT group and 47 in the PGA group completed follow-up .
RESULTS	Analysis was based on intent to treat .
RESULTS	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 ) .
RESULTS	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 ) .
RESULTS	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 ) .
RESULTS	No patients required glaucoma surgery .
RESULTS	Additional medications were required in 22.0 % of patients in the SLT group compared with 8.0 % in the PGA group ( P = .05 ) .
RESULTS	One patient in the SLT group ( 2.0 % ) had a transient posttreatment IOP spike greater than 5 mm Hg .
RESULTS	The mean endothelial cell count showed a significant decrease from baseline in the SLT arm ( 4.8 % decrease ; P = .001 ) .
RESULTS	No other events such as persistent uveitis or increase in peripheral anterior synechiae were noted in eyes that underwent SLT .
RESULTS	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 .

