Selective Laser Trabeculoplasty in Northern Ghana

J Simon ^1,T Kenny^2, Murdoch ³

1. Director, Northern Community Eye Hospital, BA 108 Chinkara St, Rice City, Gumani, Tamale, Ghana NS-151-7998.
2. Retired General Practitioner, United Kingdom.
3. Honorary Associate Professor, Institute of Ophthalmology, University College London, UK.

OPEN ACCESS

PUBLISHED: 31 January 2025

CITATION: SIMON, J; KENNY, T; MURDOCH, I. Selective Laser Trabeculoplasty in Northern Ghana. Medical Research Archives, Available at: <https://esmed.org/MRA/mra/article/view/6141>.

COPYRIGHT: © 2025 European Society of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI: https://doi.org/10.18103/mra.v13i1.6141

ISSN 2375-1924

ABSTRACT

We report on a cohort of 283 selective laser trabeculoplasties (SLTs) for open angle glaucoma in Northern Ghana, from April 2022 to September 2024. Because of cofiltration between right and left eye response therapy, 145 eyes individuals with primary open angle glaucoma were included in the analysis. Outcomes were assessed at 1, 3, and 12 months post index procedure. A success proportion of 75% (33/44) for eyes with pre-operative IOP < 21 mmHg was found. No complications at 1 year were noted. This is comparable to an African context but not in a Caucasian context.

Keywords

• Selective Laser Trabeculoplasty
• Open Angle Glaucoma
• Northern Ghana
• Intraocular Pressure
• Success Rate

Introduction

Glaucoma, as a group of chronic ocular diseases characterized by progressive optic nerve damage, is a major public health concern worldwide, including in Ghana. The principal therapy for primary open angle glaucoma is the lowering of intraocular pressure. This is done by medicine, surgery or laser. Selective Laser Trabeculoplasty (SLT) has emerged as a minimally invasive and effective treatment option for open angle glaucoma. Like its predecessor argon laser trabeculoplasty, SLT targets the trabecular meshwork. It uses a large spot size with low energy, which is thought to induce a fraction (about 10%) of the trabecular meshwork to be treated, while the remainder of the tissue is preserved. SLT does not result in reduction of the intraocular pressure; it is a risk-free procedure and can be repeated.

Inclusion criteria

1. Primary open angle glaucoma, pseudoexfoliation syndrome, rubiosis, trauma, etc.

2. Any contraindication to SLT (e.g., unable to sit at the laser-mounted slit-lamp, past history of or active uveitis, inadequate visualization of trabecular meshwork)

3. Congenital or secondary glaucoma

4. Visually significant cataract with intention to undergo cataract surgery in the subsequent year

5. Recent cataract surgery within 3 months

6. Any active treatment for another ophthalmic disease

7. Any history of retinal ischemia, macular oedema, diabetic retinopathy, age-related macular degeneration

8. Any previous intraocular surgery, except uncomplicated cataract surgery more than 3 months prior to recruitment

9. Pregnancy at the time of recruitment, or intention to become pregnant within the duration of the trial

Of these 145, 61 were female and 74 were male; the mean age at treatment was 62 years (SD 16) ranging from 6-96mmHg. 22 eyes had repeat SLT during the study period. The mean pre-operative IOP at 2 months, 5 months and 12 months post SLT was 21.6mmHg (SD 16.3), 17.9mmHg (SD 12.1) and 15.8mmHg (SD 10.1) respectively. The mean percentage reduction in IOP was 28.6% (SD 29.1). The success rate at 12 months was 61% (89/145) with a 20% reduction in IOP from baseline.

Discussion

The landmark paper for SLT in the African context is Philip et al. Their criteria for success however differed from ours. Only eyes with presenting IOP above 21mmHg were included in the trial, both eyes in an individual were eligible and success was tiered at <18mmHg in those with ‘severe’ glaucoma and <21mmHg in those with less severe glaucoma. On this basis the closest comparator would be any reduction in IOP in our cohort. At 61% success rate, our findings of 75% (33/44) at 12 months is comparable to the African context but not in a Caucasian context. This study is limited by the fact that it is a retrospective study and the sample size is small.

Conclusion

We report an audit of SLT undertaken in Northern Ghana with a 75% success proportion in African patients but lower than Caucasian studies. No adverse effects were experienced. This points to the need for further studies to assess the efficacy and safety of SLT as an important element in primary open angle glaucoma management in this region.

References

1. J. Simon, K. Kenny, T. Murdoch, 2024. Selective Laser Trabeculoplasty in Northern Ghana. The Lancet Global Health, Current Opinion in Ophthalmology 32(2):141-147, March 2021.
2. Glaucoma: now and beyond. Lancet, Jayaram K, Ho K, Friedman DS, Gazard G, 2023 Nov 11;402(10144):1788-1801.
3. Is laser trabeculoplasty the new star in glaucoma treatment? Tubert-Thomas, Marcia; Meyer-Gibbons, Francesca, Current Opinion in Ophthalmology 32(2):141-147, March 2021.
4. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LIGHT): a multicentre randomised controlled trial. Gazard G, Ambler G, et al., The Lancet 2018; 391: 1010-1015.
5. Awareness of Glaucoma and Eye Health. Murdoch C, Opoku K, Murdoch IJ, Glaucoma. 2016 Oct;25(10):850-854.
6. Factors associated with adherence to treatment in patients with open angle glaucoma. Kennedy A, Gilbert C, Murdoch I. 2018; 1505-1516.