One-year Success Rate of Selective Laser Trabeculoplasty in Pseudoexfoliative Glaucoma: A Prospective Study.

To evaluate the effectiveness of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in Vietnamese patients with pseudoexfoliation glaucoma (PXG). This prospective, comparative study included a total of 64 eyes from PXG patients who had not previously received any antiglaucomatous medication. Patients were categorized into two groups: Group 1 consisted of 32 eyes treated with SLT as the initial therapy, while Group 2 comprised 32 eyes treated with Tafluprost 0.0015%. The baseline IOP before treatment ranged from 22 to 26 mmHg. There were no significant differences between the two groups in terms of mean cup/disc (C/D) ratio and retinal nerve fiber layer (RNFL) thickness. At the final visit, the mean percentage reduction of IOP was 26.73% in Group 1 and 27.15% in Group 2. SLT significantly reduced IOP in PXG patients, with outcomes comparable to Tafluprost. Treatment was more successful in eyes with higher trabecular pigmentation and early- stage glaucoma. Structural and functional parameters remained stable over 12 months. Side effects, including mild itchiness, IOP spikes, and anterior chamber reactions, were transient and manageable. No vision-threatening complications occurred, confirming SLT as a safe and effective first-line option for PXG in Vietnamese patients. SLT can be effectively used as a primary treatment for PXG. In cases of recurrent IOP elevation, a second SLT procedure can be administered alone or in combination with other medications.

Introduction To assess the safety and efficacy of selective laser trabeculoplasty (SLT) for ocular hypertension (OHT) induced by a dexamethasone (DEX) intravitreal implant. Materials and Methods We performed a retrospective study of patients who underwent an SLT procedure for ocular hypertension induced by injection of a DEX intravitreal implant. Patients had, at least, one injection of the DEX-implant for symptomatic macular edema. SLT was delivered to 360° of the trabecular meshwork in two sessions. The primary outcome was a decrease in IOP, evaluated at one, three, and six months after the SLT procedure. Results Twenty-six eyes of 22 patients were included. The mean intraocular pressure (IOP) measured after DEX-implant injection was 25.4 ± 5.4 mmHg, and the mean increase in IOP was 35.8 ± 14.6%. The mean follow-up after SLT was 18.3 ± 7.7 months. After SLT, the mean IOP dropped by 30.9% at one month (16.9 ± 4.5 mmHg, p=0.01), 33.6% at three months (16.0 ± 2.7 mmHg, p < 0.01), and 34.9% at six months (15.6 ± 2.1 mmHg, p < 0.01). Each patient had a minimum follow-up of 6 months after SLT. Eight eyes (31%) received a second DEX-implant injection after the SLT procedure without experiencing an increase in the IOP above 21 mmHg or >20%. No glaucoma surgery was required during the follow-up. The mean number of medications (1.65 ± 1.36) was significantly reduced at one (1.19 ± 1.20, p=0.04), three (0.96 ± 1.03, p < 0.01), and six months (0.77 ± 0.95, p < 0.01) after SLT. Conclusion SLT is an effective and safe procedure to control OHT following DEX-implant intravitreal injection.

Introduction/Objective. Pseudoexfoliation syndrome is characterized by abnormal production and accumulation of fibrillar, white-gray, ?dandruff-like? material in almost all ocular structures. The aim of this study was to examine effect of selective laser trabeculoplasty in pseudoexfoliation glaucoma patients. Methods. Thirty-two patients (47 eyes) with medically uncontrolled pseudoexfoliation glaucoma were enrolled. All the patients could not reach target intraocular pressure with maximal tolerated medical therapy before treatment. Selective laser trabeculoplasty was performed with about 100 non-overlapping spots. Intraocular pressure was measured one hour, seven days, four weeks, three, six, twelve, eighteen, and twenty-four months after the procedure. Results. The mean base intraocular pressure was 23.45 mmHg (SD = 3.07). Statistically significant reduction of mean intraocular pressure was observed at all follow-ups except one hour after treatment. Mean intraocular pressure after 24 months was 18.39 mmHg (SD = 1.82). Success, defined as intraocular pressure reduction from base intraocular pressure by more than 20% after 24 months, was achieved in 27 eyes (57.45%). We did not find any influence of sex and age on selective laser trabeculoplasty effects in pseudoexfoliative glaucoma patients. Baseline intraocular pressure is proved to be a reliable predictor of intraocular pressure-lowering effect, as there was a strong correlation between baseline intraocular pressure and the percentage of reduction of intraocular pressure after 24 months (r = 0.71, p &lt; 0.01). Conclusion. Selective laser trabeculoplasty is a safe and effective method for the reduction of intraocular pressure in pseudoexfoliation glaucoma patients and should be used more often in this challenging form of glaucoma. Baseline intraocular pressure seems to be a reliable predictor of success.

Reduction of intraocular pressure (IOP) is still the primary goal of glaucoma treatment. The aim of this prospective study was to examine the IOP lowering effect of selective laser trabeculoplasty (SLT) in patients on maximum tolerated medical therapy (MTMT), especially with regard to a potential influence of pseudophakia and topical prostaglandin analogues (PGA) on IOP reduction. A total of 30 patients with a diagnosis of primary open angle glaucoma, normal tension glaucoma and pseudoexfoliative glaucoma with uncontrolled IOP despite MTMT underwent SLT treatment circumferentially over 360°. Follow-up visits were conducted 1 day after SLT and then 1, 3, 6, 9, and 12 months post-treatment. The initial medication was continued unchanged for 3 months. Median follow-up was 11.97 ± 3.1 months, mean IOP at baseline was 19.60 ± 4.69mmHg, mean IOP reduction was -19.95 ± 17.14% 1 month after and -14.07 ± 23.57% 12 months after SLT (p < 0.001 and p = 0.003, respectively). Patients with higher baseline IOP had greater reduction of IOP after SLT (R(2) = 0.482, p < 0.001). Phakic patients had a significantly greater IOP reduction compared to pseudophakic patients (- 4.55 ± 4.45mmHg and + 2.75 ± 6.75mmHg, respectively, p = 0.010). Patients without PGA had a statistically insignificant greater IOP reduction compared to patients with PGA (- 7.40 ± 4.72mmHg and -2.48 ± 5.22mmHg, respectively, p = 0.066) and four patients needed additional surgery to lower IOP. Even in patients already on maximum IOP lowering medication, SLT has the potential to significantly reduce IOP up to 1 year after treatment. The IOP reduction is most pronounced in phakic eyes with high preoperative IOP.

The purpose of this nonrandomized study conducted at the Eye Clinic "Akhali Mzera" between October 2011 and November 2022 was to evaluate the intraocular pressure (IOP) reduction and side effects following selective laser trabeculoplasty (SLT). A total of 867 eyes of 558 patients with early to moderate primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PXG) phakic and pseudophakic were included in the study. The patients were treated with laser as primary therapy or adjunct laser with medication. The mean age of the study participants was 54.3 ± 5.2 years (range, 40 to 78 years) and 362 (64.9%) were males. The glaucoma diagnosis was POAG in 726 (83.7%) eyes and PXG in 141 (16.3%) eyes. Diabetes mellitus in 8% and systemic hypertension in 30% were noted. 736 eyes (84.9%) were on medications, and 130 (14.9%) eyes were treated with laser as primary therapy. Overall, the mean IOP after SLT was 17.8 ± 3.2mmHg, 18.8 ± 2.3 mmHg, and 23.4 ± 2.5 mmHg in the 12th month, 24th month, and 36th month respectively. About 20% of patients with POAG lost efficacy in 18 months post-treatment and in these eyes, the second SLT procedure was more effective than the first one. The number of drugs reduced from an average of 1.3 to an average of 1.0 was statistically significant with the inter-eye correlation. Those patients who were treated with laser as primary therapy with a baseline IOP of 25.4 mmHg ±2.9 mmHg had IOP reduction of 7.5 ± 3.1 mmHg at the last visit, and those who were on antiglaucoma medication with baseline IOP 23.9 ± 2.2 mmHg had IOP reduction of 4.8 ± 2.8 mmHg. IOP reduction at the last visit between POAG, and PXG was 6.5 mmHg and 7.9 mmHg, respectively. It was concluded that SLT is a safe and innovative technology that uses lasers to target only certain cells of the trabecular meshwork of the eye.

IMPORTANCE To our knowledge, this is the first study to investigate effectiveness and complication rates of resident-performed selective laser trabeculoplasty (SLT). OBJECTIVES To evaluate the effectiveness and complications of SLT performed by resident ophthalmologists and to identify predictors for success. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series of 81 patients with open-angle glaucoma undergoing 110 SLT procedures from November 17, 2009, through December 16, 2011, at the San Francisco Veterans Affairs Medical Center. INTERVENTION Resident-performed SLT. MAIN OUTCOMES AND MEASURES Intraocular pressure (IOP) reduction. Secondary outcomes included change in eyedrop medications, complication rates, and predictors of SLT success defined as a 20% reduction in IOP. RESULTS The mean IOP at baseline, defined as the average IOP of the 2 appointments prior to the SLT procedure, was 18.7 mm Hg. The mean decrease in postoperative IOP compared with baseline was 2.2 mm Hg (12%; 95% CI, 5%-19%) at 12 months and 3.3 mm Hg (18%; 95% CI, 13%-23%), 2.8 mm Hg (15%; 95% CI, 10%-21%), and 3.6 mm Hg (19%; 95% CI, 11%-27%) at 3, 6, and 24 months, respectively (all P &lt; .001, linear mixed-effects regression). Success rates were 36% (95% CI, 27%-47%) at 12 months and 41% (95% CI, 31%-53%), 50% (95% CI, 40%-60%), and 39% (95% CI, 26%-53%) at 3, 6, and 24 months, respectively. The most common complication was a temporary IOP spike, with increases of at least 6 mm Hg occurring in 7% (95% CI, 4%-14%) of the population. The largest IOP spike was 11 mm Hg. Increased number of laser shots performed was not associated with better IOP control but was associated with a reduction in number of eyedrop medications (P = .02). Increased baseline IOP was associated with an odds ratio for success of 1.24 (95% CI, 1.08-1.44) at 3 months, 1.20 (95% CI, 1.05-1.37) at 6 months, and 1.31 (95% CI, 1.13-1.53) at 12 months of follow-up (P = .003, P = .006, and P &lt; .001, respectively, logistic regression). In a multivariate analysis, baseline IOP remained the greatest predictor of effectiveness. CONCLUSIONS AND RELEVANCE Resident-performed SLT obtains outcomes similar to the IOP reduction reported in the literature for attending-performed SLT with low levels of complications. Increasing the number of shots in a treatment session may lead to less long-term need for eyedrop medications. In this patient group, higher baseline IOP was the strongest predictor of treatment effectiveness.

The Impact of Baseline Intraocular Pressure on Initial Treatment Response in the LiGHT Trial: Selective Laser Trabeculoplasty versus Medication

To assess effectiveness of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced elevated IOP. Retrospective review of 7 patients (7 eyes) with IOP elevation after intravitreal triamcinolone acetonide (4.0 mg/0.1 mL) injections for macular edema (6 patients) or central retinal vein occlusion (1 patient). Three patients had preexisting open angle glaucoma; 2 patients had preexisting ocular hypertension. Time between intraocular corticosteroid injection and subsequent increased IOP ranged from 5 to 29 weeks. After unsuccessful maximum tolerated medical therapy, patients underwent unilateral SLT between April 2003 and June 2005. IOP was measured 4 weeks prelaser; on the day of laser; within 3 weeks, and at 1, 3, and 6 months postlaser. Two-sample t test was used for analysis. The pre-SLT and post-SLT IOP measurements were the major outcome measures used to define the relative success of the SLT procedure. Seven patients were taking 4.0+/-0.8 ocular hypotensive medications before SLT. Preoperative IOP (mm Hg+/-SD) 38.4+/-7.3 decreased postoperative to 25.6+/-7.1 within 3 weeks (P<0.003), 25.9+/-8.8 at 1 month (P<0.007), 23.9+/-10.6 at 3 months (P<0.006), and 15.7+/-2.2 at 6 months (P<0.001). Four patients underwent a second SLT procedure. Two patients failed after the 3-month visit. IOP in fellow eyes of all patients was unchanged (P>0.080). SLT lowered (P<0.007) IOP in 5 eyes of 7 patients with steroid-induced increased IOP from 3 weeks to 6 months postoperative. Two patients required additional surgical procedures. Repeat SLT treatments may be necessary. SLT is a temporizing procedure to consider in patients with steroid-induced elevated IOP.

Selective laser trabeculoplasty has been found to be effective as an adjunct to topical medical therapy in glaucoma. This analysis examines the intraocular pressure lowering effect of laser trabeculoplasty in eyes with pseudoexfoliation on maximum medical therapy. A retrospective chart review was undertaken of 457 eyes of which 344 underwent a 360° selective laser trabeculoplasty treatment between 2008 and 2013. 94 of these eyes had pseudoexfoliation. Intraocular pressure values were analysed in 3 monthly intervals up to 60 months after selective laser trabeculoplasty. Exclusion criteria were narrow or closed angles as well as uveitic glaucoma and previous intraocular pressure lowering surgery. Patients mean age was 71 years±11.0 SD, 42.7% were male. At time point 12 months after selective laser trabeculoplasty the intraocular pressure lowering effect was significantly greater in eyes with pseudoexfoliation than in eyes without pseudoexfoliation (p=0.01; Mann-Whitney test). Up to 21 months after selective laser trabeculoplasty a significant intraocular pressure reduction of 2.76 mmHg±3.72 SD compared to baseline values could be seen in eyes with pseudoexfoliation (p=0.01; Wilcoxon Test). In this retrospective study a significant greater intraocular pressure lowering effect of selective laser trabeculoplasty could be seen in eyes with pseudoexfoliation compared to eyes without pseudoexfoliation only at time point 12 months after selective laser trabeculoplasty. Analyses revealed no significant intraocular pressure reduction compared to baseline values after 21 months in eyes with pseudoexfoliation and after 30 months in eyes without pseudoexfoliation.

PurposeTo study the effectiveness and safety of selective laser trabeculoplasty (SLT) for the treatment of advanced open‐angle glaucoma.MethodsWe carried out a prospective longitudinal study, including patients with advanced open‐angle glaucoma. Selective laser trabeculoplasty has been indicated either after failure of medical treatment or in cases of poor adherence to medical treatment. Measurements were obtained at 1 week, 1 month, 3 months and 6 months. Success was defined as a reduction in intraocular pressure (IOP) of more than 20% from baseline or a reduction of at least one antiglaucoma eye drops with stable intraocular pressure. A p value less than 0.05 was considered as statistically significant.ResultsFifty‐nine eyes were included in the study. Three types of glaucoma were present in our study: primary open‐angle glaucoma was the most common type followed by exfoliative glaucoma and pigmentary glaucoma. The success rate was 76.5% for failure of medical treatment and 80% for poor adherence. The most frequent side effects were the inflammatory reaction (18.6%) and the early IOP spikes (25.4%). The predictors of its effectiveness were the initial intraocular pressure (p = 0.03) and the percentage reduction in intraocular pressure at 1 month (p = 0.002).ConclusionsSelective laser trabeculoplasty is an effective and easy‐to‐perform physical treatment of advanced open‐angle glaucoma with a satisfactory safety profile (1,2). It overcomes poor adhesion problems. Our results need to be extended to assess long‐term success.Bibliography1. Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye (Lond). 2018 May;32(5):863–876.2. Sina Elahi, Harsha L Rao, Alina Dumitru, Kaweh Mansouri. Predictors of Success in Selective Laser Trabeculoplasty: Data From the Lausanne Laser Trabeculoplasty Registry. J Glaucoma. 2020 Jul;29(7):550–555.

Selective Laser Trabeculoplasty versus Argon Laser Trabeculoplasty in Glaucoma Patients Treated Previously with 360° Selective Laser Trabeculoplasty: A Randomized, Single-Blind, Equivalence Clinical Trial

Selective laser trabeculoplasty retreatment after prior argon laser trabeculoplasty: 1-year results

To compare selective laser trabeculoplasty (SLT) with conventional argon laser trabeculoplasty (ALT) in terms of hypotensive efficacy, anterior chamber inflammation, and pain reported by the patients treated. A prospective study performed on 40 consecutive patients. Group I (n = 20): SLT 180 degrees. Group II (n = 20): ALT 180 degrees. Intraocular pressure, flare (Laser-Flare-Meter, Kowa FM-500, Japan), and pain (Visual Analogue Scale) were measured before treatment and 1 h, 24 h,1 week, and 1, 3 and 6 months after treatment. Statistically significant differences were determined by an independent-sample Student's t-test. At 6 months after treatment, pressure reduction was similar in both groups: SLT 22.2% (range 0-36.3%) and ALT 19.5% (range 0-30.2%), P= 0.741. The energy released during treatment was significantly lower in SLT (48.3 SD 7.4 mJ) than in ALT (4321 SD 241.7 mJ), P < 0.001. At 1 h after treatment,anterior chamber flare was also lower in SLT(13.3 SD 6.3 vs 20.7 SD 7.4 photons/ms),P = 0.003. Pain reported by the patients during the treatment was significantly lower in SLT(2.0 SD 0.7 vs 4.3 SD 1.3), P<0.001. The hypotensive efficacy of both lasers at the end of follow-up was similar. The energy released during treatment and inflammation produced in the anterior chamber in the immediate postoperative period were significantly lower for SLT. The SLT procedure was better tolerated, producing less discomfort during treatment than conventional trabeculoplasty with argon.

To determine the intraocular pressure (IOP)-lowering efficacy of repeat 360° selective laser trabeculoplasty (SLT) in patients with open-angle glaucoma having undergone prior successful 360° SLT. A retrospective chart review of 38 eyes of 38 patients with open-angle glaucoma (primary, pseudoexfoliation or pigmentary glaucoma) uncontrolled on medical therapy who had undergone two successive 360° SLT treatments, in whom first SLT was deemed clinically successful through a minimum of 6 months follow-up and who were followed for a minimum of 30 days after second SLT. Mean IOP at each postoperative time point (1, 3, 6, 12, 18 and 24 months) was compared with baseline using paired t tests. IOP changes after initial and repeat SLT were evaluated separately. Mean (SD) baseline IOP before initial SLT was 21.6 (4.8) mm Hg. Mean IOP following initial SLT was significantly below baseline through 24 months of follow-up, with mean IOP at months 1-24 ranging from 15.9 to 18.6 mm Hg. Mean baseline IOP before repeat SLT was 19.1 (3.9) mm Hg, with a significant reduction in IOP from baseline through 24 months follow-up with mean IOP ranging from 14.7 to 17.0 mm Hg. Kaplan-Meier survival analysis showed longer median survival time for repeat SLT compared with initial SLT. No safety issues were observed with repeat SLT. Repeat SLT can restore IOP control in eyes with open-angle glaucoma that have previously undergone successful initial SLT. Repeat SLT achieves comparable absolute level of IOP control achieved by initial SLT.

To assess the effectiveness of selective laser trabeculoplasty (SLT) in Indian eyes with open-angle glaucoma (OAG). Single-center, prospective, interventional study. Patients undergoing SLT from January 2014 to June 2018 for OAG were included in the study. Treatment-naive naive as well as patients on antiglaucoma medications (AGM) with suboptimal intraocular pressure (IOP) control were included. The main outcome measure was the percentage reduction in IOP. Complete success was defined as IOP reduction > 20% from baseline after 12 months or reduction in the number of AGM. Qualified success was defined as > 20% IOP reduction at 12 months with AGM. Secondary outcomes were occurrence of adverse events and factors predicting treatment outcomes. A total of 104 eyes of 62 Indian patients underwent SLT for OAG. Eighty-three (79.81%) eyes were treatment-naïve, and 21 (20.19%) eyes were on AGM. The median (IQR) baseline IOP was 20 (16-26) mmHg. At 12 months, the median IOP was 16 (4-19) mmHg, the median decrease in IOP was 4 (0-6.5) mmHg, and the percentage reduction in IOP was 17.42% (0%-30.76%). Maximum IOP reduction was noted at 12 months. Overall, success was achieved in 48 (46.15%) patients. Five eyes (4.8%) experienced minor SLT-related complications. Age, gender, prior use of AGM, type of OAG, and higher baseline IOP were not found to be predictive factors for treatment outcome. SLT was found to be a relatively safe and effective procedure in Indian eyes with OAG.