Clinical Results of Selective Laser Trabeculoplasty

Abstract

Purpose: Selective laser trabeculoplasty (SLT) is a new laser procedure using a frequency-doubled Q-switched Nd:YAG laser (wavelength: 532 mm). The laser parameters are set to selectively target pigmented trabecular meshwork (TM) cells without coagulative damage to the TM structure or non-pigmented cells. We investigated the safety and efficacy of SLT in lowering intraocular pressure (IOP). Subjects and Methods: Sixty-seven eyes of 67 patients with uncontrolled open angle glaucoma were treated with the Coherent Selecta 7000 ® (Coherent Inc., Palo Alto, CA). Nineteen of 67 patients had previously received argon laser trabeculoplasty. A total of approximately 60 non-overlapping spots were placed over 180 degrees of the TM ranging from 0.5 to 1.0 mJ per pulse. The maximum energy level at which no bubble formation was observed determined choice. Results: The average preoperative IOP was 22.4 mm Hg. Six months after the operation, mean IOP reduction was 4.4 mm Hg, and mean outflow pressure (OP) reduction was 38.1%. One month after the operation 68.7% of patients responded to treatment with an OP reduction of at least 20% (“responders”). Transient IOP elevation of 5 mm Hg or greater was seen in 25.4% of patients. The success rate at 6 months after operation was 64.6% for all patients (67 eyes) and 78.2% for the responders (46 eyes). An analysis using a Cox proportional hazard model showed that a low preoperative IOP was the significant determinant for success, and the hazard ratio for the IOP increase of 5 mm Hg was 2.12. Other factors such as age, gender, past history of ALT, and goniopigment were not significantly related to success. Conclusion: SLT appears to be a safe and effective way to lower IOP.