Abstract
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.
Highlights
To assess the safety and efficacy of selective laser trabeculoplasty (SLT) for ocular hypertension (OHT) induced by a dexamethasone (DEX) intravitreal implant
Discussion e SLT procedure appears to be a valuable and safe tool to manage increased intraocular pressure (IOP) after DEX-implant injection. e exact mechanism by which SLT decreases IOP has not been yet fully elucidated. It may involve macrophage activation, resulting from increased chemokine production, allowing trabecular meshwork (TM) clearing. e SLT procedure may allow the TM to release factors that regulate the permeability of Schlemm canal endothelial cells [25]. is effect mirrors the physiopathology of steroid-induced OHT, which involves increased responsiveness of the membranes of goniocytes to steroids, leading to increased production of fibroblasts in the TM and resulting in aqueous retention [12]. e TM extracellular matrix may be remodeled by the expression of stromelysin-1 (MMP-3), resulting in an increase in aqueous outflow [26]
Selective laser trabeculoplasty appears to have some clinical efficacy in secondary glaucoma patients, especially when dysfunction of the TM is involved, such as in DEX-implant-induced OHT
Summary
To assess the safety and efficacy of selective laser trabeculoplasty (SLT) for ocular hypertension (OHT) induced by a dexamethasone (DEX) intravitreal implant. We performed a retrospective study of patients who underwent an SLT procedure for ocular hypertension induced by injection of a DEX intravitreal implant. E primary outcome was a decrease in IOP, evaluated at one, three, and six months after the SLT procedure. E mean follow-up after SLT was 18.3 ± 7.7 months. 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%. SLT is an effective and safe procedure to control OHT following DEX-implant intravitreal injection
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
