Results Of Selective Laser Trabeculoplasty Research Articles

Selective laser trabeculoplasty (SLT) in eyes with angle recession glaucoma

AbstractPurpose: To describe the results of selective laser trabeculoplasty (SLT) in eyes with angle recession glaucoma.Methods: a retrospective case series of 8 eyes of 8 patients with history of non‐penetrating injury to the eye resulted in angle recession glaucoma. All eyes underwent SLT. Post‐treatment, the best‐corrected visual acuity (BCVA), intraocular pressure (IOP), number of glaucoma medications, additional need for intervention, and complications were recorded. Success of treatment was defined as an IOP reduction of 20% or reduction in medications and maintaining target IOP without further intervention during follow up period of more than 3 months.Results: Mean patient age was 44 years, 6 males and 2 females. Mean pre‐ and post‐SLT IOP were 20.31 ± 3.59 and 15.04 ± 3.13 mmHg, respectively. IOP decreased significantly in all follow‐up visits. SLT treatment resulted in decreased IOP by 21% in 2 patients and by 25% with reduced medication burden in 4 patients and reduced medication burden in 2 patients who stopped glaucoma medication with no significant change in IOP (from 10 to 14 mmHg) at last follow up visit at 45 months.Conclusions: SLT is a safe procedure that cloud be a reasonable alternative management in angle recession glaucoma when patients are unwilling to try medical or surgical intervention.

Using Icare HOME tonometry for follow-up of patients with open-angle glaucoma before and after selective laser trabeculoplasty.

Monitoring the results of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) using a home rebound tonometry. To evaluate the role of Icare HOME tonometry in open-angle glaucoma patients being treated with SLT. A clinic-based prospective case study. Fourteen eyes from 14 patients diagnosed with primary open-angle glaucoma were recruited. The trabecular meshwork of each eye was treated 360° with a frequency-doubled Q-switched Nd:YAG laser. IOP was measured four times a day for a week before and after SLT. On the day of SLT, the patients were required to measure the IOP in the evening to record any IOP spikes. The use of Icare HOME in following up patients post-laser trabeculoplasty without the need for clinic attendance. Icare HOME recorded a significant reduction of 5.12 mmHg in the mean IOP post-SLT (95% confidence interval [CI] 3.75-6.50 mmHg, P < .001). The maximum IOP was also reduced by 6.14 mmHg (95% CI 3.07-9.21, P < .001) with no IOP spikes recorded post-SLT. There was a reduction in IOP fluctuation post-SLT by 1.07 mmHg (95% CI 0.24-1.89 mmHg, P = .021). No adverse effects for using the Icare HOME were reported by the study participants. This methodology could be highly useful for facilitating safe follow-up of patients residing in remote and rural areas, thus reducing healthcare cost with better information on IOP.

Transscleral Selective Laser Trabeculoplasty Without a Gonioscopy Lens.

The purpose of the study was to investigate results of selective laser trabeculoplasty (SLT) performed directly on the sclera without a gonioscopy lens. Interventional case series, prospective, randomized, masked, controlled clinical trial. Setting: Meir Medical Center, Kfar-Saba, Israel. Adults with uncontrolled primary open angle or pseudoexfoliation glaucoma randomized into 2 groups. The controls underwent conventional SLT with 100 spots delivered using a gonioscopy lens for 360 degrees of the trabecular meshwork. The study group underwent irradiation using the same parameters with the laser applications administered on the perilimbal sclera. Study visits: 1 hour, 1, 7, 30, 60, 180, and 365 days postprocedure. Intraocular pressure (IOP) and side effects. Thirty adults were randomized into 2 groups. The mean (±SD) pretreatment IOP was 20.21±3.19 mm Hg for the study group (n=14) and 21.14±2.98 mm Hg for the controls (n=14; P =0.43), dropping to 15.50±3.77 and 15.00±4.08 mm Hg (P =0.74) after 6 months and to 16.00±3.31 and 14.00±2.45 mm Hg (P =0.22) after 12 months. The average IOP reduction after 6 and 12 months was 23.4% and 20.83% for the study group and 27.1% and 33.77% for the controls (P=0.528). Success (a decrease of ≥15% at 6 months with no additional medications, laser, or glaucoma surgery) was achieved in 12 (85.7%) study patients and 9 (69.2%) controls (P=0.385). Complications were mild and transient (n=30), although significantly higher in the controls (n=15; P <0.0001). SLT applied directly to the perilimbal sclera may be as efficacious as the conventional procedure for 1 year.

Clinical results of selective laser trabeculoplasty in silicone oil-induced secondary glaucoma

To analyze the efficacy of selective laser trabeculoplasty (SLT) on silicone oil-induced secondary glaucoma in terms of intraocular pressure (IOP). 42 patients (42 eyes) with silicone oil-induced secondary glaucoma were selected, and SLT was performed with 360° of the trabecular meshwork. During the 12-month follow-up, the complications, IOP, and antiglaucoma medication usage were observed. The mean IOP decreased from 23.1 ± 1.9mmHg before treatment to 18.4 ± 3.7mmHg after treatment (p < 0.05). Mean number of antiglaucoma medications used for IOP control also decreased from 2.17 ± 1.21 to 1.25 ± 0.89 (p < 0.05). The 12-month success rate in the total sample was 59.5%. The success rate was 60.7% (17 eyes) and 57.1% (eight eyes) for phakic and aphakic eyes, respectively (p > 0.05) CONCLUSIONS: SLT is a safe and effective option for the treatment of patients with silicone oil-induced secondary glaucoma.

Early Results of Selective Laser Trabeculoplasty in Patients Resistant to Deep Sclerectomy

In this study, we aimed to determine the early results of selective laser trabeculoplasty to trabeculo-Descemet membrane in patients resistant to deep sclerectomy (DS) surgery. Twelve eyes of 12 patients that had undergone DS for primary open-angle glaucoma were enrolled. Preoperative and postoperative intraocular pressures (IOP) were measured by Goldmann applanation tonometer. Time to failure after DS was noted. Failure is described as IOP higher than 20 mm Hg. All patients underwent selective laser trabeculoplasty (SLT) after failure. Eight to 10 applications of SLT were applied over the trabeculo-Descemet membrane. Laser was applied to the surgical site only. The IOPs before SLT, at postoperative first week, first month, and third month were measured. Mean follow-up time was 23.5 ± 9.5 months. Mean preoperative IOP was 34.2 ± 6.7 mm Hg; mean postoperative IOP at first week was 12.7 ± 3.2 mm Hg. Mean time to failure after DS procedure was 21.6 ± 7.6 months. Mean IOP was 20.6 ± 1.9 mm Hg just before SLT procedure. Mean IOP measurements after SLT at first week, first month, and third month were 10.5 ± 2.2 mm Hg, 10.5 ± 1.9 mm Hg, and 10.9 ± 2.1 mm Hg, respectively. Selective laser trabeculoplasty after DS is an effective and noninvasive procedure that can be done on an outpatient basis. Our results suggest that SLT applied to the surgical site is an effective intervention in the short term but long-term results are required to assess the efficacy.

Clinical Results of Selective Laser Trabeculoplasty in Open-angle Glaucoma in Japanese Eyes

To evaluate the efficacy of selective laser trabeculoplasty (SLT) in the adjunctive treatment of medically diagnosed open-angle glaucoma and to compare the difference in intraocular pressure (IOP) lowering effects between 180-degree and 360-degree SLT. This study is a retrospective consecutive chart review of open-angle glaucoma patients who had undergone first-time SLT from January of 2005 to July of 2007. All the patients had primary open-angle glaucoma or pseudoexfoliation glaucoma under medical treatment and followed for at least 3 months after the procedure. The IOP reduction and treatment success were compared with the 2 treatment types. Twenty-nine patients underwent 180-degree SLT (35 eyes) and 25 patients underwent 360-degree SLT (34 eyes). The average follow-up was 19.5 months (range 3 to 36) for 180-degree group and 17.9 months (range 3 to 36) for 360-degree group. During the follow-up period, the 360-degree SLT group showed significantly lower posttreatment IOP at each follow-up point relative to pretreatment IOP, and its IOP reduction rate stayed statistically higher than the 180-degree group. We found a positive correlation between the pretreatment IOP and the IOP reduction rate for 360-degree SLT. The lower the pretreatment IOP was, the lower IOP reduction rate became. A Kaplan-Meier survival analysis showed higher success rates after 360-degree SLT than after 180-degree SLT. The 360-degree SLT was shown to be more effective than180-degree SLT for intermediateterm reduction in IOP of Japanese patients with open-angle glaucoma as an adjunctive treatment protocol.

Long-Term Clinical Results of Selective Laser Trabeculoplasty in the Treatment of Primary Open Angle Glaucoma

To investigate the long-term efficacy of selective laser trabeculoplasty (SLT) in primary open-angle glaucoma, the authors performed a non-randomized, prospective, non-comparative clinical case series. Fifty-two eyes of 52 patients (19 male, 33 female) with primary open angle glaucoma were treated with SLT. Patients were treated with the Coherent Selecta 7000 (Coherent, Palo Alto, CA, USA) frequency-doubled q-switched Nd:YAG laser (532 nm). A total of approximately 50 non-overlapping spots were placed over 180 degrees of the trabecular meshwork at energy levels ranging from 0.6 to 1.4 mJ per pulse. After surgery, patients were maintained with the drug regimen identical to that before treatment. After 1 year the average reduction in intraocular pressure (IOP) from the baseline was 24.3% (6.0 mmHg), after 2 years 27.8% (6.12 mmHg), after 3 years 24.5% (5.53 mmHg), and after 4 years 29.3% (6.33 mmHg). A Kaplan-Meier survival analysis revealed a 1-year success rate of 60%, a 2-year success rate of 53%, a 3-year success rate of 44%, and a 4-year success rate of 44%. Despite a declining success rate, SLT is an effective method to lower IOP over an extended period of time.

Clinical Results of Selective Laser Trabeculoplasty

Purpose: Selective laser trabeculoplasty (SLT) is a new technique aimed to developed to impact pigmented trabecular cells selectively. Compared with ordinary argon laser trabeculoplasty, it is expected to have fewer complications with more efficacy for open-angle glaucoma. In this study we performed SLT on 17 eyes of 10 patients with primary open-angle glaucoma and 1 eye with capsular glaucoma. Methods: Follow-up period was up to 10 months. Average energy irrachieted was 28.14 mJ (0.47 mJ × 59 spots) against pigmented trabecular band over the half circumference of anterior chamber angle. Results: Preoperative mean intraocular pressure (IOP) was 22.8 mmHg and postoperative mean IOP was decreased significantly to 8.6, 17.3, and 16.1 mmHg at 1, 3, and 6 months after treatment, respectively. The average maximum IOP reduction was 8.8 (3 ∼1 8) mmHg after SLT. Among 11 eyes showing transient IOP elevation, 6 eyes had an elevation of more than 6 mmHg. No remarkable postoperative complications were noted. Conclusion: SLT is a safe and effective modality for the treatment of open-angle glaucoma such as primary open-angle glaucoma (POAG) and capsular glaucoma.

Clinical Results of Selective Laser Trabeculoplasty

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.