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West Indies Glaucoma Laser Study (WIGLS) 3. Anterior Chamber Inflammation Following Selective Laser Trabeculoplasty in Afro-Caribbeans with Open-angle Glaucoma

Realini, Tony MD, MPH*; Shillingford-Ricketts, Hazel MD; Burt, Darra MD; Balasubramani, Goundappa K. PhD§

doi: 10.1097/IJG.0000000000001250
Original Studies

Precis: In the absence of prophylactic anti-inflammatory therapy, anterior chamber inflammation (characterized by cells and less commonly flare) is minimal and transient after selective laser trabeculoplasty in Afro-Caribbean glaucoma patients.

Purpose: The purpose of this study was to characterize the prevalence, severity, and duration of anterior chamber inflammation (cells and flare) following selective laser trabeculoplasty (SLT) in Afro-Caribbean eyes with primary open-angle glaucoma (POAG).

Methods: In total 144 eyes of 72 POAG patients underwent first-time 360-degree SLT treatment following washout of all topical medications in the prospective West Indies Glaucoma Laser Study. No anti-inflammatory therapy was used post-SLT. Anterior chamber cells and flare were characterized pre-SLT after medication washout, and 1 week, 6 weeks, and 3, 6, 9 and 12 months post-SLT using the standardized methodology described by the Society for Uveitis Nomenclature (SUN) in which cells and flare are each graded on a scale of 0-4+ using specific slit-lamp settings.

Results: Mean cell scores in both right and left eyes rose significantly (P<0.0001) from baseline to week 1 after SLT before returning to baseline values at all subsequent time points. Mean flare scores in right eyes (P=0.0185) but not left eyes (P=0.1816) rose from baseline to week 1 after SLT before returning to baseline values at all subsequent time points. Cells appeared in 40.3% of eyes and flare appeared in 9.7% of eyes after SLT. One subject developed bilateral symptomatic anterior iritis one day postoperatively and reported a previously undisclosed history of recurrent iritis; the iritis resolved with topical steroid therapy.

Conclusions: SLT in Afro-Caribbean people with POAG is associated with mild, short-lived and self-limited anterior chamber inflammation. Routine anti-inflammatory therapy to suppress posttreatment inflammation after SLT is unnecessary in this population.

*West Virginia University Eye Institute, Morgantown, WV

Harlsbro Medical Center, Roseau, Dominica

Saint Lucia Blind Welfare Association, Castries, Saint Lucia

§Department of Epidemiology, Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, PA

Supported by NIH R01 EY023620 (TR).

Disclosure: The authors declare no conflict of interest.

Reprints: Tony Realini, MD, MPH, 1 Medical Center Drive, Morgantown, WV 26506 (e-mail:

Received January 25, 2019

Accepted March 2, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.