New findings from a study published in the Journal of Glaucoma evaluated whether patients taking systemic immunosuppressive medications experience a different intraocular pressure (IOP)-lowering response to selective laser trabeculoplasty (SLT) compared to immunocompetent patients.
Give me some background first.
Due to the fact that an immune or inflammatory response is required for IOP reduction after SLT, a research team from the Mayo Clinic of Rochester, Minnesota, sought to determine if the efficacy would be reduced in glaucoma patients on systemic immunosuppressive therapies.
And this study?
In this retrospective study, investigators identified all patients who underwent SLT at Mayo Clinic between 2017 and 2021.
Patients on systemic immunosuppressive medications at the time of SLT were compared to control patients; the percentage of patients who did not require additional therapy at each follow-up period was also noted.
Go on…
In total, the research team included 108 eyes of 72 patients who underwent SLT while on systemic immunosuppressive medications and 1,997 eyes of 1,417 patients in the control group.
The primary endpoint of the study was to assess the percentage of IOP reduction at 1-2, 3-6, and 12 months.
Findings?
Initially, the IOP-lowering effect was similar between groups; however, after 12 months, the IOP reduction in the immunosuppressive group was significantly less compared to the control group.
Talk numbers.
The change in IOP between the immunosuppressive and control groups after SLT were as follows:
- 1-2 months: −18.8±20.7% vs. −16.0±16.5%, P=0.256
- 3-6 months: −15.2±21.6% vs. −18.3±23.2%, P=0.062
- 12 months: −15.1±21.2% vs. −20.3±22.9%, P=0.045
What about additional treatments?
Investigators observed no difference between groups in the number of additional treatments during the study interval.
Expert opinion?
While the study was unable to confirm or reject a particular immune-mediated pathway involved in the IOP-lowering effect of SLT, “ the differences in IOP between groups suggests that the immune system does play a role in IOP regulation in patients who underwent SLT,” the study authors wrote.
“It is possible that a patient’s underlying diagnosis may also alter their immune-mediated response to SLT either separately from or in addition to the immunosuppressive agent itself,” they added.
Take home.
While patients in the systemic immunosuppressive therapy group experienced similar early IOP-lowering following SLT compared to the control group, the treatment response was significantly diminished at 12 months.
What’s next?
Additional studies on the efficacy of IOP reduction after SLT in immunosuppressed patients are required to further elucidate this systemic immune-mediated pressure response.