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Clinical Advances of Glaucoma: Current Status and Prospects

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Special Issue Editors

Dr. Rubén Sánchez-Jean

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Guest Editor

Hospital Clinico San Carlos, Madrid, Spain
Interests: ophthalmology; glaucoma surgery; new devices in glaucoma treatment; quality of life in glaucoma patients; cataract surgery; IOLs designs

Dr. Carmen Dora Méndez-Hernández

E-Mail Website
Guest Editor

Hospital Clinico San Carlos, Madrid, Spain
Interests: glaucoma surgery; new devices in glaucoma treatment; childhood glaucoma; intraocular pressure; retinal nerve fiber layer; retinal ganglion cell; visual field; optical coherence tomography; angiography; retinography; filtering surgery; minimally invasive glaucoma surgery
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Dr. Federico Sáenz-Francés San Baldomero

E-Mail Website
Guest Editor

Hospital Clínico San Carlos de Madriddisabled, Madrid, Spain
Interests: glaucoma; cataract surgery; eye diseases; phacoemulsification; statistics; biostatistics; clinical research; clinical ophthalmology; ophthalmology; epidemiology

Special Issue Information

Dear Colleagues,

Glaucoma currently encompasses a group of chronic and progressive diseases with no single and definitive treatment. The use of hypotensive eye drops entails a series of limitations, such as difficulty in patient compliance, lack of response in some patients, decreased hypotensive efficacy over time, and prolonged use leading to alterations in the ocular surface. Another treatment option is laser, but its hypotensive effect is of limited duration, and it is not free of complications. Filtering surgery is usually the most effective procedure for reducing intraocular pressure, but it is relatively frequently associated with the presence of complications such as hypotony, blebitis, endophthalmitis, transient loss of visual acuity, etc.

In recent years, surgical techniques have been sought that are effective in the long term with a lower incidence of complications and that are simple and easily reproducible. In this regard, multiple devices have recently been designed that facilitate the exit of aqueous humor in a minimally invasive manner through different routes: trabecular meshwork, suprachoroidal space, and subconjunctival space.

In addition, widely known technology, such as the excimer laser or the femtosecond laser, is being implemented in glaucoma surgery.

Dr. Rubén Sánchez-Jean
Dr. Carmen Dora Méndez-Hernández
Dr. Federico Sáenz-Francés San Baldomero
Guest Editors

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15 pages, 1210 KiB

Open AccessArticle

Two-Year Outcome of Selective Laser Trabeculoplasty for Normal-Tension Glaucoma in Japan: First-Line or Second-Line Selective Laser Trabeculoplasty (FSS) Study

by Tomoko Naito, Koji Nitta, Takako Miki, Akiko Narita, Tairo Kimura, Yasushi Ikuno, Shiro Mizoue, Maki Katai, Yoshiaki Saito, Mami Nanno, Naoki Tojo, Naoto Tokuda, Shigeki Yamabayashi, Katsuyoshi Suzuki, Kimihito Konno, Hiroaki Ozaki, Toru Nakazawa, Tadashi Nakano, Kenji Nakamoto, Naoya Nezu, Shigeru Mori, Kazuyuki Hirooka, Itaru Kimura, Takeshi Sagara, Toyoaki Tsumura, Aika Tsutsui, Kae Sugihara, Takuji Matsuda, Yoshitaka Tasaka, Satoru Tsuda, Tomoyuki Watanabe, Naka Shiratori, Yutaro Tobita, Kaori Komatsu, Akiko Harano, Kazuhisa Sugiyama, Keiji Yoshikawa and Masaki Tanito Show full author list Hide full author list

J. Clin. Med. 2025, 14(10), 3459; https://doi.org/10.3390/jcm14103459 - 15 May 2025

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Abstract

Objectives: The objective of this study is to investigate the two-year continuous efficacy, risk factors, and safety profile of selective laser trabeculoplasty (SLT) in Japanese individuals diagnosed with normal-tension glaucoma (NTG) who underwent SLT as either a first-line or second-line treatment. Methods: A retrospective chart review was conducted of patients with NTG who underwent SLT as either an initial or secondary therapy at 26 medical institutions in Japan between January 2020 and December 2021 with a 2-year follow-up. The primary endpoint was a reduction in the rate of intraocular pressure (IOP) over 2 years after SLT. To estimate the time-varying effect of IOP reduction, a linear mixed-effects model was employed. The secondary endpoints were numerical IOP reduction, treatment success rates shown by a Kaplan–Meier analysis, and complications. Success was defined as an outflow pressure improvement rate (ΔOP) ≥ 20% (definition A) or an IOP reduction rate ≥ 20% (definition B) without further treatment. A Cox proportional hazards regression analysis was used to identify the risk factors to successful SLT treatment. The study was registered with UMIN-CTR (ID: UMIN R000064045). Results: A total of 230 eyes from 230 individuals participated in this study, with 148 eyes receiving SLT as an initial (first-line) therapy and 82 eyes undergoing SLT as a secondary (second-line) intervention. In the first-line group, the mean IOP dropped from 16.7 ± 2.3 mmHg to 13.7 ± 2.4 mmHg at two years post-treatment, reflecting a 16.8% reduction. In the second-line group, the average IOP declined from 15.9 ± 2.5 mmHg to 13.2 ± 2.0 mmHg, marking a 14.4% decrease over the same period. The treatment success rate according to definition A (ΔOP ≥ 20%) was 73.7% at 2 years. Analysis using a linear mixed-effects model identified time (p < 0.001), age (p = 0.044), baseline IOP (p < 0.001), and central corneal thickness (CCT) (p < 0.001) as statistically significant contributors to IOP reduction following SLT. However, neither the Group (first-line vs. second-line) variable (p = 0.386) nor the Time × Group interaction (p = 0.298) reached statistical significance. A lower baseline IOP and a thicker CCT were confirmed as significant predictors of SLT treatment failure. Conclusions: Both initial and secondary SLT treatments for NTG proved to be effective and safe over a two-year period, although the extent of IOP reduction was smaller in cases with a lower baseline IOP. Our findings indicate that the IOP-lowering effect of SLT in NTG is influenced by pretreatment IOP levels, aligning with previous studies on primary open-angle glaucoma and ocular hypertension. However, in contrast to those earlier findings, our research identified pretreatment central corneal thickness as a statistically significant factor influencing SLT efficacy in NTG. These results support the role of SLT as a reliable and safe therapeutic option for managing NTG. Full article

(This article belongs to the Special Issue Clinical Advances of Glaucoma: Current Status and Prospects)

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