“Selective Laser Trabeculoplasty as a Substitute for Medications in Patients with Mild-to-moderate Glaucoma in the Brazilian Public Health System”

Abstract

Précis: Selective laser trabeculoplasty can be used as a substitute for medications in patients with mild-to-moderate glaucoma, reducing the cost of eye drop distribution in the Brazilian public health system. Purpose: To observe the effectiveness of selective laser trabeculoplasty (SLT) as a substitute for eye drops in patients with open-angle glaucoma in the Brazilian Public Health System. Materials and methods: SLT was performed bilaterally after medication washout. This is a prospective interventional study, comparing intraocular pressure (IOP) when using eye drops, at baseline (post-washout), and at 12-month follow-up, after SLT. Medication was added if the target IOP was not achieved, following the Brazilian Public Health System eye drops protocol, based on medication costs. Absolute (without eye drops) and qualified (with eye drops) success were measured with IOP ≤ 21, IOP ≤ 18, IOP ≤ 15 and IOP ≤ 12 mmHg. Besides IOP evolution, ability to reduce IOP (in %), and eye drops reduction were evaluated. Results: 92 eyes of 46 patients were included, 70 eyes with mild glaucoma and 22 with moderate glaucoma, mean number of eye drops 2.26±1.06 (82.6% were using a prostaglandin analogue) and post-washout IOP of 21.10±5.24 mmHg. There was relative success at IOP ≤18 mmHg, where the mild group had greater success than the moderate group (88.1% vs. 71.4%, P=0.824). The average IOP reductions were 23.04% and 25.74% at 6 and 12 months, respectively. The average number of eye drops was 1.02, with 1.1% using a prostaglandin analogue. Furthermore, 68.19% of the patients had a decrease in the quantity of eye drops used. Conclusion: SLT is effective in reducing IOP and replacing eye drops in patients in the Brazilian Public Health System. Moreover, there was a significant reduction in the use of prostaglandin analogues.