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Bibliography

The Ellex SLT bibliography contains more than 200 SLT references, including peer-review papers, articles, posters and book chapters. Continually updated, the bibliography can be customized based on date, topic, publication, language and/or author – simply enter your selected keywords into the search field. (Note: there is no need to add grammar or punctuation marks).

Title Body Type Lang Publication Date Authors ReserchSite
Effect of SLT in glaucoma patients with high or low CCT

Purpose: Comparison of the effect of selective laser trabeculoplasty (SLT) in glaucoma patients with high and low central corneal thickness (CCT).

Materials and methods: Clinical trial on 72 glaucoma patients, controlled on medication that received SLT as replacement therapy. We compared the effect of SLT on patients with CCT ≥ 550 μm with patients having CCT <550 μm. Primary end point was intraocular pressure and number of medications taken. Measures were made at 1 h, 1 week, 1 month, 3, 6, 12 and 18 months after SLT.

Results: Mean IOP reduction after SLT was comparable between the low and the high CCT group at most time points (p>0.05); only at 18 months after SLT, the low CCT group showed less IOP reduction compared to the high CCT group (p=0.04). The mean number of medications showed no significant differences between the high and the low CCT group at any point in time. In both groups, the mean number of medications lowered significantly; from 1.43 to 0.17 medications in the high CCT group and from 1.55 to 0.33 in the low CCT group.

Conclusion: CCT does not influence the outcome of SLT in terms of mean IOP reduction and number of medications needed.

English iMedPub Journal 2017 Myrjam de Keyser, Maya de Belder, Jonas de Belder, Veva de Groot

University of Antwerp

The Effects of Selective Laser Trabeculoplasty and Travoprost on Circadian Intraocular Pressure Fluctuations a Randomized Clinical Trail

Background: To compare the effect of selective laser trabeculoplasty (SLT) and travoprost on 24-hour IOP fluctuations in primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG).

Methods: Sixty eyes were included. Sixteen and 14 eyes of POAG patients were randomized to receive 360° SLT or 0.004% travoprost, respectively. Fourteen and 16 eyes of NTG patients were randomized to receive either SLT or travoprost, respectively. The 24-hour IOP data were collected before treatment and 6 to 8 weeks after treatment. IOP was measured at 2hours intervals in the sitting position during daytime (9 AM to 7 PM) and in the supine position during nighttime (9 PM to 7 AM). Main outcome measure was the percentage of eyes that achieved posttreatment 24-hour IOP fluctuations <3mmHg. Success in fluctuation reduction was defined as at least a 50% reduction in these fluctuations.

Results: Fifty-eight eyes were analyzed. Overall, eyes in the SLT and the travoprost groups achieved a significant reduction in IOP compared with the baseline IOP values ( 3.7mm Hg [P=0.002] vs 4.1mm Hg [P<0.001], respectively). There was no significant difference in IOP reduction in both groups according to type of glaucoma. During the diurnal period, 100% of POAG eyes in the travoprost group achieved posttreatment IOP fluctuations <3mm Hg, and 87% of eyes in the SLT group achieved the same level of fluctuations (P<0.001). Ninety-six percent of NTG eyes in the travoprost group, and 82% of eyes in the SLT group had IOP fluctuations <3mm Hg (P=0.01). Success in fluctuation reduction was 75% and 92% for the SLT and travoprost groups, respectively (P=0.005). The effect of travoprost on IOP reduction in POAG and NTG patients was significant both during the daytime and the nighttime, while the SLT’s effect was significant only during the nighttime.

Conclusions: Both travoprost and SLT can significantly reduce the IOP in patients with POAG and NTG. Based on habitual positions, travoprost better controls IOP fluctuations than SLT, especially during the daytime.

Clinical research English Medecine 2017 Weerawat Kiddee, Supreeya Atthavuttisilp
The Impact of Chronic Use of Prostaglandin Analogues on the Biomechanical Properties of the Cornea in Patients with Primary Open-Angle Glaucoma

Aims: To determine the influence of prostaglandin analogues (PGAs) on corneal biomechanical properties in patients undergoing chronic treatment for primary openangle
glaucoma (POAG).
Methods: Prospective, interventional case–control study. 70 eyes from 35 patients with POAG on chronic PGA therapy were recruited. One eye per patient underwent PGA cessation for 6 weeks while the contralateral eye continued to receive the treatment. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP) (IOPcc), central corneal thickness (CCT) and Goldmann tonometry (Haag-Streit AG, Koeniz, Switzerland) IOP (IOPGAT) were measured at baseline (visit 1), 6 weeks after PGA cessation (visit 2) and 6 weeks after PGAs reinitiation (visit 3) and were analysed using a linear mixed-effect model. The discrepancy between IOPcc and IOPGAT was defined as IOP bias (IOPcc—IOPGAT).
Results: Baseline characteristics were comparable between the two groups. In the study eyes, significant increases (p<0.0001) were detected at visit 2 in CH (9.0±1.8 vs 10.3±1.7 mm Hg), CRF (10.5±2.1 vs 11.7 ±2.1 mm Hg), CCT (541.8±43.2 vs 551.9±41.9 μm) and IOPGAT (15.4±3.0 vs 18.4±3.8 mm Hg). IOP bias in this group was significantly lowered at visit 2 (p<0.0001). These effects were reversed at visit 3. The control eyes did not demonstrate any significant changes over the study period.
Conclusion: Topical PGAs induce reversible reduction in CH, CRF and CCT in patients with POAG. These changes contribute to underestimation of the IOP measured by Goldmann applanation tonometry and warrant caution when assessing response to treatment.

Clinical research English Br J Ophthalmol 2017 Roman Meda, Qianqian Wang, David Paoloni, Paul Harasymowycz, Isabelle Brunette

University of Montreal

Selective Laser Trabeculoplasty as an Initial Treatment Option for Open-Angle Glaucoma

Although eye drops are frequently used as an initial treatment option for open angle glaucoma (OAG), side effects, and poor adherence, among others, may compromise treatment efficacy. In this scenario, laser trabeculoplasty is an interesting therapeutic option for open angle glaucoma cases. Commonly used for many years as a last alternative prior to glaucoma incisional surgery, laser trabeculoplasty has been changing its indication after the advent of selective laser trabeculoplasty (SLT). In the current review, we critically evaluated the published data regarding the use of laser trabeculoplasty as a first treatment option for open angle glaucoma patients. Studies using SLT as a first-line treatment have encouraging findings. One-year efficacy results are comparable to those obtained with prostaglandin analogues, with a good safety profile. Although the laser´s effect is known to be transitory, recent data suggest it can be successfully repeated in cases with good response to the first SLT treatment.

Peer-Review English Arq Bras Oftalmol 2017 Ana Lúcia Freitas, Michele Ushida, Izabela Almeida, Diego T. Dias, Syril Dorairaj, Fábio Nishimura Kanadani, Tiago Santos Prata

EPM, Sao Paulo

Microarchitecture of Schlemm Canal Before and After Selective Laser Trabeculoplasty in Enhanced Depth Imaging Optical Coherence Tomography

Purpose: To characterize the in vivo effect of selective laser trabeculoplasty (SLT) on the Schlemm canal (SC) in eyes with primary open-angle glaucoma (POAG).
Materials and Methods: Eighty-one serial horizontal enhanced depth imaging optical coherence tomograph B-scans (interval between B-scans, B35 mm) of the nasal corneoscleral limbus were obtained before and 4 weeks after SLT. Fifty B-scans in the overlapping regions before and after SLT were selected for analysis based on the structures of aqueous and blood vessels as landmarks. The SC cross-sectional area (CSA) was measured in each selected B-scan and averaged to generate the mean SC CSA of the eye. SC volume in the overlapping region was calculated using commercially available 3-dimensional reconstruction software. The mean SC CSA and SC volume were compared between pre-SLT and post-SLT B-scans. Correlation analysis was performed between SC CSA changes and intraocular pressure (IOP) changes.
Results: Thirteen POAG eyes (13 patients) were included for analysis (mean age, 68.2±9.2 y). After SLT, the mean IOP was reduced from 19.8±7.6 to 14.4±3.8mm Hg (P=0.003); the
mean SC CSA increased by 8%, from 2478±550 to 2682± 598 mm2 (P=0.029); and the mean SC volume increased from 4,304,592±954,777 to 4,658,250±1,039,956 mm3 (P=0.029). Increase in SC CSA had a significant positive correlation with IOP reduction after SLT (P=0.023, R=0.622).
Conclusions: SLT expands SC in POAG patients and even more so with greater IOP reduction after SLT. Post-SLT expansion of SC may be due to increased trabecular aqueous outflow, IOP decrease, or structural changes in trabecular meshwork resulting from SLT.

Article English J Glaucoma 2017 Alon Skaat, Michael S. Rosman, Jason L. Chien, Mark P. Ghassibi, Jeffrey M. Liebmann, Robert Ritch, Sung Chul Park

Manhattan Eye, Ear and Throat Hospital, New York

Selective Laser Trabeculoplasty: Effect of Number of Preoperative Topical Glaucoma Medications on Pressure Lowering and Success Rate

Purpose: To evaluate the lowering of intraocular pressure (IOP) one year after SLT and to assess if differences are related to number of pre-SLT topical treatments in ocular hypertension (OHT) and primary open angle glaucoma (POAG) patients.
Methods: Retrospective review of 106 eyes of 13 OHT and 93 POAG patients treated by SLT for insufficient IOP control, allergy, discomfort or non-compliance to glaucoma medications, excluding patients with less than 1 year of follow-up after SLT. IOP was measured by applanation before and at 1, 6 and 12 months after SLT.
Results: Hundred and six eyes untreated (n=13), or treated with one (n=25), two (n=40) or three or more (n=28) glaucoma medications were included. Mean IOP decreased from 19.4±3.6mmHg preoperatively to 15.7±3.1mmHg at 12 months, which corresponds to an average decrease of 18.8%. At 1 year, 62.2% (n=66) were responders (IOP reduction≥3mmHg): 92.3% without medications (n=12), 68% with one (n=17), 57.5% with two (n=23) and 50% with three or more medications (n=14). Their average IOP decreased from 20.7±3.4 to 15.2±2.9mmHg (26.6%), respectively from 20.8±2.6 to 15.8±3.2 (25%) without medications, 20.6±3.2 to 14.9±3.7 (27.3%) with one, 20.8±4.1 to 15.5±3.3 (25.1%) with two and 20.7±3.2 to 14.4±2.4mmHg (29.7%) with three medications.
Conclusions: The number of responders seems to be greater in OHT and POAG patients without or with few glaucoma medications, but the IOP reduction seems to be similar regardless of the number of glaucoma medications.

Peer-Review English J Fr Ophtalmol 2017 Bonnel S, Fenolland JR, Marill AF, Gaillard R, Rosenberg R, Theillac V, Mazharian A, Giraud JM, Renard JP

Rothschild Hospital, Paris

Racial Differences in SLT Efficacy

Aim: Sub-Saharan Africa has a population of 1 billion, with one ophthalmologist per million people. Basic ophthalmic support services are virtually absent for all but a few urban populations. Minimally invasive laser treatment may help. This study reports our initial experience using selective laser trabeculoplasty (SLT) in a mixed-racial population of adult glaucoma patients in Durban, South Africa.
Study design: Institution Review Board approved the 5-year chart review.
Materials and methods: Consecutive glaucomatous adults underwent SLT (Lumenis Selecta) on one or both eyes applying 360° treatment of 120 to 140 closely spaced burns (400 μm spot size for 3 ns; range 1.1–1.4 mJ). Significance of change in intraocuar pressure (IOP) from baseline at 1, 3, 6, and 12 months was assessed by two-tailed paired t-test.
Results: Among 148 eyes of 84 patients (60 African, 21 Indian, 3 Caucasian), 69 had already undergone glaucoma therapy, and 15 untreated (de novo). Among all eyes, mean IOP was reduced by >32% with mean IOP < 15 mm Hg from baseline at all four study intervals (p < 0.0001). A 20% reduction in IOP was sustained at 12 months in 90% of African eyes but in only 50% of Indian eyes.
Conclusion: Selective laser trabeculoplasty was effective in producing clinically significant IOP reduction among South African adults with or without prior medical or surgical anti-glaucoma therapy. Socioeconomically comparable individuals of Indian ancestry showed good therapeutic responses, but significantly less efficacious than those observed among Black subjects. Programs to provide first-line SLT management of glaucoma in Africa, where 90% of patients are unable to sustain prescribed medical therapy, appear to be a very appropriate option.

Article English JOCGP 2017 Emil Goosen, Kate Coleman, Linda Visser, William E. Sponsel

Port Elizabeth, Durban, San Antonio

Effect of Selective Laser Trabeculoplasty on Ocular Haemodynamics in Primary Open-Angle Glaucoma

Purpose:Selective laser trabeculoplasty (SLT) is known to reduce intraocular pressure (IOP) effectively. The aim of this study, however, was to evaluate the
effect of SLT on ocular haemodynamics.
Methods: A total of 69 eyes of 69 patients (age 67.8 ± 9.9 years) with already treated primary open-angle glaucoma who were assigned for SLT for further IOP reduction were consecutively enrolled in this prospective interventional case series. Intraocular pressure, the ocular pulse amplitude (OPA), ocular pulse volume (OPV) and pulsatile ocular blood flow (POBF) were assessed with the Ocular Blood Flow Analyzer prior to and 3 months after SLT.
Results: Intraocular pressure was statistically significantly reduced from 16.0 ± 5.4 mmHg to 12.8 ± 4.0 mmHg (p = 0.001). The OPA did not change (p = 0.783) after IOP reduction following SLT. OPV and POBF increased statistically significantly. OPV increased from 7.33 ± 3.05 to 8.59 ± 3.35 lls (17.2%; p = 0.001) and POBF from 17.11 ± 5.42 to 19.74 ± 6.59 ll/s (15.4%; p = 0.002).
Conclusion: Selective laser trabeculoplasty probably does not induce any pharmacological changes effecting systemic blood pressure or ocular blood flow as topical IOP-lowering medication might do, nor does it change biomechanical properties of the eye as surgery could. Therefore, an increase in ocular blood flow following SLT can only be explained by the reduction in IOP and might be a sign of dysfunctional autoregulation in glaucoma patients.

Peer-Review English Acta Ophthalmologica 2017 Karin R. Pillunat, Eberhard Spoerl, Naim Terai, Lutz E. Pillunat

Dresden

A Review of Selective Laser Trabeculoplasty: Recent Findings and Current Perspectives

Selective laser trabeculoplasty (SLT) has been widely used in the clinical management of glaucoma, both as primary and adjunctive treatment. As new evidence continues to arise, we review the current literature in terms of indications and efficacy, surgical technique, postoperative care, repeatability, and complications of this therapy.

SLT has been shown to be effective in various glaucomas, including primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), steroid-induced glaucoma, pseudoexfoliation glaucoma (PXFG), and primary angle-closure glaucoma (PACG), as well as other glaucoma subtypes.

Relatively high preoperative intraocular pressure (IOP) may predict surgical success, while other parameters that have been studied do not seem to affect the outcome. Different techniques for performing the procedure have recently been explored, revealing that minor modifications may lead to a more favorable or safer clinical outcome.

The utilization of postoperative medications remains controversial based on the current evidence. A short-term IOP increase may complicate SLT and can also persist in certain cases such as in exfoliation glaucoma. The efficacy and safety of repeat SLT are shown in multiple studies, and the timing of repeat procedures may affect the success rate.

English Ophthalmol Ther 2017 Yujia Zhou . Ahmad A. Aref

Chicago Medical School

Hydrus Microstent Compared to Selective Laser Trabeculoplasty in Primary Open Angle Glaucoma: One Year Results

Background: To compare the reduction of intraocular pressure (IOP) and glaucoma medications following selective laser trabeculoplasty (SLT) versus standalone placement of the Hydrus microstent, a microinvasive glaucoma surgery device.

Design: Prospective interventional case-series. University practice. Participants: Fifty six eyes (56 patients) with uncontrolled primary open-angle glaucoma.

Methods: Patients received either SLT (n = 25) or Hydrus implantation (n = 31) in two centres. Patients were evaluated at baseline and 1, 7 days, 1, 3, 6 and 12 months after surgery.

Main Outcome Measures: Intraocular pressure and number of glaucoma medications variations intergroups and intra-groups.

Results: There were no significant differences at baseline between groups, but the mean deviation was worse in the Hydrus group ( 8.43±6.84 dB, confidence limits (CL) 2.8/ 3.3 vs. 3.04±0.65dB, CL 6/ 10.8; P<0.001). After 12months, there was a significant decrease in IOP and medications in the Hydrus group compared with baseline values. In the SLT group, only the decrease in IOP was significant There was 3-fold greater reduction in medication use in the Hydrus group compared with SLT ( 1.4±0.97 vs. 0.5±1.05, P=0.001). 47%of patients were medication free at 12months in the Hydrus group (4% in the SLT group). No complications were recorded in the SLT group. In the Hydrus group, three patients experienced a temporary reduction of visual acuity post-operatively, and two patients had post-operative IOP spikes that resolved within one week.

Conclusions: Both SLT and Hydrus implantation reduced IOP without serious adverse events. Hydrus implantation led to a significant and further reduction in medication dependence at 12 months.

Article English Clin Exp Ophthalmol 2017 Antonio M Fea, Iqbal Ike K Ahmed, Carlo Lavia , Pietro Mittica, Giulia Consolandi, Ilaria Motolese , Giulia Pignata, Eduardo Motolese, Teresa Rolle & Paolo Frezzotti

Turin

Mechanism of Action of Selective Laser Trabeculoplasty and Predictors of Response

Purpose: This study was designed to evaluate the changes in aqueous humor dynamics (AHD) produced by selective laser trabeculoplasty (SLT) and to explore if baseline AHD parameters are predictive of IOP response to SLT.

Methods: Thirty-one consecutive subjects diagnosed with ocular hypertension or primary open-angle glaucoma scheduled to undergo SLT as their primary IOP-lowering therapy were enrolled in this prospective observational study. Subjects underwent baseline assessment of AHD in both eyes. Variables assessed were IOPs at 9 AM and noon, aqueous humor flow rate (fluorophotometry), episcleral venous pressure (EVP, venomanometry), outflow facility (pneumatonography and fluorophotometry) and uveoscleral outflow (calculated using modified Goldmann equation). All subjects underwent 360 degrees SLT and AHD measurements were repeated 3 months later.

Results: Compared with baseline, IOPs after SLT were significantly lower at 9 AM (22.9 6 5.1 vs. 19.7 6 3.0 mm Hg; P ¼ 0.001) and noon (23.4 6 4.6 vs. 20.0 6 3.5 mm Hg; P < 0.001). Outflow facility by fluorophotometry was significantly increased from 0.17 6 0.11 lL/min/ mm Hg at baseline to 0.24 6 0.14 lL/min/mm Hg at 3 months (P ¼ 0.008). Outflow facility by tonography (baseline: 0.16 6 0.07 lL/min/mm Hg vs. 3 months: 0.22 6 0.16 lL/min/mm Hg; P ¼ 0.046) was similarly increased. No change in aqueous flow or EVP was observed. There were no changes in IOP or AHD in the contralateral untreated eye. Using multiple linear regression models, higher baseline aqueous flow, lower baseline outflow facility, and possibly lower uvescleral outflow were associated with more IOP lowering with SLT.

Conclusions: The IOP-lowering effect of SLT is mediated through an increase in outflow facility. There is no contralateral effect. Higher aqueous flow and lower outflow facility may be predictive of better response to SLT.

Peer-Review English Invest Ophthalmol Vis Sci 2017 Vikas Gulati, Shan Fan, Bret J. Gardner, Shane J. Havens, Marie T. Schaaf, Donna G. Neely, Carol B. Toris

Omaha, Nebraska

24-Hour Intraocular Pressure Rhythm in Patients With Untreated Primary Open Angle Glaucoma and Effects of Selective Laser Trabeculoplasty

Purpose of the Study: The purpose of the study was to evaluate the 24-hour nyctohemeral rhythm of intraocular pressure (IOP) in patients with untreated primary open angle glaucoma using a contact lens sensor. To evaluate the effect of selective laser trabeculoplasty (SLT) on the 24-hour rhythm of IOP.
Materials and Methods: Prospective study conducted in a chronobiology center. Fourteen patients with primary open angle glaucoma underwent three 24-hour IOP measurement sessions after a complete wash-out of the medical treatment: before SLT and 1 and 6 months after, using the contact lens sensor Triggerfish (SENSIMED, Lausanne, Switzerland). IOP and the main parameters of nyctohemeral rhythm (existence of a rhythm, acrophase, bathyphase, midline estimating statistic of rhythm, amplitude, and range) before SLT were compared with the same parameters measured 1 and 6 months later.
Results: IOP increased from 16.3 ± 3.7 to 22.1 ± 8.4mm Hg (5.8mm Hg; 95% confidence interval (CI: 2.41-12.71; P=0.009) after the wash-out procedure. After SLT, IOP significantly decreased by 3.4mmHg (95% CI, 0.09-7.89; P=0.041) (14.9%) at 1 month and 1.9mm Hg (95% CI 0.10-3.84; P=0.044) (8.1%) at 6 months. After medication wash-out, 100% of the subjects had a nyctohemeral IOP rhythm with nocturnal acrophase (01:57 ± 3:32 AM, 01:22 ± 3:01 AM, and 03:17 ± 2:12 AM at inclusion, 1 and 6 months, respectively). SLT did not significantly change the characteristics of the 24-hour IOP pattern, notably the amplitude and the type of rhythm (persistence of nocturnal acrophase).
Conclusions: After medical treatment wash-out, patients with open angle glaucoma consistently had a significant 24-hour IOP rhythm with nocturnal acrophase. SLT reduces the absolute IOP value but does not modify the nyctohemeral IOP rhythm.

Clinical research English J Glaucoma 2017 Florent Aptel, Cecile Musson, Thierry Zhou, Antoine Lesoin, Christophe Chiquet

University of Grenoble

Impact of Laser Pulse Duration on the Reduction of Intraocular Pressure during Selective Laser Trabeculoplasty

Purpose: To evaluate the efficacy of selective laser trabeculoplasty (SLT) to lower intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG), normal tension glaucoma (NTG) or ocular hypertension (OHT), when performed with laser pulse duration of 1 ns compared with standard 3 – 5 ns.
Methods: Bilateral SLT with a 532 nm Q-switched neodymium-doped yttrium aluminium garnet laser was conducted in 30 patients (60 eyes) with POAG (n = 5), NTG (n = 2) or OHT (n = 23). Pulse duration was 1 ns in the right eye (30 eyes; cases) and 3 – 5 ns in all left eyes (controls). Main outcome measures were IOP at 1 h, 1 day, 8 weeks and 6 months, and the rate of adverse ocular tissue reactions in all eyes.
Results: Mean 1 ns and 3 – 5 ns SLT IOPs were 24.1 and 24.3 mmHg, respectively, at baseline. No statistically significant difference in mean 1 ns and 3 – 5 ns SLT IOP was observed at 1 h (P = 0.761), 1 day (P = 0.758), 8 weeks (P = 0.352) and 6 months postoperatively (P = 0.879). No significant difference in postoperative anterior chamber inflammation was observed between the eyes (P = 0.529). Treatment with both laser pulse durations resulted in minor ultrastructural changes in the drainage angle.
Conclusions: SLT performed with a 1 ns laser pulse duration does not appear to be inferior to SLT performed with the standard 3–5 ns duration at lowering IOP in treatment of patients with POAG, NTG or OHT.

Article English Int Ophthalmol 2017 Spela Stunf Pukl, Brigita Drnovsˇek-Olup

University of Ljubljana

Efficacy of Selective Laser Trabeculoplasty in Phakic and Pseudophakic Patients with Open-angle Glaucoma

Objective: To compare the efficacy of selective laser trabeculoplasty (SLT) in terms of intraocular pressure (IOP) reduction between phakic and pseudophakic patients with open-angle glaucoma (OAG).

Methods: Phakic and pseudophakic patients with OAG who had IOP ≥15 mmHg treated with ≥2 topical antiglaucoma medications were enrolled. Pseudophakic eyes with history of complicated phacoemulsification were excluded. SLT was performed 270 degrees by one surgeon under the same protocol. IOP was measured with applanation preoperatively and at 1 hour, 1 week, 3 weeks and 3 months postoperatively.

Results: There were 59 eyes (38 phakia and 21 pseudophakia) from 38 patients enrolled between September 2011 and August 2012. The mean IOP significantly decreased from 19.5±2.5 and 20.2±3.2 mm Hg preoperatively to 15.6±3.4 and 15.3±3.1 mm Hg postoperatively at 3 months in phakic and pseudophakic group respectively. Mean IOP reduction was not significantly different between phakic (3.9± 3.1 mmHg) and pseudophakic group (5.0±3.06 mmHg, p=0.197). The non-inferiority test indicated that mean IOP reduction in pseudophakic group was noninferior to phakic group (p=0.012).

Conclusion: SLT was effective for IOP reduction in both phakic and pseudophakic eyes with OAG. The efficacy of SLT in pseudophakic eyes was not inferior to phakic eyes.

Peer-Review English Siriraj Med J 2017 Sakaorat Petchyim, Naris Kitnarong, , Chutima Wongsiwaroj

Mahidol University, Bangkok

Real World Data on Laser Trabeculoplasty in the Treatment of Open-Angle Glaucoma: One Year Outcome of Micropulse Diode (MDLT) vs Selective Laser Trabeculoplasty (SLT)

Purpose: One-year outcome of micropulse diode laser trabeculoplasty (MDLT) and selective laser trabeculoplasty (SLT) as primary and secondary treatment of open angle glaucoma. Outcome measures are intraocular pressure reduction and number of topical anti-glaucoma medications required following laser therapy. Currently, no comparative studies on MDLT vs SLT as primary or secondary treatment of open-angle glaucoma are available.
Method: Single-centre retrospective, comparative case review of glaucoma patients who underwent either MDLT or SLT as primary and secondary treatment between February 2014 and February 2015.
Results: Twenty-four eyes underwent MDLT, and five eyes had SLT as primary treatment for glaucoma. About 19/24 (79%) MDLT eyes and 5/5 (100%) SLT eyes had sustained ≥ 20% IOP reduction (P=0.262, no significant difference) at 1 year. In the MDLT group, one eye needed repeat laser, seven eyes required addition of anti-glaucoma drops, and one eye needed repeat laser and addition of drops. For secondary treatment, 17/45 (38%) of MDLT eyes and 9/16 (56%) SLT eyes had sustained a ≥20% IOP reduction (P=0.199, no significant difference) at 1 year. Mean reduction of drops are 0.08 in the MDLT group and 0.17 in the SLT group . No complications.
Conclusion: Selective laser trabeculoplasty has marginally better IOP control but no significant difference when compared with MDLT. SLT has no need for additional topical anti-glaucoma treatment in primary treatment and slightly greater mean reduction of drops in secondary treatment than MDLT group at one year follow-up.

Article English Clinical and Experimental Ophthalmol 2016 Aaron Ng, Abhijit Mohite, Samuel Lee, Nicola Poole, Maria Tadros, Madiha Majid, Akash Raj

Birmingham & Midland Eye Center

Selective Laser Trabeculoplasty for Early Glaucoma: Analysis of Success Predictors and Adjusted Laser Outcomes based on the Untreated Fellow Eye

Background: To identify success predictors and to study the role of the fellow untreated eye as a co-variable for adjustment of intraocular pressure (IOP) outcomes following selective laser trabeculoplasty (SLT) in early open-angle glaucoma (OAG) patients.
Methods: A case series was carried out. Patients with uncontrolled early OAG or ocular hypertension (inadequate IOP control requiring additional treatment) underwent SLT (one single laser session) performed by the same surgeon in a standardized fashion. The same preoperative medical regimen was maintained during follow-up for all patients. Post-treatment assessments were scheduled at week 1 and months 1, 2, and 3. In order to account for possible influence of IOP fluctuation on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed adjusting for IOP changes (between visits variation) of the untreated fellow eye (adjusted analysis). Pre and post-laser IOP values were compared using paired t-test. Factors associated with the magnitude of IOP reduction were investigated using multiple regression analysis.
Results: A total of 45 eyes of 45 patients were enrolled. Mean IOP was reduced from 20.8 ± 5.1 to 14.9 ± 2. 9 mmHg at month 3 (p < 0.001). Adjusted success rate (defined as IOP reduction ≥ 20%) was 64% and mean percentage of IOP reduction was 23.1 ± 14.3% at last follow-up visit. Considering unadjusted post-laser IOP values, it was found a 20% greater absolute IOP reduction (median [interquartile range] 6 mmHg [4–7] vs 5 mmHg [3–7]; p = 0.04), with a success rate of 76%. Although baseline IOP was significantly associated with both adjusted and unadjusted post-laser IOP reduction, a stronger association was found when unadjusted IOP values were considered (p < 0.001 and R2 = 0.35; p < 0.001 and R2 = 0.67, respectively). Age, mean deviation (MD) index, central corneal thickness and type of glaucoma were not significant predictors (p ≥ 0.150).
Conclusions: In this group of patients with early OAG or ocular hypertension, our short-term results confirmed SLT as a safe and effective alternative for IOP reduction. Although better outcomes were found in eyes with higher preoperative IOP, this effect was mitigated when results were adjusted to the fellow untreated eye (to the influence of between visits-IOP fluctuations).

Clinical research English BioMed Central 2016 Mikael Chun, Carolina P. B. Gracitelli, Flavio S. Lopes, Luis G. Biteli, Michele Ushida, Tiago S. Prata

University of Sao Paulo

Polymegathism, Pleomorphism, and Endothelial Cell Count after Selective Laser Trabeculoplasty

The purpose of the study was to investigate the changes in the endothelial cell count and cell’s polymegathism and pleomorphism after selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG). SLT has been performed on 18 patients (22 eyes). Each patient underwent confocal microscopy 1 hour prior to the laser surgery and then 1 hour, 1 day, 1 week, and 1 month after SLT. The obtained micrographs were then analyzed in order to study the influence of SLT on the corneal endothelium. The difference in the mean corneal endothelial cell density, polymegathism, and pleomorphism at different time intervals was found to be statistically signifi cant. The mean endothelial cell count was reduced in 1 week after SLT from 2442 6 326 per mm2 to 2352 6 460 per mm2; polymegathism was increased from 46.1 6 11.7% to 50.9 6 13.4%; and pleomorphism was decreased from 46.2 6 11.2% to 40.9 6 7.2%. Cellular damage was also observed on the micrographs that were made in the follow-up after SLT. The highest quantity of damaged cells was observed 1 h after SLT. After 1 month, endothelial integrity was completely restored. If damaging does occur after SLT, it is not severe enough to induce serious changes in the endothelial monolayer. Nevertheless, extra care should be taken when choosing an approach to treating patients with low endothelial cell density.

Article English Biol Med 2016 N. Kurysheva, E. Shatalova

Clinical Hospital n° 86, Moscow

Selective Laser Trabeculoplasty in Controlled Uveitis with Steroid-Induced Glaucoma

Selective laser trabeculoplasty is a safe and effective procedure that can be performed in selected uveitic eyes (that have IOP between 20 and 40 mmHg and no advanced glaucoma) with fluocinolone acetonide intravitreal implant induced glaucoma with well-controlled inflammation. No specific parameters were found to indicate which eyes might have IOP reduction after SLT. Given the simplicity of the procedure, the absence of major adverse effects, and its cost-effectiveness, this procedure seems to be an alternative to increasing antiglaucoma medications or proceeding to glaucoma surgery.

Article English Ophthalmology 2016 Arash Maleki, Robert T. Swan, Andres F. Lasave, Lina Ma, C. Stephen Foster

Massachusettes Eye Research

Adherence to Glaucoma Medications Over 12 Months in Two US Community Pharmacy Chains

This study determined the degree of adherence to medications for glaucoma among patients refilling prescriptions in community pharmacies.
Methods: Data abstracted from the dispensing records for 3615 adult patients (18 years or older, predominantly over 45) receiving glaucoma medications from two retail pharmacy chains (64 stores in total) were analyzed. From a 24-month historic data capture period, the 12-month levels of adherence were determined using standard metrics, the proportion of days covered (PDC) and the medication possession ratio (MPR). The overall 12-month mean PDC was only 57%, and the mean MPR was 71%. Using a criterion by which 80% coverage was considered satisfactory adherence, only 30% had satisfactory overall 12-month PDC coverage, and only 37% had satisfactory overall 12-month MPR coverage. Refill adherence increased with age and was highest in the 65-and-older age group (p < 0.001). Differential adherence was found across medication classes, with the highest satisfactory coverage seen for those taking alpha2-adrenergic agonists (PDC = 36.0%; MPR = 47.6%) down to those taking direct cholinergic agonists (PDC = 25.0%; MPR = 31.2%) and combination products (PDC = 22.7%; MPR = 31.0%). Adherence to glaucoma medications in the community setting, as measured by pharmacy refill data, is very poor and represents a critical target for intervention. Community pharmacists are well positioned to monitor and reinforce adherence in this population.

Peer-Review English Journal of Clinical Medicine 2016 Michael Feehan, Mark A. Munger, Daniel K. Cooper, Kyle T. Hess, Richard Durante, Gregory J. Jones, Jaime Montuoro, Margaux A. Morrison, Daniel Clegg, Alan S. Crandall, Margaret M. DeAngelis

University of Utah, SLC

Early and Delayed Effect of Using Steroid following SLT

Purpose: To determine the effect of using topical corticosteroid in the early post-SLT period on the result of the procedure; intraocular pressure (IOP) reduction, development of postoperative uveitis and patient’s discomfort level in the early postoperative period.
Methods: Patients underwent bilateral SLT as primary treatment or as an alternative treatment after washout of their glaucoma medications. Following SLT, one eye was selected randomly to use topical prednisolone for 1 week Post-SLT inflammation, discomfort and IOP level during the following 6 months was compared between eyes used prednisolone and eyes did not.
Results: 15 patients were recruited, most had POAG. Eyes were randomized between group 1 used topical Prednisolone 1% qid for 1 week following 360* SLT, the other eye was in group 2 and only used lubrications. IOP for group 1 and 2; pre SLT 24.1 ± 2 & 24.5 ± 3 (p = 0.66),3 months following SLT 17.2 ± 2 & 17.7 ± 3 (p = 0.75), and on final 6 months visit, 17 ± 2 & 17.7 ± 3 (p = 0.32). IOP reduction following SLT in group 1 and 2 was 7.2 and 6.8 (p = 0.60). A day after SLT 4 eyes had mild uveitis in group 1 and 6 in group 2, all cleared by 1 week. More eyes had more sever conjunctiva congestion in group 2 than in group 1. One patient developed IOP increase upon using Prednisolone, IOP dropped after cessation of treatment (steroid responder).
Conclusions: The use of potent steroid following SLT does not have an effect on the final IOP reduction, and reduced post SLT inflammation and discomfort.

Article English Acta Ophthalmologica 2016 L. Ali Aljasim, O. Owaidhah

KKESH

Corneal Topographic Alterations after Selective Laser Trabeculoplasty

Purpose: To investigate the presence of corneal alterations in the long term among patients with primary open-angle glaucoma (POAG) after a single session of selective laser trabeculoplasty (SLT) treatment.
Materials and Methods: The files of the POAG patients who had been treated with SLT were evaluated retrospectively. The Pretreatment Scheimpflug corneal topographic (SCT) findings were then compared with the post-treatment findings.
Results: The files of 33 patients were eligible. The changes in central corneal thickness, thinnest point of cornea, and posterior corneal asphericity at 5 and 8mm were statistically significant (p = 0.03, 0.01, 0.02, and 0.04 respectively). On the other hand, the simulated K, anterior 3mm K, anterior 5mm K, posterior 3mm K, posterior 5mm K, anterior asphericity at 3mm, posterior asphericity at 3mm, and Zernike values did not change significantly following the treatment (p = 0.19, 0.08, 0.1, 0.3, 0.2, 0.75, 0.09, and 0.3 respectively).
Conclusions: SLT can slightly alter pretreatment SCT findings in 3 to 6 months. Clinicians should wait for at least 6 months after SLT before performing any subsequent surgeries that depend on corneal parameters.

Article English Int Ophthalmol 2016 Kursat Atalay, Ahmet Kirgiz, Kubra Serefoglu Cabuk, Havva Erdogan Kaldirim

Istanbul

Transscleral Selective Laser Trabeculoplasty Without a Gonioscopy Lens

Purpose of the Study: The purpose of the study was to investigate results of selective laser trabeculoplasty (SLT) performed directly on the sclera without a gonioscopy lens.
Design: Interventional case series, prospective, randomized, masked, controlled clinical trial.
Methods: Setting: Meir Medical Center, Kfar-Saba, Israel. Study population: Adults with uncontrolled primary open angle or pseudoexfoliation glaucoma randomized into 2 groups. Intervention: 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.
Main Outcome Measures: Intraocular pressure (IOP) and side effects.
Results: Thirty adults were randomized into 2 groups. The mean (±SD) pretreatment IOP was 20.21±3.19mm Hg for the study group (n=14) and 21.14±2.98mm Hg for the controls (n=14; P =0.43), dropping to 15.50±3.77 and 15.00±4.08mm Hg (P=0.74) after 6 months and to 16.00±3.31 and 14.00±2.45mm 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 Z15% 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).
Conclusions: SLT applied directly to the perilimbal sclera may be as efficacious as the conventional procedure for 1 year.

Clinical research English J Glaucoma 2016 Noa Geffen, Shay Ofir, Avner Belkin, Fani Segev, Yaniv Barkana, Audrey Kaplan Messas, Ehud I. Assia, Michael Belkin

Tel Aviv

A Case of Hyphema after Selective Laser Trabeculoplasty

Purpose:To report a case of hyphema after selective laser trabeculoplasty (SLT) in a patient with pseudoexfoliative glaucoma.
Case summary: A 77-year-old female was referred for elevation of intraocular pressure (IOP). Previously, she had been diagnosed with pseudoexfoliative glaucoma in the right eye and was using topical IOP-lowering agents. The best corrected visual acuity was 20/100 in the right eye and 20/40 in the left eye. IOP, measured with Goldmann applanation tonometer, was 32mmHg
in the right eye and 20mmHg in the left eye. Gonioscopy revealed open-angle glaucoma with +2 trabecular meshwork pigmentation but without peripheral anterior synechiae or neovascularization. SLT was performed in the right eye. Two days later, the patient had sudden onset of blurred vision and pain in the right eye. Visual acuity was limited to light perception, and IOP was 34mmHg in the right eye. Slit-lamp examination revealed 1.1mm hyphema with 4+ red blood cell count in the anterior chamber. Three weeks after the SLT, hyphema in the right eye disappeared, but IOP was measured to be 42mmHg. The patient underwent trabeculectomy in the right eye.
Conclusions: SLT is an effective means of lowering IOP with low risk of complications. However, hyphema can rarely occur after SLT and can affect the outcome of the treatment.

Clinical research English J Korean Ophthalmol Soc 2016 Sungsoon Hwang, Jong Chul Han, Chang Won Kee

Sungkyunkwan University, Seoul

Long-term Results of Selective Laser Trabeculoplasty vs Latanoprost or Dorzolamide/Timolol Fixed Combination

Purpose: To compare the efficacy of selective laser trabeculoplasty (SLT) in patients treated with either latanoprost or dorzolamide/timolol fixed combination (DTFC) for primary open-angle glaucoma.
Methods: This retrospective study included 92 consecutive patients who underwent a 180-degree SLT for the first time. The subjects divided into two groups; patients who received latanoprost (n = 63) or DTFC (n = 29) before and after SLT. The main outcome measure was intraocular pressure (IOP) decrease over five years after SLT. The mean IOP change, mean percentage of IOP reduction, and success rates were compared between the patients treated with latanoprost and the patients treated with DTFC. Success was defined as an IOP decrease ≥ 3mmHg or IOP reduction ≥ 20% without additional medications, laser surgery, or glaucoma surgery.
Results: At the postoperative one-year follow-up, the mean IOP was 15.7 ± 2.2mmHg in the latanoprost group and, 16.2 ± 2.4mmHg in the DTFC group. At the postoperative five-year follow-up, the mean IOP was 15.1 ± 2.5mmHg in the latanoprost group and, 14.6 ± 1.7mmHg in the DTFC group. There were no statistically significant differences in IOP change, percentage IOP reduction, or success rate between the groups at each time point after the SLT (p > 0.05).
Conclusions: Selective laser trabeculoplasty showed a reasonable efficacy in lowering the IOP over a five-year follow-up period. There were no significant differences in IOP lowering effect or success rate between the patients treated with latanoprost or DTFC.

Clinical research English J Korean Ophthalmol Soc 2016 Jong Hoon Lim, Don Gyung Kim, Seok Ho Cho, Young Jae Hong

Nune Eye Hospital, Seoul

Comparison of Outcomes of Laser Trabeculoplasty Performed by Optometrists vs Ophthalmologists in Oklahoma

Importance: Oklahoma is one of the few states where optometrists have surgical privileges to perform laser trabeculoplasty (LTP). Optometrists in other states are lobbying to obtain privileges to perform LTP and other laser procedures. Little is known whether outcomes of patients undergoing this procedure by optometrists are similar to those undergoing LTP by ophthalmologists.
Objective: To compare outcomes of LTPs performed by ophthalmologists with those performed by optometrists to determine whether differences exist in the need for additional LTPs.
Design, Setting and Participants: This retrospective longitudinal cohort study used a health care claims database containing more than 1000 eyes of Medicare enrolees with glaucoma who underwent LTP in Oklahoma from January 1, 2008, through December 31, 2013. For each procedure, the data specify the type of eye care professional who performed the LTP. The rate of LTPs performed by ophthalmologists that required 1 or more additional LTPs in the same eye was compared with the rate of LTPs performed by optometrists. Regression models determined factors affecting risk of undergoing more than 1 LTP in the same eye.
Main Outcomes and Measures: Proportion of enrolees requiring additional LTPs, hazard ratio with 95%CIs of undergoing additional LTPs.
Results: A total of 1384 eyes of 891 eligible patients underwent LTP from January 1, 2008, through December 31, 2013. There were 1150 eyes that received LTP (83.1%) by an ophthalmologist and 234 eyes (16.9%) that had the procedure performed by an optometrist. The mean (SD) age at the initial LTP was 77.7 (7.5) years for enrolees with ophthalmologist performed LTP and 77.6 (8.0) years for those with optometrist-performed LTP (P = .89). Among the 1384 eyes receiving LTP, 258 (18.6%) underwent more than 1 LTP in the same eye. The proportion of eyes undergoing LTP by an optometrist requiring 1 or more subsequent LTP session (35.9%) was more than double the proportion of eyes that received this procedure by an ophthalmologist (15.1%). Medicare beneficiaries undergoing LTP by optometrists had a 189% increased hazard of requiring additional LTPs in the same eye compared with those receiving LTP by ophthalmologists (hazard ratio, 2.89; 95% CI, 2.00-4.17; P < .001) after adjusting for potential confounders.
Conclusions and Relevance: Considerable differences exist among the proportions of patients requiring additional LTPs comparing those who were initially treated by ophthalmologists with those initially treated by optometrists. Health policy makers should be cautious about approving laser privileges for optometrists practicing in other states until the reasons for these differences are better understood.

Clinical research English JAMA Ophthalmol 2016 Joshua D. Stein, Peter Y. Zhao, Chris Andrews and Gregory L. Skuta

University of Michigan, Ann Arbor

Public Health Policy Lessons From Oklahoma

Discussion of above article with conclusion that further studies should be done before optometrists are allowed to perform LTP.

Peer-Review English JAMA Ophthalmol 2016 Alan L. Robin

Wilmer, Baltimore

Laser Trabeculoplasty Use Patterns Among Optometrists and Ophthalmologists in Oklahoma

Further discussion, refuting the conclusions as being inconsistent with the data and confirming the need for further studies, taking all parameters into account.

Peer-Review English JAMA Ophthalmol 2016 Murray Fingeret

State University of New York

Randomized Prospective Study of the Use of Anti-Inflammatory Drops After Selective Laser Trabeculoplasty

Purpose: Evaluating the use of Indomethacin, Dexamethasone, and no anti-inflammatory treatment immediately after selective laser trabeculoplasty (SLT).
Materials and Methods: Prospective randomized clinical trial of 132 eyes. Both eyes of the patient underwent SLT. One of the eyes was treated with Indomethacin 0.1% or Dexamethasone 0.1% 3 times daily for 1 week; the other eye did not receive any antiinflammatory treatment. Intraocular pressure (IOP) and inflammatory parameters were recorded at 1 hour, 1 week, 1, 3, and 6 months.
Results: Cells in the anterior chamber were present in 57% to 71% of the patients after 1 hour. About 16% to 37% of the patients reported pain/discomfort after 1 hour. Redness was present before SLT in 29% to 34% of the patients, probably due to antiglaucoma medication. After 1 hour, the amount of redness recorded raised from 32% to 42%, but the amount of patients with redness returned to pretreatment levels after 1 week. An IOP peak of >5mm Hg above baseline IOP 1 hour after laser was present in 3% to 9% of the patients. IOP lowered 11% to 21% compared with IOP at baseline. The number of medications needed changed from 1.45 to 1.49 before, to 0.23 to 0.45 six months after SLT. No differential effects based on the kind of anti-inflammatory treatment or no treatment were found for any of the parameters.
Conclusions: SLT induces little inflammation: anti-inflammatory drops do not make a significant difference in pain, redness, cells in anterior chamber, or peak IOP following SLT. The IOP-lowering effect of the SLT is not influenced by the use of Indomethacin or Dexamethasone.

Clinical research English J Glaucoma 2016 Myrjam De Keyser, Maya De Belder and Veva De Groot

Antwerp

Selective Laser Trabeculoplasty Reduces Intraocular Pressure Peak in Response to the Water Drinking Test

Purpose: To determine the effect of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) peak and fluctuation induced by the water drinking test (WDT) in patients with open-angle glaucoma and ocular hypertension.
Methods: Patients with open-angle glaucoma or ocular hypertension underwent the WDT before and after SLT within a 12- month period. No other changes to therapeutic regimen were permitted. IOP was measured with a Goldmann applanation tonometer at baseline and every 15 minutes for 45 minutes following a fluid challenge of 800mL over 15 minutes. Baseline, peak, and percentage fluctuation in IOP from baseline were compared using a repeated measures analysis of variance with Bonferroni adjustment.
Results: Twenty eyes from 20 patients were included in this study. The median patient age was 73±15 years (interquartile range) and 70% of patients were female. Ten eyes (50%) had a diagnosis of primary open-angle glaucoma and 10 eyes had ocular hypertension. Following SLT there was a statistically significant reduction in mean baseline IOP from 16.9±2.4 to 14.2±2.3mm Hg (P<0.001), peak IOP from 21.9±3.7 to 16.9±3.1mm Hg (P<0.001).
Conclusions: Patients with open-angle glaucoma and ocular hypertension treated with SLT have significantly reduced peak IOPs and fluctuation in IOP in response to the WDT.

Clinical research English J Glaucoma 2016 Nathan M. Kerr, Henry R. Lew and Simon E. Skalicky

Melbourne

Intraocular Pressure-Lowering Potential of Subthreshold Selective Laser Trabeculoplasty in Patients with Primary Open-Angle Glaucoma

Purpose: To compare the efficacy of subthreshold and conventional selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in the patients with primary open-angle glaucoma (POAG).
Methods: Fifty-two eyes from fifty-two POAG patients were randomized into two groups, one group treated with subthreshold SLT using two-thirds of the conventional energy and the other one treated with the conventional energy. IOP was measured with the Goldmann tonometer and the anterior chamber inflammation was determined using laser flare meter.
Results: The initial energy dosage used in subthreshold SLT group was significantly lower than the amount of the energy used in conventional SLT group (0.4 ± 0.1 mJ versus 0.6 ± 0.1 mJ, P= 0.030). The total energy dosage was also significantly lower in subthreshold SLT group compared to the other group (37.6 ± 3.3 mJ versus 51.8 ± 5.7 mJ, P= 0.036). However, the level of inflammation in aqueous humor, amount of reduction in IOP, and the success rate in controlling IOP was the same in both groups.
Conclusions: The efficacy of subthreshold SLT group in reducing IOP in POAG patients is comparable to the efficacy of conventional SLT group.

Article English J Ophthalmology 2016 Hong Yang Zhang, Yong Jie Qin, Yang Fan Yang, Jian Gang Xu,Min Bin Yu

Guangdong Eye Inst., Guangzhou

Hydrus Microstent Compared to Selective Laser Trabeculoplasty in Primary Open Angle Glaucoma: One-Year Result

Background: To compare the reduction of intraocular pressure (IOP) and glaucoma medications following selective laser trabeculoplasty (SLT) versus stand-alone placement of the Hydrus microstent, a microinvasive glaucoma surgery device. Design: Prospective interventional case-series. University practice.
Participants: 56 eyes (56 patients) with uncontrolled primary open-angle glaucoma. Methods: patients received either SLT (n=25) or Hydrus implantation (n=31) in two centers. Patients were evaluated at baseline and 1, 7 days, 1, 3, 6, and 12 months after surgery. Main outcome measures: IOP and number of glaucoma medications variations inter- and intra- groups.
Results: There were no significant differences at baseline between groups but the mean deviation was worse in the Hydrus group (-8.43±6.84dB, confidence limits (CL) -2.8/-3.3 versus -3.04±0.65dB, CL -6/-10.8; p<0.001). After 12 months, there was a significant decrease in IOP and medications in the Hydrus group compared to baseline values. In the SLT group, only the decrease in IOP was significant. There was 3-fold greater reduction in medication use in the Hydrus group compared to SLT (-1.4±0.97 versus -0.5±1.05, p=0.001). 47% of patients were medication free at 12 months in the Hydrus group (4% in the SLT group). No complications were recorded in the SLT group. In the Hydrus group, three patients experienced a temporary reduction of visual acuity post-operatively and two patients had post-operative IOP spikes that resolved within one week.
Conclusions: Both SLT and Hydrus implantation reduced IOP without serious adverse events. Hydrus implantation led to a significant and further reduction in medication dependence at 12 months.

Article English Clin Experiment Ophthalmol 2016 Antonio M Fea, Iqbal Ike K Ahmed, Carlo Lavia, Pietro Mittica, Giulia Consolandi, Ilaria Motolese, Giulia Pignata, Eduardo Motolese, Teresa Rolle, Paolo Frezzotti

University Turin

Intraocular Pressure Changes Post Selective Laser Trabeculoplasty in the Contralateral Untreated Eyes of Nigerian Patients With Primary Open Angle Glaucoma

Background: Glaucoma is the commonest cause of irreversible blindness in Nigeria and raised intraocular pressure (IOP) is the only modifiable risk factor. Selective laser trabeculoplasty (SLT), one of the treatment modalities, has been reported to have a cross-over effect on the fellow untreated eyes.
Objectives: To determine the lOP lowering effect of SLT on the contralateral untreated eyes in patients with primary open angle glaucoma.
Methods: This was a retrospective chart review of patients who underwent SLT at Guinness Eye Centre, Lagos from June 2011-June 2012. Information on bio-data, diagnosis and modality of treatment were retrieved. Excluded were patients who had glaucoma surgery or needed additional medications. Each patient had SLT in one eye either as primary or adjunctive treatment. IOPs were measured post-operatively in both treated and untreated eyes at various time points using the Goldmann applanation tonometer. Data was analysed using paired and unpaired two-tailed t-test for comparison of means with level of significance set at p<0.05.
Results: Forty eyes of twenty subjects were included. 60% (12) were males and 40% (8) were females. The mean age was 48.9 +/- 17.0 years (range, 23-74 years). Reduction in IOP from baseline was found in both the treated and the fellow untreated eyes at the various time points. Mean IOP reduction was maximal at 3 months; 8 mmHg or 26% (p=0.024) in the treated eyes and 7 mmHg or 25.9% (p=0.097) in the untreated eyes. Mean IOP reduction from baseline-were 1.3 +/- 5.9mmHg or 6.3% (P=.624) in the treated eyes and 2.9 +/- 7.5 mmHg or 9.7% (P=.418) in the untreated eyes at 6 months.
Conclusions: This study shows that there is a sustained IOP reduction in the fellow untreated eyes following SLT in patients with POAG. In view of the retrospective nature of the study, small sample size, non-randomization and lack of control, definite conclusions cannot be drawn from the findings.

Article English Nig Q J Hosp Med 2016 Onakoya AO, Olowoyeye AO, Onyekwelu OM, Abikoye TM.

Lagos

Randomized Controlled Comparison of Titanium-Sapphire Comparison of Titanium-Sapphire Versus Standard Q-Switched Nd:YAG Laser Trabeculoplasty

Purpose: To evaluate the clinical effects of laser trabeculoplasty using a novel 790nm wavelength titanium-sapphire laser (TLT) compared with a 532nm Q-switched Nd:YAG laser used in standard selective laser trabeculoplasty (SLT).
Methods: Single institution prospective clinical trial of open-angle glaucoma patients randomized to TLT or SLT at the Yale Eye Center from 2011 to 2012. Patients with previous glaucoma surgery or trabeculoplasty were excluded. Trabeculoplasty was performed by a single surgeon unmasked to treatment group. All patients received 360 degrees of treatment. The main outcome measure was intraocular pressure (IOP) at 2 years.
Results: Thirty-seven patients were enrolled. The mean baseline IOPs were 19.7 in TLT (n=18) and 20.4mm Hg in SLT (n=19, P=0.69). At 2 years, the mean IOP was 12.9mm Hg (35% decrease, P<0.001) in the TLT group and 15.4mm Hg (25% decrease, P=0.006) in the SLT group. The 2 groups did not differ in glaucoma medication use. Success, defined as IOP20% reduction from baseline without the need for secondary glaucoma procedures, occurred in 44% of TLT patients and 61% of SLT patients at 1 year and in 22% of TLT patients and 46% of SLT patients at 2 years (P=0.11). No patients experienced significant pain, anterior chamber reaction, corneal edema, or loss of vision.
Conclusions: TLT may be a safe and effective alternative to SLT to lower IOP in patients with open-angle glaucoma.

English J Glaucoma 2016 Kevin Kaplowitz, Samantha Wang, Richard Bilonick, Julius T. Oatts, Tomas Grippo, Nils A. Loewen

Yala University

Effectiveness of Unilateral Selective Laser Trabeculoplasty for Primary Open Angle Glaucoma

Objective: To study the effectiveness of unilateral selective laser trabeculoplasty (SLT) on the both eyes of patients with primary open-angle glaucoma (POAG).
Methods: This was a self-controlled clinical study. Thirty-two patients of 32 eyes with OAG who used same anti-glaucoma medications for both eyes were included aat the Department of Ophthalmology Peking University third Hospital from February 2010 to April 2014. SLT was performed for the poorly controlled eye for each patient. Patients were examined before operation and 1 hour, 1 week, 1 month, 3 months and 6 months after operation. The intraocular pressure was examined after 1 hour of SLT. The rest time points were examined by visual acuity, intraocular pressure (IOP), slit lamp microscope, fundus ophthalmoscope and visual field. The paired t test (Bonferroni) was used to compare the IOP at each time point after SLT with the baseline IOP before SLT. Single factor analysis of variance was used to compare the percentage of IOP drop. Linear correlation analysis was used to analyze the amplitude of the decrease of IOP between treated eyes and untreated eyes at 6-month post-operatively and analyze the IOP between preoperative eyes and 6-month post-operative eyes. The magnitude of the decrease of IOP in patients with glaucoma medication and 6 months after surgery was analyzed. We also analyzed the types of antiglaucoma medications and IOP reductions range for 6 month after SLT.
Results: The preoperative mean IOP was (18.9±2.5) mmHg (1 mmHg=0.133 kPa) in the treated eye of patients with OAG. Mean IOP reduction for 1 week, 1, 3, and 6 months after SLT were (1.7±2.9) mmHg, (2.5±2.5) mmHg, (3.5±2.8) mmHg, (3.4±2.5) mmHg and the percentage of IOP reduction were (8±16) %, (13±13) % (18±14) %, (18±12) % respectively (compared with the baseline, P<0.05) . With the success criteria of IOP reduction ≥3.0 mmHg or ≥20%, the success rate of SLT in the treated eye after 1 week, 1, 3, 6 months was 38%, 52%, 50% and 60% respectively. For the untreated fellow eyes, the preoperative mean IOP was (17.3±2.4) mmHg. Mean IOP reduction for 1 week, 1 month, 3 months, and 6 months after SLT were (1.1±2.0) mmHg, (1.0±2.7) mmHg, (2.6±2.2) mmHg and (2.5±2.2) mmHg respectively (compared with the baseline, P<0.05). There was a positive correlation between preoperative IOP and IOP reduction either in the treated or in the untreated eyes at 6-month post-SLT (R=0.63, P<0.01; R=0.60, P<0.01). There was a positive correlation in IOP reduction between treated eyes and untreated eyes at 6-month post-operative (R=0.66, P<0.01). All patients didn't need further treatment such as another laser treatment or surgery. Anti-glaucoma medications were remained unchanged after SLT.
Conclusions: In poorly anti-glaucoma medication controlled Chinese POAG eyes with mean IOP about 18.0 mmHg, unilateral STL can reduce the IOP about 18% at 6-month post-operative for the treated eyes. There was also a continuous IOP reduction effects for the fellow eyes.

English Chin J Ophthalmol 2016 Di X, Fan X, Zhou JC, Wu LL

Beijing University III Hospital

Predictors, Resource Utilization, and Short-term Costs of Laser Trabeculoplasty Versus Medication Management in Open-Angle Glaucoma

Purpose: Adjunctive Laser trabeculoplasty (LT) is an alternative to topical medications for open-angle glaucoma (OAG). The purpose was to: (1) identify predictors of LT versus glaucoma medication treatment; and (2) estimate the resource utilization and short-term costs associated with LT versus medication management. DESIGN: Retrospective administrative claims analysis.
Methods: Medical and pharmacy claims data between 2007–2012 were analyzed to identify prostaglandin analog monotherapy OAG patients with an indexdate LT claim or second medication class claim. Patients were followed for 12-months pre-index and 24 months post-index. Predictive LT attributes included age, sex, employment status, medication adherence, comorbidity status, and geographic region. Short-term costs included glaucoma-specific and comprehensive healthcare encounters. Cohort comparisons were analyzed using chi-square and Student’s t tests, logistic regression (predictive), and generalized linear models (cost).
Results: The study included 4,743 LT and 16,484 medication patients. Baseline demographics were similar but significant differences were identified for comorbidities, adherence, and geography. Younger age (odds ratio [OR]: 1.21; P<.001), low adherence (OR: 1.18; P=.001), high comorbidities (OR: 1.12; P=.006), and region (OR: 1.50; P<.001) significantly predicted LT receipt. Within LT patients, 60% did not have a pharmacy claim 45 days post-index; by 2 years, this reduced to 20%. LT attributed significantly higher medical ($2,684 vs $1,980; P<.0001), lower pharmacy ($807 vs $1,467; P<.0001), and greater overall costs ($3,441 vs $3,408; P=.325).
Conclusions: Poor adherence, younger age, and more comorbidities were predictors of receiving LT. Despite the potential for LT to address adherence, most patients had a medication claim within 2 years. Overall, LT does not provide glaucomaspecific cost savings.

Peer-Review English Am J Ophthalmol 2016 Neil M. Schultz, William B. Wong, Anne L. Coleman, Daniel C. Malone

University of Tucson

Preoperative Intraocular Pressure as a Predictor of Selective Laser Trabeculoplasty Efficacy

Purpose: To identify predictors of intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) in patients with high- and lowpressure primary open-angle glaucoma, who are already taking maximally tolerated IOP-lowering medication and need further IOP reduction.
Methods: In this prospective interventional case series, 157 eyes of 157 openangle glaucoma patients who were assigned for SLT for further IOP reduction were included. Each patient had diurnal IOP measurements taken before and on average 6 months following SLT. The mean of six IOP measurements was compared. The following parameters were analysed for their association with SLT success: age, gender, spherical equivalent, high-pressure or normal-pressure open-angle glaucoma, number and type of pressure-lowering medications, lens status, pre-SLT IOP, IOP at the time of diagnosis, duration of glaucoma, visual field stage and central corneal thickness.
Results: The only parameter that was predictive for absolute and relative mean diurnal IOP reduction after SLT was the preoperative mean diurnal IOP. One hundred per cent of the patients with a mean diurnal preoperative IOP of more than 18 mmHg had an IOP reduction after SLT. With mean diurnal preoperative values of 14–18 mmHg, 83.1% of the patients, and with values below 14 mmHg only 64% of the patients, showed an IOP reduction. This difference was statistically significant (>18 compared to 14–18: p = 0.002; >18 compared to <14: p = 0.001; 14–18 compared to <14: p = 0.030).
Conclusions: The pressure-lowering effect of SLT can best be predicted by the individual IOP level before treatment. Patients with mean diurnal IOP levels below 14 mmHg might not benefit from the procedure at all.

Peer-Review English Acta Ophthalmologica 2016 Karin R. Pillunat, Eberhard Spoerl, Greta Elfes, Lutz E. Pillunat

University of Dresden

Selective Laser Trabeculoplasty as Primary Treatment for Open-Angle Glaucoma

Open-angle glaucoma is a silent, chronic disorder which results in progressive and permanent vision loss. Designing the optimal treatment regimen can be particularly challenging in the management of high-risk patients with frequent loss to follow-up or a longstanding history of medication noncompliance. In this article we aim to review fundamental techniques in glaucoma diagnosis and treatment with emphasis on the strengths and weaknesses of selective laser trabeculoplasty, a technique in modern therapy which may mold the future of primary treatment in open angle glaucoma management.

Peer-Review English Rhode Island Medical Journal 2016 LAITH M. KADASI, SAFA WAGDI, KIMBERLY V. MILLER

Brown University, Rhode Island

Maximizing Cost-Effectiveness by Adjusting Treatment Strategy According to Glaucoma Severity

Background: The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer’s perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers.

Methods: Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year).

Results: In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient.

Conclusion: All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a preferred strategy for each glaucoma stage, according to a cost-effectiveness ratio ranking.

English Medecine 2016 Ricardo Augusto Paletta Guedes, Vanessa Maria Paletta Guedes, Carlos Eduardo de Mello Gomes, Alfredo Chaoubah

Juiz de Fopra, MG

Intraocular Pressure Changes After Selective Laser Trabeculoplasty (SLT) in Open-Angle Glaucoma

Background: Selective laser trabeculoplasty (SLT) use laser to selectively target pigmented trabecular meshwork without producing collateral damage to adjacent non-pigmented cells or structures. A previous data suggests that SLT is effective at every stage of open-angle glaucoma (OAG). SLT can be used as a first-line therapy, alternative to medical therapy, or as an adjunctive therapy to topical glaucoma drops. The aim of this study was to determine the changes in intraocular pressure (IOP) after SLT in patients with OAG.

Methods: Design of this research was cohort-prospective study. Twenty-six eyes of 18 patients with OAG participated in this study. All the patients were treated with 180o SLT to the temporal trabecular meshwork and followed by 180o SLT to the nasal trabecular meshwork 1 week after the first treatment. A frequency-doubled (532 nm) Q-switched Nd:YAG laser with a 400 μm spot size was used to deliver 0.4-1.0 mJ of energy for 0.3 ns to perform the procedure. Additionally, IOP in the treated eye was assessed and measured with Goldman applanation before SLT, and 1 hour, 1 week, and 2 weeks following complete SLT. All patients were given corticosteroid (prednisolone acetat 1% eyedrop) 4 times a day for 7 days after SLT to prevent elevation of IOP caused by inflammation.

Results: The average pre-SLT IOP were 19.94 mmHg. The mean IOP 1 hour post-SLT was slightly increase. IOP 2 weeks after complete SLT showed a significant decrease compared to before SLT (Wilcoxon-test, before: p=0.033; 1 hour: p=0.915; 1 week: p=0.098; 2 weeks: p=0.009)

Conclusion: Intraocular pressure lowering effect was significant at 2 weeks after SLT treatment. SLT effectively reduces IOP in open-angle glaucoma. It can be used as a primary or adjunctive therapy in patient with open-angle glaucoma.

Article English Ophthalmol Anaheim of Ina 2016 Amalia Mayasari, Maharani Cahyono
Selective Laser Trabeculoplasty in Patients with Pseudoexfoliative Glaucoma vs Primary Open Angle Glaucoma: A One-Year Comparative Study

Aim: To compare the efficacy of single-session 360-degree selective laser trabeculoplasty (SLT) for reduction of intraocular pressure (IOP) in patients with pseudoexfoliative glaucoma (PXFG) and primary open angle glaucoma (POAG).
Methods: This is a single-center, prospective, non-randomized comparative study. Patients older than 18 years of age with uncontrolled PXFG or POAG eyes requiring additional therapy while on maximally tolerated IOP-lowering medications were included. The primary outcome measure changed in IOP from baseline. Success was defined as IOP reduction 20% from baseline without any additional IOP-lowering medication. All patients were examined at 1d, 1wk, 1, 3, 6, 9, 12 months after SLT.
Results: Nineteen patients (20 eyes) with PXFG and 27 patients (28 eyes) with POAG were included in the study. In the visual fields mean deviation was -2.88 (1.67) in the POAG and -3.1 (1.69) in the PXFG groups (=0.3). The mean (SD) IOP was 22.9 (3.7)mm Hg in the POAG group and 25.7 (4.4) mm Hg in the PXFG group at baseline and decreased to 18.4 (3.2) and 18.0 (3.9)mm Hg in the POAG group (<0.001 and =0.02), and to 17.9 (4.0) and 21.0 (6.6) mm Hg in the PXFG group (<0.001 and =0.47) at 6 and 12mo, respectively. The number of medications was 2.6 (0.8) in the POAG group and 2.5 (0.8) in the PXFG group at baseline, and did not change at all follow-up visits in both groups (=0.16 in POAG and 0.57 in PXFG). Based on Kaplan-Meier survival analysis, the success rate was 75% in the POAG group compared to 94.1% in the PXFG group (=0.08; Log-rank test) at 6 months, and 29.1% and 25.0% at 12 months, respectively (=0.9; Log-rank).
Conclusion: The 360-degree SLT is an effective and well-tolerated therapeutic modality in patients with POAG and PXFG by reducing IOP without any change in number of medications. The response was more pronounced early in the postoperative period in patients with PXFG whereas there was no statistically significant difference at 12-month follow-up.

Clinical research English Int J Ophthalmol 2016 Arezoo Miraftabi, Naveed Nilforushan, Nariman Nassiri, Kouros Nouri-Mahdavi

Tehran University of Medical Sciences

A Study of Selective Laser Trabeculoplasty as Adjunctive Treatment in Patients Affected by Open Angle Glaucoma for Control of Intraocular Pressure in Indian Eyes

Background: Prospective Interventional Pilot study of selective laser trabeculoplasty as adjunctive treatment in patients affected by open angle glaucoma for control of intraocular pressure in Indian eyes.
Methods: This prospective Interventional pilot study included 29 eyes of 29 patients affected by open angle glaucoma, were treated with Selective laser trabeculoplasty (360 degree trabecular meshwork treated with 100 spots) for IOP control between January 2011 to December 2011. Of these 29 patients, 24 were males, 5 were females. Mean age was 58.96 ± 18.19 years. Primary open Angle Glaucoma was diagnosed in 22 patients, Secondary Open Angle Glaucoma in 6, and Juvenile Open Angle Glaucoma in 1 patient. All patients underwent complete ophthalmic evaluation before SLT and at each follow up. This evaluation included visual acuity, IOP (GAT), slit lamp examination with 90D. The gonioscopy and visual field analysis was done at 6 and 12 months. The IOP was measured on day 1, day 7, 1 month, 3 month, 6 month and at 1 year post SLT On GAT.
Results: Main outcome measure was lowering of intraocular pressure on Goldmann Applanation Tonometry. The mean IOP Pre SLT (Selective Laser Trabeculoplasty) was 24.62 ± 6.38, IOP was reduced to 14.20 ± 4.10 mmHg on Day 1 (42.32% reduction), on day 7 it was 15.96 ± 4.731 mmHg (35.17% reduction), at 1 month it was 17.27 ± 4.77 mmHg (29.82% reduction), at 3 months it was 19.41 ± 4.40 mmHg (21.10% reduction), at 6 months it was 16.93±4.03 mmHg (31.23% reduction) and at 1 year it was 16.47 ± 4.04 mmHg (31.3% reduction). After 3 months of follow up, 6 eyes out of 29 eyes, required Trabeculectomy with mitomycin C, for inadequate IOP control post SLT. These patients were considered as failures. In 2 patients topical medications decreased following SLT, remaining patients continued on same antiglaucoma medications. At follow up of 3 months 22 eyes (75.86%) out of 29 eyes maintained at least 20% reduction from baseline IOP (Pre SLT IOP). At 6 months and 1 year of follow up 22 eyes out of 23 (95.65%), maintained at least 20% reduction from baseline IOP (Pre SLT IOP). None of our patient had any complication or side effect following SLT.
Conclusion: Selective laser trabeculoplasty is effective and safe as a secondary/adjunctive treatment for lowering IOP in patients of open angle glaucoma not adequately controlled with medical therapy in Indian eyes. SLT has good compliance and affordability.

Clinical research English Ophthalmology Research 2015 Ojha Sushil, S. S. Pandav, Kaushik Sushmita, Raj Srishti

Chandigarh

Argon Versus Selective Laser Trabeculoplasty in Younger Patients: 2-Year Results

OBJECTIVE: To compare the effectiveness of argon laser trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in younger patients (age 60 or less).

METHODS: This was a prospective randomized control trial. 42 young patients (age 29 to 60y) had 1 eye randomized to ALT (n=22) or SLT (n=20). IOP was measured before laser and 1 hour, 1 day, 6 weeks, 3 months, every 3 months until 2 years, and then yearly post-laser. Chi-square analysis and Student t test were used to determine statistical significance.

RESULTS: The mean IOP before treatment was 21.9 mm Hg for ALT and 19.1 mm Hg for SLT with no statistical difference between the groups (P>0.05). At 2 years, 86.4% of ALT and 75.0% of SLT eyes required no further surgical intervention (laser trabeculoplasty or trabeculectomy). During the same time period, there was a statistically significant IOP decrease of 11.1% after ALT (P=0.01) and 7.7% after SLT (P=0.01) with no statistical difference between the lasers (P>0.05).

CONCLUSION: In younger patients, both ALT and SLT have a significant ocular hypotensive effect 2 years after treatment, with no differences in outcome identified between laser modalities.

Peer-Review English J Glaucoma. 2012 Feb 21: 112-115 2012 Liu Y, Birt C M.

Faculty of Medicine, University of Ottawa, Ottawa, Canada. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada

Clinical Results of Selective Laser Trabeculoplasty in Open-Angle Glaucoma in Japanese Eyes: Comparison of 180 Degree With 360 Degree SLT

PURPOSE: To evaluate the efficacy of SLT in the adjunctive treatment of medically diagnosed open-angle glaucoma and to compare the difference in IOP lowering effects between 180-degree and 360-degree SLT

METHODS: This study is retrospective consecutive chart review of open-angle glaucoma patients who had undergone first-time SLT from January 2005 to July 2007. All the patients had POAG 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.

RESULTS: 29 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 post-treatment IOP at each follow-up point relative to pre-treatment IOP, and its IOP reduction rate stayed statistically higher than the 180-degree group. We found a positive correlation between the pre-treatment IOP and the IOP reduction rate for 360-degree SLT. The lower the pre-treatment 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.

CONCLUSION: The 360-degree SLT was shown to be more effective than the 180-degree SLT for intermediate term reduction of IOP of Japanese patients with open-angle glaucoma as an adjunctive treatment protocol.

Peer-Review English J Glaucoma. 2012 Jan 21: 17-21 2012 Shibata M, Sugiyama T, Ishida O, Ueki M, Kojima S, Okuda T, Ikeda T.

Department of Ophthalmology, Osaka Medical College, Daiigaku-machi, Takatsuki-shi, Osaka, Japan. Department of Ophthalmology, Okuda Eye Clinic, Nara-cho, Tenri-shi, Nara, Japan

Selective Laser Trabeculoplasty in the Treatment of Open-Angle Glaucoma

PURPOSE: To determine the effect of SLT on different types of open-angle glaucoma in terms of IOP

METHODS AND MATERIALS: In this prospective, nonrandomized, interventional study, patients with OAG, unresponsive to maximum tolerable anti-glaucoma medication, were enrolled. 136 eyes were studied. Distribution of glaucoma type was 91 POAG eyes (66.9%), 22 Pseudoexfoliative glaucoma (PEX 16.2%) eyes and 23 pigmentary glaucoma (PG 16.9%) eyes. Main outcome measures were IOP and number of anti-glaucoma medications used before operation at 1 day, at 1 week and at 1 to 18 months after surgery. Using the standard approach 360-degree SLT was done.

RESULTS: The mean follow-up was 16.6 +/- 4.3 months. The mean preoperative IOP was 22.0 +/- 3.7 mm Hg, and reduced to 18.3 +/-3.7 mm Hg at last visit. the overall mean IOP decrease was 3.6 +/- 2.6mm Hg (16.3%) on the last visit compared with before surgery, indicating a reduction of 16.7% in POAG, 16.6% in PEX and 14.5% in PG. Comparison of IOP values at 6 and 16 months showed an increase of 0.5 and 2.7 mm Hg in total sample and PG group. IOP reduction was significantly less among diabetic patients.

CONCLUSION: SLT resulted in a significant IOP reduction of 16.3% at 16 months after surgery. The level of IOP reduction did not vary in POAG, PEX and PG groups. A significant increase in IOP was observed in PG group after 6 months. The procedure seemed least effective in diabetic patients.

Peer-Review English J Glaucoma. 2012 Jan 21: 65-70 2012 Koucheki B, Hashemi H.

Noor Ophthalmology Research Center, Noor Eye Hospital and Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

What’s New in Laser Treatment For Glaucoma?

PURPOSE OF REVIEW: This review highlights recently published studies on prevailing and newer laser therapies in glaucoma and critically evaluates their roles in the treatment algorithm.

RECENT FINDINGS: Recently published studies suggest a role for SLT as initial therapy for open-angle glaucoma and ocular hypertension and have demonstrated efficacy in other glaucoma subtypes. Novel laser applications (micro-pulse diode laser trabeculoplasty, titanium sapphire laser trabeculoplasty and excimer laser trabeculoplasty) have shown favourable early results. Endoscopic and transscleral cyclophotocoagulation (ECP, TCP) are generally reserved for refractory glaucomas, although some recent studies report its use in patients with good visual acuity. The effectiveness of laser iridotomy with or without iridoplasty for long-term prevention of PACG is undetermined. Laser goniopuncture is an important adjunct to non-penetrating surgery, but wide adoption of the procedure is lacking.

SUMMARY: The use of lasers in glaucoma continues to evolve, with a trend towards primary and earlier intervention. SLT is assuming an expanded role in the treatment of additional subtypes of glaucoma, whereas ECP and TCP are generally reserved for refractory glaucomas. Newer laser modalities show promise as alternatives and adjuncts to topical medications and non-penetrating surgery. Additional research is needed to better define their safety and efficacy.

Article English Curr Opin Ophthalmol. 2011, Dec 19 2011 Jay J. Meyer, Scott D. Lawrence

Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Phophylactic Selective Laser Trabeculoplasty in the Prevention of Intraocular Pressure Elevation After Intravitreal Triamcinolone Acetonide Injection

PURPOSE: To evaluate the prophylactic efficacy of Selective Laser Trabeculoplasty for preventing an increase in Intraocular Pressure (IOP) after intravitreal triamcinolone acetonide injection.

DESIGN: Prospective, comparative, interventional case series.

METHODS: We studied 31 eyes with a baseline IOP of 21 mm Hg or more of 31 patients for which intravitreal triamcinolone acetonide injection was planned for diabetic macular edema. The patients were divided into 2 groups, a study group and control group. The study group comprised 15 eyes of 15 patients that underwent SLT a mean of 8.3 +/- 4.1 days before intravitreal triamcinolone acetonide injection. The control group comprised 16 eyes of 16 patients who underwent only intravitreal triamcinolone acetonide injection. Main outcomes measures were mean IOP and number of patients requiring antiglaucomatous therapy.

RESULTS: Mean baseline IOP was 21.6 +/- 0.9 mm Hg in the study group and 21.5 +/-0.8 mmHg in the control group (P=0.98). mean IOP at 1 day after injection was 17.0 +/- 2.0 mm Hg in the study group and 19.5 +/- 4.3 mm Hg in the control group (P=0.23). Mean IOP at 1 week after injection was 16.9 +/- 1.7 mm Hg and 18.4 +/- 4.0 mm Hg, respectively (P=0.49); mean IOP at 1 month after injection was 16.4 +/- 1.5 mm Hg and 20.8 +/- 5.6 mm Hg, respectively (P=0.003); mean IOP at 3 months after injection was 15.8 +/- 2.5 mm Hg and 18.3 +/- 5.5 mm Hg, respectively (P=0.01); and mean IOP at 6 months after injection was 15.7 +/- 1.4 mm Hg and 17.1 +/- 1.5 mm Hg, respectively (P=0.03). The number of patients requiring antiglaucomatous therapy during follow-up was 0 of 15 eyes in the study group and 8 of 16 eyes in the control group (P=0.001).

CONCLUSION: The IOP elevation after intravitreal triamcinolone acetonide injection may be prevented by performing SLT before intravitreal triamcinolone acetonide injection, especially in cases with a baseline IOP of 21 mm Hg or more.

Peer-Review English Am J Ophthalmolog. 2011 Dec; 152(6): 976-981 2011 Bozkurt E, Kara N, Yazici AT, Yuksel K, Demirok A, Yilmaz OF, Demir S.

Beyoglu eye Research and Education Hospital, Istanbul, Turkey

Selective Laser Trabeculoplasty
Book Chapter English Glaucoma - Current clinical and research aspects. Editor: Pinakin Gunvant. Nov. 2011 2011 Pignatto S, Veritti D, Gabai A, Lanzetta P.

Department of Ophthalmology, University of Udine, Italy

Long Term Effects On the Lowering of Intraocular Pressure: Selective Laser Or Argon Laser Trabeculoplasty?

OBJECTIVE: Selective Laser Trabeculoplasty (SLT) and Argon Laser Trabeculoplasty (ALT) are used to lower intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). We report long-term follow-up data comparing SLT to ALT.

DESIGN: Follow-up of prospective randomized clinical trial.

PARTICIPANTS: Patients with glaucoma from the practices of 3 ophthalmologists at the University of Ottawa

METHODS: We randomized 176 eyes of 156 patients with uncontrolled IOP on a maximal tolerated medical therapy (MTMT with or without previous ALT) to undergo either SLT or ALT. Data were available for 142 eyes at 3 years, 134 eyes at 4 years, and 120 eyes at 5 years. The primary outcome was change in IOP from pre-treatment baseline.

RESULTS: Comparison of baseline parameters was similar in the 2 groups. Lowering of IOP were similar at 3 years (SLT -6.7 +/- 7.1 vs ALT -6.1 +/- 5.1); at 4 years (SLT 7.0 +/- 7.7 vs ALT -6.3 +/- 5.0); and at 5 years (SLT -7.4 +/- 7.3 vs ALT -6.7 +/- 6.6). There was no statistically significant change of IOP in either of the 2 groups. Medication changes were equivalent in each group. A number of interventions were required in both groups. Cumulatively, over the 5-year follow-up period (49 SLT and 33 ALT). Survival analysis indicated that the time to 50% failure in each group was approximately 2 years.

CONCLUSION: The IOP-lowering effect of SLT and ALT was similar over 5 years in this group of patients with open-angle glaucoma on MTMT.

Peer-Review English Can J Ophthalmol. 2011 Oct; 46(5):408-13 2011 Bovell AM, Damji KF, Hodge WG, Rock WJ, Buhrmann RR, Pan YI

University of Ottawa Eye Institute, Ottawa, Ontario, Canada

Reconditioning of the Trabeculodescemet’s Membrane With the 532-Nm Nd: YAG (SLT) Laser After Deep Sclerectomy

The purpose of this study was to evaluate the intraocular pressure (IOP)-lowering effect of modified goniopuncture with 532-nm Nd:YAG Selective Laser Trabeculoplasty (SLT) laser on eyes after deep sclerectomy with collagen implant 5DSCI). This was an interventional cased series. The effects of modified goniopuncture on eyes with insufficient IOP-lowering after DSCI were observed. Goniopuncture was performed using a Q-switched, frequency-doubled 532-nm Nd:YAG laser (SLT-goniopuncture, SLT-G). Outcome measures were amount of IOP-lowering and rapidity of decrease after laser intervention. In all, 10 eyes of 10 patients with a mean age of 71.0 +/- 7.7 (SD) years were treated with SLT-G. The mean time of SLT-G after DSCI procedure was 7.1 +/- 10.9 months. SLT-G decreased IOP from an average of 16.1 +/- 3.4 mm Hg to 14.2 +/- 2.8 mm Hg (after 15 min), 13.6 +/- 3.9 mm Hg (at 1 day) , 12.5 +/- 4.1 mm Hg (at 1 month), and 12.6 +/- 2.5 (at 6 months) (P<0.0125). There were no complications related to the intervention. Patients in this series achieved an average 22.5 % of IOP reduction after SLT-G. The use of the SLT laser appears to be an effective and safe alternative to the traditional Nd:YAG laser for goniopuncture in eyes after DSCI, with potential advantages related to non-perforation of trabeculo-descemet's membrane (TDM).

Peer-Review English Eye, 16 Sept 2011; 10.1038/eye.2011.231 2011 Mansouri K, Mariani A, Ravinet E.

Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA

Laser Trabeculoplasty: An Investigation Into Factors That Might Influence Outcomes

OBJECTIVE: To examine the effectiveness of argon (ALT) or selective (SLT) laser trabeculoplasty (LTP) in lowering IOP and to determine whether patient-related factors had any impact on outcome.

PARTICIPANTS: 500 patients treated with LTP over 14 years

METHODS: This study was conducted at Sunnybrook Health Sciences Centre, University of Toronto. Five patient-related characteristics were used as dependent variables-age, race, gender, pseudophakic status, and pseudoexfoliation. IOP decrease and treatment failure at 12 months were the main outcome variables.

RESULTS: 500 eyes of 500 patients were included, 350 after ALT and 150 after SLT. The mean +/- standard deviation baseline IOP was significantly higher in the patients treated by ALT than in those treated by SLT (24.2 +/- 5.4 versus 22.2 +/- 4.6, p<0.0001) at baseline but not at 1 year (19.6 +/- 5.1 versus 19.5 +/- 6.1, p=0.'&). When the final IOP was examined by multiple regression analysis, there was a significant effect in favour of ALT over SLT (p=0.03) and for patients with higher baseline IOPs (p<0.0001). No significant effect was found for any of the demographic subgroupings. However, when the outcome variable was success or failure, only the baseline IOP remained significant.

CONCLUSION: Specific patient characteristics do not significantly influence LTP outcome after 12 months of follow-up. The most powerful predictor of either final IOP or clinical success was a higher baseline IOP, but ALT may have a better ability to lower IOP

Peer-Review English Can J Ophthalmol. 2011 Aug; 46(4):305-9 2011 Tzimis V, Tze L, Ganesh J, Muhsen S, Kiss A, Kranemann C, Birt CM.

Department of Ophthalmology & Vision Sciences, University of Toronto, Ont., Canada

Keeping Glaucoma Laser Therapy On Target

SLT has become a popular first or second-line therapy for lowering the IOP in many types of POAG. Complications associated with this procedure include conjunctivitis, corneal abrasion, excessive inflammation, a significant short-lived or sustained elevation IOP, and a failure to achieve a persistent decrease in IOP.

Article English Glaucoma Today, Fall 2011 2011 Hylton R. Mayer

Washington D.C., USA

Laser Trabeculoplasty For Open-Angle Glaucoma

OBJECTIVE: To provide an evidence-based summary of the outcomes, repeatability, and safety of laser trabeculoplasty for open-angle glaucoma.

METHODS: A search of the peer-reviewed literature in the PUbMed and the Cochrane Library databases was conducted in June 2008 and was last repeated in March 2010 with no date or language restrictions. The search yielded 637 citations, of which 145 were considered to be of possible clinical relevance for further review and were included in the evidence analysis.

RESULTS: level I evidence indicates an acceptable long-term efficacy of initial ALT for open-angle glaucoma compared with initial medical treatment. Among the remaining studies, level II evidence supports the efficacy of SLT for lowering IOP for patients with open-angle glaucoma. Level III evidence supports the efficacy of repeat use of laser trabeculoplasty.

CONCLUSION: Laser trabeculoplasty is successful in lowering IOP for patients with open-angle glaucoma. At this time, there is no literature establishing the superiority of any particular form of laser trabeculoplasty. The theories of action of laser trabeculoplasty are not elucidated fully. Further research into the differences among the lasers used in trabeculoplasty, the repeatability of the procedure, and techniques of treatment is necessary.

Peer-Review English Ophthalmology 2011; 118:2296-2302 2011 Samples JR, Singh K, Lin, SC, Francis B, Hodapp E, Jampel H, Smith S

Department of Ophthalmology, Oregon Health and Sciences University, Portland, OR, USA. Department of Ophthalmology, Stanford University, Stanford, CA, USA. Department of Ophthalmology, University of California, San Francisco, CA, USA

Selective Laser Trabeculoplasty in Uncontrolled Pseudoexfoliation Glaucoma

BACKGROUND AND OBJECTIVE: To assess the efficacy and safety of SLT in uncontrolled pseudoexfoliation glaucoma (PEXG)

PATIENTS AND METHOD: 57 eyes (57 patients) with uncontrolled PEXG and IOP greater than 23 mm Hg underwent SLT. All received ophthalmic evaluation preoperatively and at intervals postoperatively. IOP was measured at 1 hour, 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. During follow-up, patients were treated with topical anti-glaucoma medications as necessary.

RESULTS: One year postoperatively, mean IOP in all patients decreased from 26.01 +/- 2.5 to 17.8 +/- 2.8 mm Hg (31.5% p<0.001). Mean medications per patient decreased from 2.8 to 2.3. Complications included conjunctival redness and infection within 1 day postoperatively in 30 eyes (67%). One hour after SLT treatment, an increase in IOP greater than 5mm Hg was detected in 2 eyes (3.5%) and resolved within 24 hours with topical medication.

CONCLUSION: SLT is safe and effective in patients with PEXG

Peer-Review English Ophthalmic Surg Lasers Imaging 2011; 42:390-393 2011 Goldenfeld M, Geyer O, Segev E, Kaplan-Messas A, Melamed S.

Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel

The Influence of Topical Prostaglandin Analogues in Inflammation After Selective Laser Trabeculoplasty Treatment

PURPOSE: Reducing intraocular pressure (IOP) seems to be the only treatment that slows progression in glaucoma. The IOP can be decreased by pharmaceutical treatment, laser selective laser trabeculoplasty (SLT)] treatment, or surgery. Prostaglandin analogues have been postulated to share action mechanisms with SLT and the possibly diminish the effects of SLT treatment. The aim of the current study was to investigate the effects of prostaglandin analogues in inflammation and IOP reduction after SLT treatment.

METHODS: Prospective nonrandomized study. 118 patients were included in the study. Inclusion criteria: Glaucoma (open-angle or pseudoexfoliation glaucoma) patients who will be treated with SLT. Inflammation was measured with a laser flare meter (Kowa FM-500). Measurements were made before SLT and treatment was performed over 90

Peer-Review English JOURNAL of OCULAR PHARMACOLOGY AND THERAPEUTICS, Volume 27, Number 6, 2011. Mary Ann Liebert, Inc. DOI: 10.1089/jop.2011.0084 2011 Ayala M, Chen E.

Department of Glaucoma, St. Eriks Eye Hospital, Karolinska Institutet, Stockholm, Sweden

Comparison of Selective Laser Trabeculoplasty (SLT) in Primary Open Angle Glaucoma And Pseudoexfoliation Glaucoma

BACKGROUND AND OBJECTIVE: The aim of the present study was to compare intraocular pressure 5IOP) reduction and inflammation after Selective Laser Trabeculoplasty (SLT) treatment in patients suffering from Primary Open Angle (POAG) vs Pseudoexfoliative (PXFG) glaucoma.

STUDY DESIGN/PATIENTS AND METHODS: 60 eyes participated in the study. Glaucoma patients (POAG or PXFG) scheduled for treatment with SLT were included. Inflammation was measured with a laser flare meter (Kowa FM-500). Measurements were made before SLT and 2 hours, 1 week, and 1 month after SLT treatment. IOP was also checked at the same time intervals.

RESULTS: Inflammation after SLT showed no significant difference between the groups (t-test, before: P+0.16; 2 hours: P=0.14; 1 week: P=0.12; and 1 month: P=0.36). IOP reduction was the same in both groups (t-test, P=0.27).

CONCLUSION: SLT safely reduces IOP in both POAG and PXFG. Pseudoexfoliation does not seem to be a risk factor for post-laser complications.

Peer-Review English Clinical Ophthalmology 2011:5 1469-1473 2011 Ayala M, Chen E.

Department of Glaucoma, St. Eriks Eye Hospital, Karolinska Institutet, Stockholm, Sweden

Pattern of Intraocular Pressure Reduction Following Laser Trabeculoplasty in Open-Angle Glaucoma Patients: Comparison Between Selctive And Nonselective Treatment

OBJECTIVE: To compare the pattern of Intraocular Pressure (IOP reduction following Selective Laser Trabeculoplasty (SLT) versus Argon Laser Trabeculoplasty (ALT) in open-angle glaucoma 5OAG) patients, and to investigate the ability of initial IOP reduction to predict mid-term success.

METHODS: A prospective, nonrandomized, interventional case series was carried out. Consecutive uncontrolled OAG glaucoma patients underwent SLT or ALT; the same preoperative medical regimen was maintained during follow-up. Data collected included age, type of OAG, pre- and postoperative IOP, number of glaucoma medications, and surgical complications. Post-treatment assessments were scheduled at day 1 and 7 and months 1, 3 and 6.

RESULTS: A total of 45 patients (45 eyes) were enrolled [SLT group (n+25); ALT group (n+20)]. Groups were similar for age, baseline IOP, and number of glaucoma medications (P>=0.12). we found no significant differences in mean IOP reduction between SLT (5.1 +/- 2.5 mm Hg; 26.6%) and ALT (4.4 +/- 2.8 mm Hg; 22.8%) groups at month 6 (P=0.38). Success rates (IOP = 25%) at last follow-up visit were similar for SLT (72%) and ALT (65%) groups (P=0.36). Comparing the pattern of IOP reduction (% of IOP reduction at each visit) between groups, we found a greater effect following SLT compared with ALT at day 7 (23.7% +/- 13.7% vs 8.1% +/- 9.5%; P=0.32). Additionally, the percentage of IOP reduction at day 7 and at month 6 were significantly correlated in the SLT group (R(2)=0.36; P<0.01), but not in the ALT group (P=0.89). Early postoperative success predicted late success in most SLT cases (82%). No serious complications were observed.

CONCLUSION: Although mid-term results suggest SLT and ALT as effective and equivalent alternatives, a greater initial IOP reduction was observed following SLT. IN addition, the initial IOP reduction was a good predictor of mid-term success in patients undergoing SLT, but not ALT.

Peer-Review English Clinical Ophthalmology 2011:5 933-6 2011 Almeida ED Jr, Pinto LM, Fernandes RA, Prata TS.

Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil

Trabecular Meshwork Gene Expression After Selective Laser Trabeculoplasty

BACKGROUND: Trabecular meshwork and Schlemm’s canal are the tissues appointed to modulate the aqueous humour outflow from the anterior chamber. The impairment of their functions drives to an intraocular pressure increase. The SLT is a laser therapy of the trabecular meshwork able to decrease Intraocular Pressure. The exact response mechanism to this treatment has not been clearly delineated yet. The herein presented study is aimed at studying the gene expression changes induced in trabecular meshwork cells by SLT in order to better understand the mechanisms subtending its efficacy.

METHODOLOGY/PRINCIPAL FINDINGS: Primary human trabecular meshwork cells cultured in fibroblast medium underwent SLT treatment. RNA was extracted from a pool of cells 30 minutes after treatment while the remaining cells were further cultured and RNA was extracted respectively in 2 and 6 hours after treatment. Control cells stored in incubator in absence of SLT treatment were used as reference samples. Gene expression was evaluated by hybridization on miRNA-microarray and laser scanner analysis. Scanning electron microscopic examination was performed on 2 Trabecular meshwork samples after SLT at 4(th) and 6(th) hour from treatment. On the whole, SLT modulates in trabecular meshwork the expression of genes involved in cell motility, intercellular connections, extracellular matrix production, protein repair, DNA repair, membrane repair, reactive oxygen species production, glutamate toxicity, antioxidant activities, and inflammation.

CONCLUSIONS/SIGNIFICANCE: SLT did not induce any phenotypic alteration in TM samples. TM is a complex tissue possessing a great variety of function pivotal for the active regulation of aqueous humour outflow from the anterior chamber. SLT is able to modulate these functions at the post-genomic molecular level without inducing damage either at molecular or phenotypic levels.

Peer-Review English PLoS One. 2011; 6(7):e20110 2011 Izzotti A, Longobardi M, Cartiglia C, Rathschuler F, Sacca SC.

Department of Health Sciences, Faculty of Medicine, University of Genoa, Genoa, Italy

Predictive Factors of Success in Selective Laser Trabeculoplasty (SLT) Treatment

PURPOSE: Glaucoma is a progressive optic neuropathy that may lead to blindness. Reducing Intraocular Pressure (IOP) is the only known treatment to slow progression in glaucoma. IOP can be reduced by pharmaceutical treatment, laser and surgery. The aim of the present study was to assess predictive factors of success after Selective Laser Trabeculoplasty (SLT) treatment.

METHODS: We used a retrospective chart review of eyes that underwent SLT between January 1, 2005 and December 31, 2005. The dependent variable was time to failure after SLT treatment. Failure after SLT was defined as any changes in the medical treatment, and/or a new SLT treatment was performed and/or the patient was sent for surgery. All patients were treated with 90

Peer-Review English Clinical Ophthalmology 2011:5 573-576 2011 Ayala M, Chen E.

Department of Glaucoma, St. Eriks Eye Hospital, Karolinska Institutet, Stockholm, Sweden

Inflammation Assessment After Selective Laser Trabeculoplasty (SLT) Treatment

PURPOSE: Selective Laser Trabeculoplasty (SLT) appears to be a safe and effective method to lower Intraocular Pressure (IOP). The exact mechanism of action for reducing IOP and inflammation levels is not known. The aim of this study was to assess inflammation after SLT treatment.

METHODS: 40 patients (80 eyes) were included in the study. Inclusion criteria: Glaucoma (pigmentary and pseudoexfoliative glaucoma)/ocular hypertension patients that will be treated with SLT in just one eye, both with and without eye drops. Exclusion criteria: patients suffering from ocular or systemic inflammatory diseases are treated with cortisone or immunosuppressive drugs. Inflammation was measured in two different ways: (i) clinically with a slit lamp and classified 0-4; (ii) objectively with a ‘Laser flare meter (Kowa FM 500)’. Measurements were taken before SLT, 2 hr, 1 week and 1 month after SLT treatment, both eyes were evaluated. IOP was also checked in the same way. SLT treatment was performed in 90

Peer-Review English Acta Ophthalmol. 2011 Jun; 89(4):e306-9 2011 Ayala M, Landau H

Department of Glaucoma, St. Eriks Eye Hospital, Karolinska Institutet, Stockholm, Sweden

Selective Laser Trabeculoplasty Versus Medical Therapy As Initial Treatment of Glaucoma: A Prospective, Randomized Trial

PURPOSE: To compare outcomes of Selective Laser Trabeculoplasty (SLT) with drug therapy for glaucoma patients in a prospective randomized clinical trial.

PATIENTS AND METHODS: 69 patients (127 eyes) with open-angle glaucoma or ocular hypertension were randomized to SLT or medical therapy. Target Intraocular Pressure (IOP) was determined using the Collaborative Initial Glaucoma Treatment Study formula? Patients were treated with SLT (100 applications 360 degrees) or medical therapy (Prostaglandin analogue). 6 visits over 1 year followed initial treatment. If target IOP range was not attained with SLT, additional SLT was the next step, or in the medical arm additional medications were added. Primary outcome: IOP; secondary: number of steps.

RESULTS: 69 patients were treated. Data collection terminated with 54 patients reaching 9 to 12-months follow-up. 29 patients were in the SLT group, 25 patients in the medical group. Baseline mean IOP for all eyes was 24.5 mm Hg in the SLT group, 24.7 mm Hg in the medical group. Mean IOP (both eyes) at last follow-up was 18.2 mm Hg (6.3 mm Hg reduction) in the SLT arm, 17.7 mm Hg (7.0 mm Hg reduction) in the medical arm. By last follow-up, 11% of eyes received additional SLT, 27% required additional medication. There was not a statistically significant difference between the SLT and medication groups.

CONCLUSION: IOP reduction was similar in both arms after 9 to 12-months follow-up. More treatment steps were necessary to maintain target IOP in the medication group. Although there was not a statistically significant difference between groups. These results support the option of SLT as a safe and effective initial therapy in open-angle glaucoma or ocular hypertension.

Peer-Review English J Glaucoma 2011 May 3 2011 Katz LJ, Steinmann WC, Kabir A, Molineaux J, Wizov SS, Marcellino G.

Glaucoma Service, Wills Eye Institute, Philadelphia, PA, USA

The Efficacy of Low-Energy Selective Laser Trabeculoplasty

BACKGROUND AND OBJECTIVE: To analyse the efficacy of low-energy Selective Laser Trabeculoplasty (SLT) in patients.

PATIENTS AND METHODS: in 74 patients (74 eyes) with ocular hypertension, suspected glaucoma, or primary open-angle glaucoma, SLT was the first-choice treatment. 39 patients in the low-energy group received treatment using half of conventional laser energy over 360

Peer-Review English Ophthalmic Surg Lasers Imaging 2011 Jan 1; 42(1):59 2011 Tang M, Fu Y, Fyu MS, Fan Y, Zou HD, Sun XD, Xu X.

Shanghai Jiaotong University Affiliated First People's Hospital, Ophthalmology, Shanghai, China.

Long-Term Safety And Efficacy of Selective Laser Trabeculoplasty As Primary Therapy For the Treatment of Pseudoexfoliation Glaucoma Compared With Primary Open-Angle Glaucoma

PURPOSE: To investigate the safety and efficacy of Selective Laser Trabeculoplasty (SLT) to reduce Intraocular Pressure (IOP) in patients with pseudoexfoliation glaucoma (PXFG) compared with primary open-angle glaucoma (POAG).

DESIGN: Non-randomized, prospective, clinical trial.

METHODS: 19 eyes of 13 patients with POAG and 18 eyes of 13 patients with PXFG were treated with SLT. Patients were followed without anti-glaucoma medications until additional medical, laser, or surgical intervention was initiated, at which time they were considered failures, had withdrawn from the study, or underwent a second SLT.

RESULTS: The POAG and PXFG eyes showed similar reductions of IOP over the 49 months of follow-up. At 30 months of follow-up the POAG group showed a mean IOP of 17.6 +/- 2.8 mm Hg and a mean IOP reduction of 5.7 +/- 2.1 mm Hg; the PXFG group showed a mean IOP of 18.3 +/- 4.7 and a mean IOP reduction of 5.3 +/- 3.0 mm Hg. 4 eyes in the PXFG group and 3 eyes in THE POAG group failed by 30 months. The cumulative probability of success was 74% for the PXFG for the PXFG group and 77% for the POAG group. 4 PXFG eyes underwent a second SLT after 30 months of follow-up with a final IOP of 17.6 +/- 2.8 mm Hg. There were no serious adverse events.

CONCLUSION: SLT is safe and effective method to lower IOP in patients with PXFG as initial glaucoma therapy. Both groups showed similar IOP reductions and failure rates.

Peer-Review English Clinical Ophthalmol. 2010 Dec 16; 5:5-10 2010 Shazly AT, Smith J, Latina MA.

Ophthalmology Department, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA

Corneal Edema And Haze After Selective Laser Trabeculoplasty.

PURPOSE: To report two cases of corneal edema, haze, and thinning in patients after undergoing selective laser trabeculoplasty.

METHODS: Selective laser trabeculoplasty was performed for the treatment of primary open-angle glaucoma on 2 patients who subsequently developed corneal stromal haze within 24 to 48 hours of the procedure.

RESULTS: The patients were treated with topical steroids for several weeks. Although their corneal edema resolved, both patients were left with residual corneal scarring and thinning. One patient had a significant hyperopic shift.

CONCLUSION: Corneal edema, haze, and thinning after selective laser trabeculoplasty is an extremely rare event, with only 2 other cases reported in the literature. Although certain causes are postulated to play a role in this complication, it is not yet understood what may predispose a patient to corneal changes as a result of this laser procedure.

Peer-Review English J Glaucoma. 2010 Aug 16 2010 Regina M, Bunya VY, Orlin SE, Ansari H.

Scheie Eye Institute, University of Pennsylvania, Philadelphia, SA

Selective Laser Rrabeculoplasty Reduces Mean IOP And IOP Variation in Normal Tension Glaucoma Patients.

PURPOSE: To evaluate the effect of selective laser trabeculoplasty (SLT) in normal tension glaucoma (NTG) patients.

PATIENTS AND METHODS: A retrospective review was performed of NTG patients who had undergone SLT at the Duke University Eye Center between 12/2002 and 7/2005. For each eye of each patient at pre-laser and post-laser time points, the IOP measurements were summarized by mean, standard deviation, and range. Then for each of these descriptive statistics, the differences between pre-laser and post-laser values were obtained. Statistical analysis was performed using a random effects model.

MAIN OUTCOME MEASURES: difference in mean IOP, standard deviation of IOP, and range of IOP.

RESULTS: Thirty-one eyes of 18 patients were included for analysis. The average of the mean pre-operative IOP measurements was 14.3 +/- 2.6 mmHg compared to 12.2 +/- 1.7 mmHg (P < 0.001) post-operatively. The mean pre-operative standard deviation was 1.9 +/- 0.9 mmHg compared to 1.0 +/- 0.6 mmHg (P = 0.002) post-operatively while the mean IOP range prior to treatment was 4.5 +/- 2.5 mmHg compared to 2.5 +/- 1.9 mmHg (P = 0.017) after treatment.

CONCLUSION: In this pilot study, SLT was found to lower mean IOP and inter-visit IOP variation in NTG patients. Given the importance of IOP variation and its association with glaucoma progression, measurement of IOP variation following treatment with SLT may be considered.

Peer-Review English Clin Ophthalmol. 2010 Aug 9;4:889-93. 2010 El Mallah MK, Walsh MM, Stinnett SS, Asrani SG.

Ocala Eye, Ocala, Florida, USA

Impact of Laser Trabeculoplasty On Trabectome((R)) Outcomes

BACKGROUND/OBJECTIVE: To report the impact of prior laser trabeculoplasty on clinical outcomes of Trabectome (NeoMedix Corporation, Tustin, CA) surgery.

PATIENTS/METHODS: This is a retrospective, non-comparative study of consecutive cases of Trabectome surgery with 36 months of follow-up. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, and the occurrence of secondary procedures.

RESULTS: In the trabeculoplasty group, mean IOP measured 16.5 +/- 4.0 mm Hg with an average decrease of 24% from preoperative IOP at 12 months. In eyes without previous trabeculoplasty, IOP measured 15.7 +/- 3.0 mm Hg with an average decrease of 30% at 12 months. Adjunctive medications decreased to 2.1 and 1.5 glaucoma medications, respectively. Secondary procedures were performed in 12% and 10% of eyes in each group.

CONCLUSION: Previous laser trabeculoplasty does not appear to significantly impact IOP, but may increase the need for glaucoma medication in patients undergoing Trabectome surgery.

Article English Ophthalmic Surg Lasers Imaging. 2010 Jul-Aug;41(4):443-51 2010 Vold SD, Dustin L.

Not specified

Similar Effects of Selective Laser Trabeculoplasty And Prostaglandin Analogs On the Permeability of Cultured Schlemm Canal Cells.

PURPOSE: To evaluate whether selective laser trabeculoplasty and prostaglandin analogs regulate the permeability of cultured human Schlemm canal cells by inducing intercellular junction disassembly.

DESIGN: Laboratory investigation.

METHODS: Intercellular junctions were made visible in living cells by making them fluoresce after transfection with a plasmid expressing the zonula occludens 1 protein tagged with green fluorescent protein. Schlemm canal cells were treated by direct laser irradiation; by exposure to media conditioned by either lasered Schlemm canal cells or trabecular meshwork cells; by exposure to the prostaglandin analogs latanoprost, bimatoprost, and travoprost; or by the addition of the nonprostaglandin agents brimonidine, timolol, and dorzolamide. Junction disassembly was monitored using fluorescence microscopy, and permeability alterations were measured as changes in conductivity using flow meters.

RESULTS: The direct laser irradiation of Schlemm canal cells caused a 3-fold increase in conductivity. Exposure of the cells to media conditioned by lasered Schlemm canal cells or trabecular meshwork cells induced junction disassembly and a 2- to 4-fold increase in conductivity. Exposure to prostaglandin analogs also induced junction disassembly and a 4- to 16-fold increase in conductivity, whereas the 3 nonprostaglandin agents tested were ineffective in both regards.

CONCLUSION: Exposure to factors secreted by lasered Schlemm canal cells and lasered trabecular meshwork cells and the application of prostaglandin analogs induced junction disassembly while increasing the permeability of Schlemm canal cells. These findings support our hypothesis that selective laser trabeculoplasty and prostaglandin analogs share a common mechanism that likely mediates their pressure-lowering effects.

Peer-Review English Am J Ophthalmol. 2010 Aug;150(2):254-64 2010 Alvarado JA, Iguchi R, Martinez J, Trivedi S, Shifera AS.

Beckman Vision Center, Department of Ophthalmology, University of California-San Francisco, 10 Koret Way, San Francisco, CA 94143-0730, USA alvaradoj@vision.ucsf.edu

SLT As Primary And Secondary Therapy in Patients With Glaucoma

PURPOSE: To evaluate SLT as primary (initial) therapy, to decrease IOP, in patients with glaucoma. To evaluate SLT as secondary (adjunctive) therapy, to decrease IOP and medications (meds) used, in patients with glaucoma.

METHODS: Retrospective chart review was performed on 3121 eyes from a consecutive case series of patients treated with SLT over 8 years. Two-tailed paired t-test was used to compare maximum pre- and average post-procedure IOP and meds.

RESULTS: Mean follow-up on 1016 eyes was 520 days. Mean IOP decreased by 22 % from a mean of 20 mmHg to 16 mmHg. Mean meds decreased by 57 % from a mean of 2.3 meds to 1.0 meds
Results were significant with p < 0.01.

CONCLUSION: In this series of over 3,000 eyes followed for more than 8 years: Selective Laser Trabeculoplasty (SLT) as primary (initial) therapy significantly lowered intraocular pressure (IOP) in patients with glaucoma; Selective Laser Trabeculoplasty (SLT) as secondary (adjunctive) therapy significantly lowered intraocular pressure (IOP) and medications (meds) used in patients with glaucoma.

Paper Presentation English ESCRS Congress, Paris, 2010 2010 Jindra L.

Floral Park Ophthalmology, New York, USA

Is There A Role For SLT in Managing Steroid-Related OHT?

For some eyes with steroid-related OHT, SLT (and probably ALT) appears to provide a rapid and dramatic reduction in IOP. When faced with a patient who has medically uncontrolled IOP after steroid therapy, it is reasonable for physicians to consider SLT before proceeding with incisional surgery. More than one SLT treatment may be necessary. Based on the limited data available, at least some SLT-treated eyes will avoid incisional surgery. Given that there are no significant downsides to SLT, the potential benefit more than justifies the small risk.

Article English Glaucoma Today, Spring 2010 2010 Realini T.

West Virginia University Eye; Institute in Morgantown, USA

Observational Study of Aqueous Dynamic Effects of Selective Laser Trabeculoplasty (SLT) And Topical Latanoprost

PURPOSE: SLT is thought to increase trabecular outflow and prostaglandins are believed to increase uveoscleral outflow. We compared the aqueous dynamics changes following SLT and latanoprost treatment in a group of previously untreated patients.

METHODS: Retrospective observational report. Since June 2007, all untreated primary open angle glaucoma (POAG) and ocular hypertension (OHT) patients in our clinic are invited to have aqueous dynamic measurements, at baseline and 3 month post treatment: intraocular pressure (IOP) using pneumotonometry, tonography using the electronic Schiotz and fluorophotometry for aqueous flow. Patients were free to choose between primary 360 degree SLT or medical treatment.

RESULTS: 60 patients were identified from our database with baseline and 3 month data. 16 patients were excluded as they were treated with either timolol or bimatoprost. 20 had SLT and 24 had latanoprost, of which 5 SLT and 10 latanoprost patients were excluded due to poor measurements. 16 eyes of 15 SLT treated patients and 17 eyes of 14 latanoprost treated patients were included in this report (Table 1). Mean IOP was reduced in each treatment group: 24.2mmHg pre and 18.9mmHg post SLT (p<0.001), 24.5mmHg pre and 19.8mmHg post latanoprost (p<0.001) (Table 2). Tonographic outflow facility improved from 0.095 to 0.156 in SLT (P=0.003), but did not change significantly in latanoprost (0.166 pre to 0.160 post). Both treatments did not have significant effect on aqueous flow rate.

CONCLUSION: SLT and latanoprost have slightly different effects on aqueous dynamics in that only SLT appeared to enhance tonographic outflow facility significantly.

Poster Presentation English ARVO 2010 2010 E.C. Jones, P. Alaghband, L. Beltran-Agullo, S. Goyal, K. Lim.

St Thomas' Hospital, London, UK.

Effect of Selective Laser trabeculoplasty (SLT) On Ocular Hemodynamics in Glaucoma

PURPOSE: SLT is known to reduce intraocular pressure effectively. Aim of the present study, however, was to evaluate the effect of SLT on ocular hemodynamics.

METHODS: 75 patientsith mostly advanced glaucoma underwent SLT (Solo

Poster Presentation English ARVO 2010 2010 K.R. Hornykewycz, E. Spoerl, R. Stodtmeister, L.E. Pillunat.

Dept of Ophthalmology, Univ Clinic Carl Gustav Carus Dresden, Dresden, Germany.

SLT And Adjunctive Medical Therapy: A Prediction Rule Analysis.

PURPOSE: To investigate if specific classes of anti-glaucoma medications have an influence on selective laser trabeculoplasty (SLT) success.

METHODS: This retrospective prediction rule analysis investigated 120 eyes from 120 patients diagnosed with either open angle glaucoma or ocular hypertension, who underwent SLT treatment. Treatment success was defined as >/=20% intraocular pressure (IOP) reduction at 3 and 6 months after the treatment date. Multivariate logistic regression analyses were performed to determine success predictors.

RESULTS: Pre-SLT IOP (up to 4 wk before SLT therapy) was the only independent predictor for >/=20% IOP reduction with an odds ratio of 1.30 when controlling for pre-SLT anti-glaucoma drops. The area under receiver operator characteristic curve was 0.777.

CONCLUSION: Topical medications do not adversely, nor favourably, affect SLT success. SLT efficacy is positively associated with the degree of IOP elevation before SLT treatment. Pigmentation of the anterior chamber angle, class of anti-glaucoma medications, diabetes, sex, corneal thickness, pseudophakia, diagnosis, washout of eye drops, and previous argon laser trabeculoplasty treatment are not associated with SLT treatment efficacy.

Peer-Review English J Glaucoma. 2010 Jun 23. 2010 Martow E, Hutnik CM, Mao A.

Department of Ophthalmology, Ivey Eye Institute, St Joseph's Hospital, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada

Monocyte Modulation of Aqueous Outflow And Recruitment To the Trabecular Meshwork Following Selective Laser Trabeculoplasty.

OBJECTIVES: To determine whether selective laser trabeculoplasty (SLT) induces monocyte recruitment to the trabecular meshwork (TM) in human and monkey eyes and whether monocytes increase both aqueous outflow in vivo and the conductivity of human Schlemm canal endothelial cells (SCEs) in vitro.

METHODS: Monocyte recruitment was examined morphometrically in control human and monkey eyes and compared with that following SLT applied 1 to 3 days earlier. Outflow facility was measured for up to 4 days after the intracameral infusion of autologous macrophages in rabbits. Schlemm canal endothelial cell conductivity was measured using flow meters after exposing cultured SCEs to monocytes and monocyte-secreted factors for 24 hours.

RESULTS: Our estimates show that the TM in the human eye normally had an average of 15 003 monocytes, while in the monkey eye there were 3181 monocytes, and this number increased 4- to 5-fold following SLT. The intracameral infusion of autologous macrophages in rabbits increased outflow facility 2-fold in a rapid and sustained manner. Human monocytes and monocyte-secreted factors increased SCE conductivity 2-fold in vitro.

CONCLUSION: The number of monocytes/macrophages in the TM increases substantially after SLT and monocytes augment both outflow facility and SCE conductivity. Clinical Relevance These findings indicate that the innate immune system in general and monocytes in particular play an important role in aqueous outflow homeostasis. The recruitment of monocytes in increased numbers after SLT likely plays a role in lowering the intraocular pressure after this procedure. The intracameral introduction of autologous monocytes harvested from a vein could have therapeutic potential as a cell-based individualized treatment of glaucoma.

Peer-Review English Arch Ophthalmol. 2010 Jun;128(6):731-7. 2010 Alvarado JA, Katz LJ, Trivedi S, Shifera AS.

Department of Ophthalmology, University of California, San Francisco, CA 94143-0730, USA. alvaradoj@vision.ucsf.edu

Influence of Selective Laser Trabeculoplasty On 24-Hour Diurnal Intraocular Pressure Fluctuation in Primary Open-Angle Glaucoma: A Pilot Study.

BACKGROUND AND OBJECTIVE: To investigate the influence of selective laser trabeculoplasty on mean diurnal intraocular pressure (IOP) and diurnal IOP fluctuation in primary open-angle glaucoma.

PATIENTS AND METHODS: After washout from intraocular pressure-lowering drugs, a baseline diurnal IOP curve was obtained for 26 eyes of 13 patients before selective laser trabeculoplasty. The IOP curve was repeated at 3 and 6 months.

RESULTS: In five eyes, office time (8:00 a.m. to 12:00 p.m.) IOP decreased by 20% or more. No similar decrease was seen in mean diurnal IOP in any case. IOP-lowering drugs were required for 11 eyes before the 3-month visit. Baseline diurnal IOP was higher for these eyes than for the others (P = .002). Compared with baseline values, a significant decrease was seen in mean IOP at the 6-month visit (P = .017) and in IOP fluctuation at both visits (P < .001 and P = .004, respectively) for the eyes without drug treatment.

CONCLUSION: Although no eyes showed mean diurnal IOP reduction of 20% or more, selective laser trabeculoplasty resulted in a significant decrease in the amplitude of diurnal IOP fluctuation.

Peer-Review English Ophthalmic Surg Lasers Imaging. 2010 May-Jun;41(3):342-7. 2010 K

Department of Ophthalmology, Semmelweis University, Budapest, Hungary.

Effect of Primary Selective Laser Trabeculoplasty On Tonographic Outflow Facility: A Randomised Clinical Trial.

PURPOSE: To investigate the effect of 180 degrees versus 360 degrees primary selective laser trabeculoplasty (SLT) on tonographic outflow facility and intraocular pressure (IOP).

DESIGN: Prospective, single masked randomised clinical trial.

PARTICIPANTS: Patients with untreated primary open angle glaucoma or ocular hypertension both with IOP >21-35 mmHg.

METHODS: 40 patients randomly treated with 180 degrees or 360 degrees SLT after baseline tonographic outflow facility (electronic Schi

Peer-Review English Br J Ophthalmol. 2010 May 14. 2010 Goyal S, Beltran-Agullo L, Rashid S, Shah SP, Nath R, Obi A, Lim KS.

St Thomas' Hospital, London, UK.

Bilateral Diffuse Lamellar Keratitis Following Consecutive Selective Laser Trabeculoplasty in LASIK Patient.

A 48-year-old man with a history of myopic laser in situ keratomileusis (LASIK) had selective laser trabeculoplasty (SLT) for the treatment of glaucoma in the right eye. He subsequently developed grade 2 diffuse lamellar keratitis (DLK). He then elected to have SLT in the left eye and developed grade 1 DLK. To our knowledge, this is the first report of bilateral consecutive late postoperative DLK following SLT after LASIK.

Peer-Review English J Cataract Refract Surg. 2010 May;36(5):847-9. 2010 Holz H, Pirouzian A.

Department of Ophthalmology, Kaiser Permanente Medical Group, Santa Clara, California 95051, USA. haholz2002@yahoo.com

The Present Glaucoma Treatment Paradigm Should Be Re-Evaluated

Clearly, the current century-old paradigm of glaucoma therapy, consisting of primary drug therapy followed by surgery is far from optimal. While this paradigm is not directly recommended by the American Academy of Ophthalmology Preferred Practice Patterns, it is definitely indicated by European Glaucoma Society and the British National Institute for Heath and Clinical Excellence Guide for Diagnosis and Management of Primary Open Angle Glaucoma and Ocular Hypertension of April 2009 and is the one practiced by most ophthalmologists. The degree of success of ophthalmology in preventing glaucoma-induced visual disability is certainly not commensurate with the huge amounts of resources invested in glaucoma diagnosis, treatment, and monitoring according to this traditional well entrenched paradigm. I believe that the reason for this failure has to do not only with over-dependence on drug therapy but also, and equally important, under-utilization of the laser and surgical options, which depend far less on the patient

Article English Journal of Current Glaucoma Practice, January-April 2010;4(1):5-12 2010 Belkin M.

Goldschleger Eye Research Institute, Tel Aviv University, Sheba Medical Center, Tel Hashomer, Israel

Selective Laser Trabeculoplasty For Elevated Intraocular Pressure Following Subtenon Injection of Triamcinolone Acetonide.

PURPOSE: To report on the efficacy of selective laser trabeculoplasty (SLT) for elevated intraocular pressure (IOP) following subtenon injection of triamcinolone acetonide.

METHOD: SLT was performed on four of 148 eyes in which IOP was elevated after a subtenon injection of triamcinolone acetonide and could not be maintained within normal limits by conventional medications. Postoperative IOP and relative reduction of IOP were evaluated.

RESULTS: IOP was reduced in three eyes to within the normal range without any medications six months after SLT alone, but trabeculotomy was performed on one eye. Percentage reduction in IOP after SLT was 21.6% at one month, 45.0% at three months, and 52.7% at nine months.

CONCLUSION: SLT may be effective in reducing elevated IOP following subtenon injection of triamcinolone acetonide and should be considered before glaucoma surgery.

Peer-Review English Clin Ophthalmol. 2010 Apr 26;4:247-9. 2010 Yuki K, Inoue M, Shiba D, Kawamura R, Ishida S, Ohtake Y.

Department of Ophthalmology, Keio University School of Medicine, Japan

Rapid And Delayed Death of Cultured Trabecular Meshwork Cells After Selective Laser Trabeculoplasty.

BACKGROUND AND OBJECTIVE: Selective laser trabeculoplasty (SLT) is becoming increasingly employed to reduce elevated intraocular pressure in glaucoma patients. SLT is known to target the ocular trabecular meshwork (TM), but the exact response mechanisms to this treatment have not been clearly delineated. The aim of the present study, therefore, was to investigate the modes of death of cultured bovine TM cells subjected to SLT in vitro.

MATERIALS AND METHODS: Bovine TM cell cultures were established, pigmented with exogenous melanin and irradiated with a Q-switched, frequency doubled, Nd:YAG laser, at different energy settings (0.05-1.0 mJ). Influences on cells were determined for up to 10 days post-treatment by trypan blue exclusion, terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) and by morphological assessment. Furthermore, homogeneous mixtures of pigmented and non-pigmented TM cells were irradiated to ascertain selectivity of laser effects.

RESULTS: At higher energy levels (1.0, 0.75 mJ), immediate loss of cells was detected at the irradiated site. Trypan blue exclusion analysis showed that necrotic cell death subsequently occurred up to 8 hours following irradiation, peaking at 60 minutes. This was followed by delayed cell death peripheral to the irradiated area which was characteristic of apoptosis and which peaked at 2-3 days post-treatment. When mixed cultures were tested, laser treatment selectively killed pigmented cells at an energy level equivalent to the lower cell killing threshold in the initial studies (0.2 mJ) but at the higher laser energy of 0.35 mJ, all cells were non-selectively killed.

CONCLUSION: SLT treatment killed pigmented TM cells in culture by a variety of processes (instant vaporization, rapid necrosis, delayed apoptosis), depending on the magnitude of the energy used and the distance from the center of the irradiated zone. These data may assist in the elucidation of the mechanism of action of the SLT procedure on TM cells in situ.

Peer-Review English Lasers Surg Med. 2010 Apr;42(4):326-37. 2010 Wood JP, Plunkett M, Previn V, Chidlow G, Casson RJ.

South Australian Institute of Ophthalmology, Ophthalmic Research Laboratories, Level 2 Hanson Institute, IMVS, Frome Road, Adelaide, SA 5000, Australia. john.wood@imvs.sa.gov.au

Excimer Laser Trabeculotomy Vs 180 Degrees Selective Laser Trabeculoplasty in Primary Open-Angle Glaucoma. A 2-Year Randomized, Controlled Trial.

PURPOSE: To compare the effectiveness and safety of excimer laser trabeculotomy (ELT) ab interno vs selective laser trabeculoplasty (SLT) over 24 months of follow-up in patients with primary open-angle glaucoma (POAG) refractory to medical therapy.

PATIENTS AND METHODS: This prospective, randomized study included 30 consecutive eyes assigned randomly to either ELT or SLT group. ELT was carried out using a XeCl Excimer Laser with an emission wavelength of 308 nm. Eight spots were equally distributed at a distance of 500 microm from one another over the anterior trabeculum. The SLT patients were treated with a frequency-doubled q-switched neodymium:yytrium-aluminum-garnet laser (wavelength 532 nm). Approximately 50 adjacent, but not overlapping, laser spots were distributed over 180 degrees of the trabecular meshwork, using an energy level ranging from 0.7 to 1.0 mJ per pulse. The main outcome measure was intraocular pressure (IOP) lowering after ELT and SLT. Success was defined as >or=20% reduction in IOP without further glaucoma intervention.

RESULTS: At 24 months, complete success rates were 53.3% for the ELT group and 40% for the SLT group (P=0.35, Fisher’s exact test); qualified success rates were 33.3% for the ELT and 26.6% for the SLT group (P=0.5, Fisher’s exact test).Mean IOP decreased from 25.0+/-1.9 to 17.6+/-2.2 mmHg (-29.6%; P<0.0001) in the ELT group and from 23.9+/-0.9 to 19.1+/-1.8 mmHg (-21%; P<0.0001) in the SLT group.

CONCLUSION: Both ELT and SLT proved to be effective techniques in the treatment of POAG refractory to medical therapy.

Peer-Review English Eye (Lond). 2010 Apr;24(4):632-8. Epub 2009 Jul 10. 2010 Babighian S, Caretti L, Tavolato M, Cian R, Galan A.

Department of Ophthalmology, St Antonio Hospital, Padova, Italy. s.babighian@libero.it

Selective Laser Trabeculoplasty in Pseudophakic Glaucoma.

Glaucoma following cataract operation is more common when complications occur during surgery. Patients who had posterior capsule rupture during cataract surgery usually have a prolonged intraoperative time and manipulation. In such cases, secondary glaucoma may develop due to chronic trabecular damage and prolong topical steroid use. It is usually treated with topical anti-glaucoma medication or surgery. Recently selective laser trabeculoplasty (SLT) has emerged as a relatively new, safe and effective treatment modality. Three cases of pseudophakic secondary glaucoma following complicated cataract surgery treated successfully with 180 degrees SLT treatment are presented. Case 1 responded well to SLT during 5-year available follow-up, along with reduction in topical anti-glaucoma medication. In Cases 2 and 3, SLT was used as adjunctive to topical anti-glaucoma medication and target intra ocular pressure (IOP) was maintained for 4 and 2 years of available follow-up, respectively. To our best knowledge this is the first case series where SLT has been shown effective in cases of pseudophakic secondary glaucoma.

Peer-Review English Ophthalmic Surg Lasers Imaging. 2010 Mar 9:1-2. 2010 Nagar M, Shah N, Kapoor B.

Not specified

One Year Results of Selective Laser Trabeculoplasty in the Treatment of Primary Open Angle Glaucoma.

OBJECTIVE: To evaluate the efficacy and safety of selective laser trabeculoplasty (SLT) as a treatment of primary open angle glaucoma (POAG).

MATERIAL AND METHOD: In a prospective clinical study, 21 eyes suffering from POAG were treated with SLT over inferior 180 degrees of trabecular meshwork. The intraocular pressure (IOP) was measured before and 1 hour, 1 week, and 1, 3, 6, and 12 months after the treatment. The glaucoma medications were continued on the same regimen during the study period.

RESULTS: The mean preoperative IOP was 18.6 mmHg (SD 2.2). The mean IOP reduction were 4.9 mmHg (26.3%) 1 hour after SLT, 2.6 mmHg (14.0%) 1 week after SLT, 4.0 mmHg (21.5%) 1 month after SLT, 3.5 mmHg (18.8%) 3 months after SLT, 3.7 mmHg (19.9%) 6 months after SLT, and 3.3 mmHg (17.7%) 12 months after SLT. There were minimal adverse reactions including conjunctival injection and mild anterior chamber reaction.

CONCLUSION: SLT is a safe and effective procedure to reduce IOP in POAG patients.

Peer-Review English J Med Assoc Thai. 2010 Feb;93(2):211-4. 2010 Thatsnarong D, Ngamchittiampai C, Phoksunthorn T.

Department of Ophthalmology, Mettapracharak Hospital, Nakhon Pathom, Thailand. duangdaot@gmail.com

The Impact of Anti-Inflammatory Therapy On Intraocular Pressure Reduction Following Selective Laser Trabeculoplasty.

BACKGROUND AND OBJECTIVE: To determine whether the use of postoperative topical anti-inflammatory therapy affects the intraocular pressure (IOP)-lowering efficacy of selective laser trabeculoplasty in eyes with primary open-angle glaucoma.

PATIENTS AND METHODS: In this prospective, randomized, observer-masked study, 25 participants with primary open-angle glaucoma following bilateral 360 degrees selective laser trabeculoplasty used prednisolone acetate 1% four times daily in one randomly selected eye for 1 week. IOP was assessed at baseline and 1 week, 1 month, and 3 months after selective laser trabeculoplasty.

RESULTS: Baseline IOP and selective laser trabeculoplasty treatment parameters were comparable in both groups. Mean IOP was similar in eyes that did and did not receive steroid therapy at 1 week (17.0 vs 16.3 mm Hg, respectively, P = .613), 1 month (16.8 vs 16.2 mm Hg, respectively; P = .571), and 3 months (16.0 vs 15.8 mm Hg, respectively; P = .819).

CONCLUSION: A 1-week course of topical prednisolone acetate 1% four times daily did not affect the IOP-lowering effect of selective laser trabeculoplasty in eyes with primary open-angle glaucoma.

Peer-Review English Ophthalmic Surg Lasers Imaging. 2010 Jan-Feb;41(1):100-3. 2010 Realini T, Charlton J, Hettlinger M.

West Virginia University Eye Institute, Morgantown, Huntington, West Virginia, USA.

Laser Trabeculoplasty. SLT As Primary Therapy

For eligible patients, Dr Condon likes to start SLT early, usually with a 180 degrees or 360 degrees treatment to start. He also offers SLT as a second-line therapy for patients who are not controlled with a prostaglandin, or when he suspects noncompliance with medication is an issue. Generally, he sees an IOP drop of 4-8 mmHg or more in 70 per cent of patients, with those with the highest initial IOP seeing the greatest drop and those on multiple medications the least. IOP spikes are most common among patients with pigmentary glaucoma. Final effects are generally observed six to eight weeks after treatment. “This combination of effectiveness, reduced side effects and retreatment potential make SLT an attractive laser option”, Dr Condon concluded.

Article English Eurotimes, Volume 15 , Issue 7/8 2010 Condon J. P.

Drexel University College of

Available Laser Systems And Mechanism of Action in Laser Trabeculoplasty

Intraocular pressure-lowering laser procedures such as argon laser trabeculoplasty and selective laser trabeculoplasty are nowadays an essential part of glaucoma therapy. This article presents the currently most popular laser systems. These various laser procedures are based on the physical structure of the different lasers and on variable generation of laser light. They vary in their effect on the trabecular meshwork on a histopathological level, as well as in the active principles of intraocular pressure reduction. The mechanical, biological, and repopulation theories are currently used to explain the intraocular pressure-lowering effect of the different laser systems; these are discussed in detail.

Peer-Review German Ophthalmologe. 2010 Jan;107(1):8-12. 2010 Kuerzinger GR, Eckert S.

Augenklinik, Universit

Effectiveness And Relevance of Laser Trabeculoplasty: Treatment of Open-Angle Glaucoma

Laser trabeculoplasty is a common glaucoma therapy that is safe and effective for reducing intraocular pressure. It was developed as a treatment for open-angle glaucoma in the 1970s, and larger studies proved its effectiveness in the years that followed. In recent years, through the implementation of newer processes such as selective laser trabeculoplasty, laser trabeculoplasty has experienced further developments. Because it causes less damage to the trabecular meshwork, it should have fewer adverse effects, making it a repeatable treatment. Studies on the indications, contraindications, and effectiveness of this method in lowering intraocular pressure are reviewed.

Peer-Review German Ophthalmologe. 2010 Jan;107(1):18-21. 2010 Eckert S.

Augenklinik, Universit

Mastering the Techniques of Glaucoma
Book Chapter English Diagnosis and Management Editors Dr A Garg & Prof S Melamed 2010 Madhu Nagar

Wakefield, UK

From the Bedside To the Bench And Back Again: Predicting And Improving the Outcomes of SLT Glaucoma Therapy.

PURPOSE: To determine whether selective laser trabeculoplasty (SLT) and prostaglandin analogues (PGAs) have a common mechanism of action that involves increasing conductivity across Schlemm’s canal endothelial cells (SCEs) and inducing a similar decrease in intraocular pressure (IOP) in a given patient.

METHODS: The intercellular junctions in SCEs were made visible by transfection of a plasmid containing a GFP-tagged gene for ZO-1 protein. Transfected SCEs were treated with media conditioned by lasered trabecular meshwork endothelial cells (TMEs), or with latanoprost, bimatoprost, or travoprost. Non-transfected SCEs were exposed to brimonidine, timolol, or brinzolamide. Confocal microscopy and conductivity measurements documented the in vitro treatment effects. Clinically, the IOP in the first SLT-treated eye of 24 patients was measured (1) while on PGA therapy, (2) at “baseline” several weeks after discontinuing PGA therapy, and (3) approximately 90 days after SLT treatment.

RESULTS: Both the in vitro addition of any of the 3 PGAs and of media conditioned by lasered TMEs induced similar SCE effects involving junction disassembly, paracellular pathway widening, and increased conductivity. Clinically, PGAs decreased IOP by a mean of 5.58 mmHg and SLT decreased IOP by 6.60 mmHg from a baseline of 21.52 mmHg.

CONCLUSION: Exposure to media conditioned by lasered TMEs, or the addition of PGAs, induces the disassembly of intercellular junctions opening up the SCE barrier. Clinically, a positive PGA response predicts both a successful SLT outcome and the magnitude of the decrease in IOP after SLT. We hypothesize that SLT and PGA therapies may share a common mechanism of action.

Peer-Review English Trans Am Ophthalmol Soc. 2009 Dec;107:167-81. 2009 Alvarado JA, Iguchi R, Juster R, Chen JA, Shifera AS.

Beckman Vision Center, Department of Ophthalmology, University of California San Francisco, USA

Hyphema Following Selective Laser Trabeculoplasty.

Selective laser trabeculoplasty is an effective means of lowering intraocular pressure in patients with open-angle glaucoma with a low risk of complications. The authors report a case of hyphema noted 3 days after selective laser trabeculoplasty in a 77-year-old woman with primary open-angle glaucoma. Her intermittent use of oral nonsteroidal anti-inflammatory medications and chronic topical nonsteroidal anti-inflammatory use may have been a contributing risk factor.

Peer-Review English Ophthalmic Surg Lasers Imaging. 2009 Sep-Oct;40(5):493-4. 2009 Rhee DJ, Krad O, Pasquale LR.

Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.

Selective Trabeculoplasty in Combination With Vasoactive Agents in the Complex Treatment of Primary Open-Angle Glaucoma

The purpose of the present study was to evaluate the efficiency of complex treatment that has pathogenetic effects on the developmental stages of primary open-angle glaucoma (POAG), by activating the trabecular network via selective laser trabeculoplasty (SLT) and by improving microcirculation with the vasodilator Cavinton Forte. Fifty-seven patients aged 48 to 70 years (72 eyes) who had a developed stage of POAG with uncompensated ophthalmotonus were followed up. Group 1 (a study group) comprised 35 patients (42 years) who received complex therapy (the vasodilator Cavinton Forte 10 mg thrice daily for 2 months along with beta-blockers and prostaglandins. Group 2 (a control group) consisted of 22 patients (30 years) who were first only antihypertensive therapy that did not differ from that taken in Group 1. The complex treatment in patients with the uncompensated developed stage of POAG made it possible to reduce opththalmotonus in 80.9% of the patients to 35% after single application of SLT, to lower intraocular pressure stably, to cause easy outflow of intraocular fluid 2 weeks after SLT, to have positive changes in the stereometric parameters in the optic disk and structural alterations in accordance with the GPS classification, and to discontinue topical antihypertensive agents in 14.3% of the patients.

Peer-Review Russian Vestn Oftalmol. 2009 Sep-Oct;125(5):28-31. 2009 Shaimova VA, Shaimov RB, Goloshchapov KP.

Not specified

Selective Laser Trabeculoplasty For Primary Angle Closure With Persistently Elevated Intraocular Pressure After Iridotomy.

PURPOSE: To determine whether selective laser trabeculoplasty (SLT) can lower intraocular pressure (IOP) in eyes with chronic primary angle closure, elevated IOP, and a patent iridotomy.

PATIENTS AND METHODS: Patients with chronic angle closure who had underwent iridotomy, had an IOP greater than 21 mm Hg and a gonioscopically visible pigmented trabecular meshwork for at least 90 degrees were enrolled. SLT was applied to open angle segments. Duration of follow-up was 6 months.

RESULTS: Sixty eyes of 60 patients were enrolled. The mean baseline IOP was 24.6+/-2.5 mm Hg. At 6 months, IOP reduction of > or =3 mm Hg or 4 mm Hg was measured in 82% and 72% of eyes, respectively, and IOP reduction of > or =20% or 30% was measured in 54% and 24% of eyes, respectively. When only eyes that were treated with the same number or fewer medications were considered, these IOP reductions were measured in 67%, 58%, 43%, and 15%, respectively. During the study period 1 eye (1.7%) required trabeculectomy owing to IOP elevation shortly after the SLT. There were no other significant complications attributable to SLT.

CONCLUSION: SLT seems to be a safe and effective method of reducing IOP in many eyes with primary angle closure and a patent iridotomy in which there is a sufficient extent of visible trabecular meshwork.

Peer-Review English J Glaucoma. 2009 Sep;18(7):563-6. 2009 Ho CL, Lai JS, Aquino MV, Rojanapongpun P, Wong HT, Aquino MC, Gerber Y, Belkin M, Barkana Y.

Department of Ophthalmology, Singapore National Eye Center, Tan Tock Seng Hospital, Singapore.

Selective Laser Trabeculoplasty – Efficacy of 270

PURPOSE: To determine the efficacy of 270

Paper presentation English World Glaucoma Congress 2009 2009 Vyborny, Petr.

Central Military Hospital, Prague 6, Czech Republic

Selective Laser Trabeculoplasty: Nsaids Vs Steroids in Post-Operative Management

PURPOSE: To compare the effectiveness of a topical non-steroidal anti-inflammatory eye drop, diclofenac sodium 0.1% ophthalmic solution to a topical steroid, prednisolone acetate 1%, in patients who have undergone selective laser trabeculoplasty (SLT).

DESIGN: This is a randomized, multi-center, prospective, double-blind, active-control study. PARTICIPANTS: Patients with glaucoma who have undergone SLT.

METHODS: A total of 73 participants were randomized to either the NSAID or the steroid treatment group. Study visits took place at baseline and post-operatively at 1 hour, 7 days, 1 month, 3 months and 6 months. The primary outcomes of the study are intraocular pressure (IOP) and inflammation control in the NSAID compared to the steroid group at 6 months. The comparisons of these parameters at other time points as well as patient comfort throughout the duration of the study were considered secondary outcomes.

MAIN OUTCOME: The main outcomes are IOP and inflammation control at 6 months.

RESULTS: Pre and post-operative IOP means for the NSAID group were significantly different at 24.07 mmHg and 17.25 mmHg respectively (p<0.001). Similarly, pre and post-operative means for the steroid group were significantly different at 24.23 mmHg and 17.50 mmHg (p 0.080), with the exception of increased anterior chamber flare at 1 hour following SLT in the steroid group (p=0.030). Patient comfort was not found to differ between treatment groups (all p values> 0.143).

CONCLUSION: Both topical NSAIDs and steroids can be considered equally successful treatment options for the management of IOP control and inflammation following selective laser trabeculoplasty. Patient comfort is satisfactory with both therapies.

Poster Presentation English World Glaucoma Congress 2009 2009 Calafati, Jennifer

Credit Valley Eyecare, Mississauga, Canada

Selective Laser Trabeculoplasty As Initial And Adjunctive Treatment in Open Angle Glaucoma

PURPOSE: To evaluate the efficacy and safety of selective laser trabeculoplasty (SLT) as initial and adjunctive treatment in open angle glaucoma. Design: Prospective clinical study Participants: 114 eyes of 74 patients underwent SLT.

METHODS: 360 degrees SLT was performed by a single surgeon using a Latina goniolens. While 32 eyes (28%) were treated as initial therapy, 82 eyes (72%) were already on an average of 3 medications. Intraocular pressure (IOP) was measured at basal examination, at 1, 3, 6, 9 and 12 months. Topical steroids or non-steroidal anti-inflammatory agents were not prescribed after SLT. Main outcome measures: IOP was the main outcome measure. Success was defined as IOP reduction of at least 3 mmHg or at least 20% reduction from baseline

RESULTS: The mean basal IOP was 22.5

Poster Presentation English World Glaucoma Congress 2009 2009 Baser, Esin

Celal Bayar University School of Medicine, Manisa, Turkey

Selective Laser Trabeculoplasty For the Treatment of Pseudoexfoliative Glaucoma

PURPOSE: To evaluate the efficacy and safety of selective laser trabeculoplasty (SLT) for the treatment of pseudoexfoliative glaucoma. Design: Prospective clinical study Participants: 20 eyes of 16 pseudoexfoliative glaucoma patients with a mean age of 62.2 underwent SLT.

METHODS: 360 degrees SLT was performed by a single surgeon using a 532 nm Nd:YAG laser with the aid of a Latina goniolens. While 5 eyes (25%) were treated as initial therapy, 15 eyes (75%) were already on an average of 2 medications at the time of SLT. Intraocular pressure (IOP) was measured at basal examination, at 1, 3, 6, 9 and 12 months. Topical steroids or non-steroidal anti-inflammatory agents were not prescribed after SLT Main outcome measures: IOP was the main outcome measure Success was defined as IOP reduction of at least 3 mmHg or at least 20% reduction from baseline.

RESULTS: The mean basal IOP was 22.7

Poster Presentation English World Glaucoma Congress 2009 2009 Baser, Esin

Celal Bayar University School of Medicine, Manisa, Turkey

Selective Laser Trabeculoplasty: Alternative Approach To Glaucoma

OBJECTIVE: Argon-laser trabeculoplasty (ALT) has been used for decrease of intraocular pressure (IOP) over 20 years. This method is an alternative to medications and surgical operation for patients with uncontrolled glaucoma. Selective laser trabeculoplasty (SLT) is an improvement of standard ALT. The SLT technique excludes thermal injury of trabecular meshwork and gives a possibility of repeated procedure.

DESIGN: The aim of our report is to define the efficiency of SLT at glaucoma and eye hypertensia. Participants and/or controls: We have had 21 eyes under our supervision. Average age of the patients was 56.0 years. Average initial IOP reached 23.43 mm Hg. All patients displayed visual acuity of 20/20: a) in 66.67 % without correction; b) in 23.81 % of cases with correction; c) in 9.52 % with correction 20/20, however the field sight was tubular (narrowing to a fixing point). The most typical changes in terms of field of vision were nasal steps (from 5

Poster Presentation English World Glaucoma Congress 2009 2009 Buniatyan, Irina

Ophthalmologic Centre n.a. S.Malayan, Yerevan, Armenia

18-Month Results of Selective Laser Trabeculoplasty in Primary Open Angle Glaucoma And Ocular Hypertension. Egyptian Study

PURPOSE: to investigate the efficacy and safety of selective laser trabeculoplasty in primary open angle glaucoma and ocular hypertension in Egyptian population. Treatment was considered as primary, adjunctive, or replacement therapy.

DESIGN: A prospective intervention clinical study Participants: 117 eyes were enrolled in the study. Female /Male: 55/45. The mean age was 53.2 years. The mean intraocular pressure (IOP) was 19.44 mmHg under a mean of 1.49 antiglaucoma therapy.

METHODS: the treatment protocol consists of 360 degrees laser application to the trabecular meshwork, starting with 0.4 mJ and increasing the power as needed. Topical steroids were then applied for three days. Antiglaucoma therapy was then adjusted according to patient

Poster Presentation English World Glaucoma Congress 2009 2009 Abdelrahman, Ahmed

Cairo University, Giza, Egypt

One Year After the Treatment By Selective Laser Trabeculoplasty

PURPOSE: To evaluate efficacy of selective laser trabeculoplasty (SLT) in glaucoma patients. Design: Retrospective study.

PARTICIPANTS: In this study have been evaluated 110 eyes of 58 patients, 24 men and 34 women. The age ranged between 24 years and 80 years (mean, 63,8 years

Poster Presentation English World Glaucoma Congress 2009 2009 Eliasova, Miloslava

Hospital Litomysl, Litomysl, Czech Republic

Slt For Exfoliatif Glaucomas And Primary Open Angle Glaucomas Eight -Year Follow Up

PURPOSE: Selective laser trabeculoplasty (SLT) is a technique developed to meshwork for glaucoma. The purpose of this study to establish the efficacy of SLT for exfoliatif glaucoma (EG) and primary open-angle glaucoma(POAG)

METHOD: We assessed to 8-years efficacy of SLT a randomised treatment of glaucoma. Trabecular meshwork of 42 eyes (25 patients) was treated with Q-switched frequency doubled Na-YAG laser with a wave-length of 532

Poster Presentation English World Glaucoma Congress 2009 2009 Koev, Krassimir,

University Hospital "Aleksandrovska", Sofia, Bulgaria

Selective Laser Trabeculoplasty in Pseudoexfoliation Glaucoma

OBJECTIVE OR PURPOSE: Selective laser trabeculoplasty (SLT) is a new method to reduce intraocular pressure in glaucoma associated with pigmentation of trabecular meshwork. This pigmentation is often obtained in pseudoexfoliation glaucoma (PEG).The purpose was to evaluate the long-term results, safety and efficacy of SLT in the patients with PEG.

DESIGN: the prospective clinical trial

PARTICIPANTS: SLT has been performed in 64 eyes with PEG. The comparison group 48 eyes with PEG, treated only with medications (timolol twice daily). Intervention or methods or testing: Intraocular pressure (IOP) has been measured in 24 hours, 1 week, 1, 6 and 12 months after SLT.

RESULTS: IOP was reduced significantly (10,2 mmHg from baseline) in 24 hours after SLT. In 1 week the mean IOP reduction from baseline was 4,6 mmHg, in 1 month 2,3 mmHg, in 6 month 5,3 mmHg and in 12 months after SLT 6,8 mmHg. As SLT has been performed as a first-line treatment in 10 eyes, no low-tension medications were needed to control IOP in one year follow up in these eyes. The mean IOP reduction from baseline was more significant in SLT treated PEG patients (20%) then in comparison group (15%).

CONCLUSION: SLT is an effective method for IOP reduction in pseudoexfoliation glaucoma.

Poster Presentation English World Glaucoma Congress 2009 2009 Kurysheva, Natalia et al

Eye Institute of Medical and Biological Agency of Russian Federation, Moscow, Russia

Higher Energy May Improve Success With Selective Laser Trabeculoplasty (Slt) in Patients With Previous Failure in the First Eye

PURPOSE: To determine factors associated with SLT success in patients with previous failure in the first eye.

DESIGN: Retrospective comparative case series.

PARTICIPANTS AND CONTROLS: Patients who underwent SLT in both eyes were followed for at least 6 months, and in whom SLT had failed in the first eye.

METHODS: Medical records of the patients who underwent SLT in the last 5 years were reviewed. Logistic regression analysis was conducted to find predictors of SLT success in the second eyes. Factors used in the analysis include age, race, sex, history of diabetes, hypertension, or hypercholesterolemia, type of glaucoma, cup disc ratio, baseline intraocular pressure, number of antiglaucoma medications and various SLT parameters, etc. Failure was defined as an intraocular pressure decrease of less than 3 mm Hg from the baseline during follow-up. Success was defined as a lowering >3 mmHg following SLT. Main outcome measure: Factors associated with SLT success in the second eye in patients with SLT failure in the first eye.

RESULTS: 330 SLT procedures were identified. 41 patients had SLT in both eyes; 25 met entry criteria. Out of 25 patients who have failed SLT in the first eye, SLT was successful in the second eye in 7 patients (28%), and failed in the second eye in the remaining 18 patients (72%) during mean of 17.6 months of follow up (range; 6.0-55.3 months). Logistic regression analysis revealed statistically significant decrease in the risk of SLT failure in the second eye with higher SLT energy (odds ratio, 0.023; 95% confidence interval 0.001-0.753; p=.034). Mean SLT energy was 0.89

Poster Presentation English World Glaucoma Congress 2009 2009 Jea, Seung-Youn et al

Massachusetts Eye & Ear Infirmary/Harvard Medical School, Boston, USA

Comparison of Slt (Selective Laser Trabeculoplasty) Efficacy in Patients With Open Angle And Angle Closure Glaucoma

PURPOSE: To compare efficacy of 180 degrees selective laser trabeculoplasty (SLT) in lowering intraocular pressure between open angle and angle closure glaucoma patients.

DESIGN: Retrospective study

PARTICIPANTS: Open angle and angle closure glaucoma patients Method: Medical records of patients who underwent 180 degree selective laser trabeculoplasty (SLT) from June 2005 to Jan 2008 at King Chulalongkorn Memorial hospital, Bangkok, Thailand, were reviewed. Intraocular pressure (IOP) and number of glaucoma medications were assessed at baseline, 4-week and 12-week after SLT. Main outcome was IOP reduction from baseline and each follow up visit between open angle glaucoma (OAG) and angle closure glaucoma (ACG) patients. Main outcome measure: IOP after SLT treatment.

RESULTS: There were 39 open angle glaucoma and 20 angle closure glaucoma patients enrolled into the study. Mean (SD) age of open angle glaucoma and angle closure glaucoma patients were 63.13(11.89) and 66.00(9.12) years. Mean (SD) IOP at baseline in OAG and ACG groups were 18.47(4.72) and 19.48(3.78) mmHg, respectively. At 4 weeks after SLT, mean (SD) IOP of OAG and ACG groups were 15.92(3.36) and 18.05(4.21) mmHg, respectively. At 12 weeks after SLT, mean (SD) IOP of OAG was 15.12(2.81) mmHg, whereas ACG was 16.93(3.56) mmHg. SLT can significantly decrease IOP in both open angle and angle closure groups at 12 weeks after laser (p 0.05). The number of glaucoma medications used between baseline and 12-week post laser in both groups were not different.

CONCLUSION: Selective Laser Trabeculoplasty can reduce intraocular pressure in both open angle and angle closure glaucoma. No statistically significant difference of SLT efficacy was shown between both groups.

Poster Presentation English World Glaucoma Congress 2009 2009 Tantisevi, Visanee et al

Chulalongkorn University, Bangkok, Thailand

Selective Laser Trabeculoplasty As Adjunctive Treatment For Open-Angle Glaucoma in Indian Eyes

OBJECTIVE: To study the safety and efficacy of selective laser trabeculoplasty (SLT) as adjunctive treatment of open-angle glaucoma (OAG) in Indian eyes

DESIGN: Non-randomized, prospective, interventional study.

PARTICIPANTS: Forty eyes of twenty two Indian patients with open angle glaucoma who underwent selective laser trabeculoplasty were included in the study.

METHODS: 50 laser spots were placed over 180 degree of the trabecular meshwork Main outcome measures: Pre-laser and post laser IOP was noted at 2 weeks, 1, 3 and 6 months following SLT. IOP spikes and any complications were recorded. Reduction in number of topical medications to achieve target IOP was noticed.

RESULTS: Mean pre-treatment IOP was 24.8 mmHg. Mean IOP at 6 months following treatment was 17.3 mmHg. Mean decrease in IOP was 6.2mmHg. Seventy percent of the patients had an IOP decrease of more than 15%. Eighteen percent of the eyes showed no change in IOP. 16 percent of patients had a reduction of topical medication by one drop. Six patients had a transient spike in IOP (6-9 mm Hg), which settled within 24-72 hours. No other significant complications were noted.

CONCLUSION: SLT was found to be efficacious and safe as adjunctive therapy in reducing IOP in OAG in Indian eyes. Long-term prospective randomised studies with a larger sample size, are required to provide stronger evidence.

Poster Presentation English World Glaucoma Congress 2009 2009 Gupta, Ajay

Dr. Gupta Memorial Eye Institute, Indore, India

Laser Trabeculoplasty Induces Changes in the Trabecular Meshwork Glycoproteome: A Pilot Study.

Laser trabeculoplasty (LT) is a commonly used modality of treatment for glaucoma. The mechanism by which LT lowers the intraocular pressure (IOP) is unknown. With the use of cat eyes, selective laser trabeculoplasty (SLT) with a Q-switched frequency doubled Nd:YAG laser was used to treat the trabecular meshwork (TM). Laser treated TM was then subjected to proteomic analysis for detection of molecular changes and histological analysis for the detection of structural and protein expression patterns. In addition, the protein glycosylation patterns of laser treated and non-treated TM was assessed and differentially glycosylated proteins were proteomically identified. SLT laser treatment to the TM resulted in elevated glycosylation levels compared to non-lasered TM. TM laser treatment also resulted in protein expression levels changes of several proteins. Elevated levels of biglycan, keratocan and prolargin were detected in laser treated TM compared to non-lasered controls. Further investigation is anticipated to provide insight into how glycosylation changes affect TM proteins and TM regulation of aqueous outflow in response to laser trabeculoplasty.

Peer-Review English J Proteome Res. 2009 Jul;8(7):3727-36. 2009 Amelinckx A, Castello M, Arrieta-Quintero E, Lee T, Salas N, Hernandez E, Lee RK, Bhattacharya SK, Parel JM.

Bascom Palmer Eye Institute, Ophthalmic Biophysics Center, University of Miami Miller School of Medicine, Miami, Forida 33136, USA.

Five Year Experience of Effect of Race On Selective Laser Trabeculoplasty As Therapy in Patients With Glaucoma

PURPOSE: To examine the effect of Selective Laser Trabeculoplasty (SLT) on intraocular pressure (IOP) as primary and secondary therapy in glaucoma patients of varying ethnicity.

METHODS: Retrospective chart review was performed on 1403 eyes from a consecutive case series of 2056 eyes treated with SLT over 5 years. Eyes were divided into those treated with primary and secondary therapy, then subdivided by race: Black and White. Mean decrease in IOP and change in meds after treatment with SLT was recorded and analyzed.

RESULTS: In eyes which had SLT as primary treatment, Blacks and Whites showed an average IOP drop of 28% and 27% respectively. In eyes which had SLT as secondary treatment, Blacks and Whites showed an average IOP drop of 24% and 23%, respectively; analysis of the change in medication post-SLT showed that Blacks and Whites showed an average decrease in meds of 54% and 33%, respectively. Results were significant (p<0.01).

CONCLUSION: In this study, the mean IOP drops after primary SLT for Blacks and Whites were not significantly different; mean IOP drops after secondary SLT for Blacks and Whites were not significantly different (p<0.01). The mean decrease in meds after secondary SLT for Blacks and Whites were significantly different, with Blacks having a larger mean decrease in meds than Whites (p<0.01).

Poster Presentation English ARVO 2009 2009 J.A. Donnelly1, E.B. Moses2, E.M. Miglino3, L.F. Jindra4,5

1Hofstra University, Hempstead, NY; 2Stony Brook University, Stony Brook, NY; 3Floral Park Ophthalmology, Floral Park, NY; 4Columbia University, New York, NY; 5Winthrop University Hospital, Mineola, NY, USA

Efficacy of Selective Laser Trabeculoplasty (SLT) in Patients With Insufficient Control of Intraocular Pressure (IOP)

PURPOSE: To measure the IOP lowering effect of SLT in patients with open angle glaucoma and insufficient control of IOP under maximum tolerated therapy.

METHODS: Open-label, non-controlled, prospective, single center study. Preoperative examinations included best corrected visual acuity (VA), Goldmann applanation tonometry (GAT), slit lamp examination, gonioscopy, and non-dilated funduscopy.

SLT was performed using a frequency doubled, Q-switched Nd:YAG laser (Ellex Medical Pty Ltd., Adelaide). Preoperatively, one drop of Brimonidine was administered. We treated 360

Poster Presentation English ARVO 2009 2009 C. Hirn1, S.A. Zweifel2, A. Hediger1, J. Funk1.

1Ophthalmology, University Hospital Zurich, Zurich, Switzerland; 2Vitreous-Retina-Macula Consultants of New York, New York, NY, USA

Long-Term Outcomes of Selective Laser Trabeculoplasty in Patients With Uveitis

PURPOSE: To assess the effectiveness of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with uveitis.

METHODS: A Retrospective chart review was conducted of 61 patients (69 eyes) with uveitis and IOP elevation at the Massachusetts Eye Research and Surgery Institution. Outcomes of SLT, including IOP and number of uveitis flare-ups, were assessed at 1, 3, 6 and 12 months following the procedure.

RESULTS: Among the 69 eyes treated with SLT, 40 eyes (58%), 4 eyes (5.8%), and 25(36.2%) had anterior uveitis, intermediate uveitis, and posterior or panuveitis respectively. The total number of eyes that were followed-up at 1, 3, 6, and 12 months was 56, 54, 54 and 26 respectively. The mean intra-ocular pressure reduction from baseline at 1,3,6 and 12 months was 15.8%, 20.3%, 21.3% and 23.0% respectively, which was significant. The mean number of uveitis flare-ups following SLT at 1, 3, 6, and 12 months was 0.36, 0.25, 0.35, 0.58 respectively. Six eyes required other glaucoma surgery to control IOP.

CONCLUSION: SLT significantly lowered IOP at all follow-up visits. This procedure can be used effectively as an adjunctive therapy for patients with uveitic glaucoma.

Poster Presentation English ARVO 2009 2009 F. Zakka, S. Pujari, M. Shaikh, E. Yuksel, D. Hinkle, C.S. Foster.

Occular Immunology, MA Eye Research and Surgery Institution, Cambridge, MA, USA

The Effect of Brimonidine in IOP Spike Prophylaxis After Argon Laser Trabeculoplasty Or Selective Laser Trabeculoplasty Procedures in Chronic Vs. Non-Chronic Users of Brimonidine

PURPOSE: The goal of this study was to compare the effectiveness of brimonidine use during initial Argon Laser Trabeculoplasty/Selective Laser Trabeculoplasty (ALT/SLT) procedures as an intraocular pressure (IOP) spike prophylaxis among chronic and non-chronic users of brimonidine.

METHODS: This is a retrospective study reviewing a total of 256 charts of patients with glaucoma who underwent their first ALT or SLT procedure on a single eye. All patients were given brimonidine .15% prophylaxis 15-20 minutes prior to laser therapy. Patients were divided into 2 groups, those with chronic (=6 months) use of brimonidine as medical therapy for glaucoma prior to ALT or SLT and non-chronic (<6 months or no exposure) users of brimonidine. The following variables were collected: Length of use of brimonidine, number of additional glaucoma medications, pre-op IOP, one hour post-op IOP, total energy, C/D ratio, 1,3,6, and 12 month follow up IOP, patient age, race, sex, type of glaucoma and comorbidities of hypertension and diabetes. An IOP spike was defined as an increase in IOP =3 mmHg. Data were evaluated using chi-square, Fisher exact test, paired/unpaired t-test, standard deviation and mean.

RESULTS: There were 87 chronic brimonidine users and 169 non-chronic users. The mean pre-op IOP for chronic users was 18.5 (SD 4.7) mmHg and 19.5 (SD 5.1) mmHg for non-chronic users (p=0.12). An IOP spike of =3 was observed in 19/87 chronic users and 16/169 non-chronic users (chi-square p= 0.006) (Fisher

Poster Presentation English ARVO 2009 2009 C.D. Simpson1, B.A. Hughes2, M.S. Juzych2, A. Goyal2, M.Y. Alexander2, S.D. Wolfe2, C. Kim2

1Wayne State University School of Medicine, Detroit, MI; 2Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, USA

The Effect of Selective Laser Trabeculoplasty (SLT) With Heavy Versus Light Pigmentation of the Trabecular Meshwork

PURPOSE: To compare the effect of Selective Laser Trabeculoplasty (SLT) in reducing intraocular pressure (IOP) in patients with light, moderate, or heavy pigmentation of the trabecular meshwork (TM).

METHODS: This is a retrospective chart review of 83 eyes of 77 patients with open angle glaucoma (OAG) who underwent SLT from November 2006 to June 2008 for inadequately controlled IOP. Six patients underwent SLT in both eyes. Patients undergoing SLT for retreatment were excluded from analysis. Patients were assessed at time of SLT and classified as having light (Group I), moderate (Group II), or heavily (Group III) pigmented TM by gonioscopy. Post-SLT IOP

Poster Presentation English ARVO 2009 2009 M. Haque1, B.A. Hughes2, M.S. Juzych2, A. Goyal2, M.Y. Alexander2, S. Wolfe2, C. Kim2

1Ophthalmology, Wayne State University School of Medicine, Detroit, MI; 2Ophthalmology, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA

Repeat Selective Laser Trabeculoplasty.

PURPOSE: To evaluate the efficacy of repeat 360-degree selective laser trabeculoplasty (SLT) in glaucoma patients with prior successful 360-degree SLT.

DESIGN: Retrospective chart review.

METHODS: Forty-four eyes of 35 patients, > or =18 years of age, with open-angle glaucoma (primary open-angle, pseudoexfoliation, or pigmentary glaucoma), uncontrolled on maximum tolerable medical therapy, underwent an initial 360-degree SLT (SLT1), which was successful for > or =6 months, but eventually lost efficacy and was followed by a repeat 360-degree SLT (SLT2). Patients with prior argon laser trabeculoplasty or other glaucoma surgery, before or during the study period, were excluded. Intraocular pressure (IOP) measurements were recorded before each procedure and 1 to 4 weeks, 1 to 3 months, and 5 to 8 months post-treatment and 15 to 21 weeks after the initial SLT.

RESULTS: Reduction in IOP after SLT1 and SLT2 was significantly less with repeat treatment at 1 to 3 months, with average decreases of -5.0 and -2.9 mm Hg, respectively (P=0.01), but there were no statistically significant differences between treatments at the other equivalent time points. Using a definition of “success” as > or =20% peak IOP reduction, success rates for SLT1 and SLT2 were not significantly different. There was also no significant difference in eyes that received SLT2 6 to 12 months after SLT1 compared with those that received SLT2 12 months or more after SLT1.

CONCLUSION: Our findings suggest that repeat 360-degree SLT may be safe and effective after an initially successful 360-degree SLT has failed. These results may be achieved as early as 6 months after the first treatment.

Peer-Review English J Glaucoma. 2009 Mar;18(3):180-3. 2009 Hong BK, Winer JC, Martone JF, Wand M, Altman B, Shields B.

Yale University School of Medicine, New Haven, CT, USA.

Intraocular Pressure Measurements Throughout the 24 H

PURPOSE: This review summarizes the relationship of 24 h intraocular pressure (IOP) on the management of glaucoma.

RECENT FINDINGS: The 24 h IOP pattern demonstrates nocturnal elevation in the majority of individuals. Prostaglandin analogs and carbonic anhydrase inhibitors lower both diurnal and nocturnal IOPs. Timolol monotherapy and timolol add-on treatment to a prostaglandin analog does not lower IOP during the nocturnal period. Laser trabeculoplasty can reduce nocturnal IOP elevation in medically treated glaucoma patients, even in those without significant reduction of diurnal IOP. Though both IOP and central corneal thickness display a 24 h rhythm with peaks during the nocturnal period, there is no correlation between central corneal thickness and 24 h IOP variation in normals and glaucoma patients. Corneal biomechanical properties (corneal hysteresis and corneal resistance factor) remain relatively stable during the 24 h period and are not associated with 24 h IOP fluctuation.

SUMMARY: Antiglaucoma therapies differ in their ability to lower IOP throughout the 24 h day. The 24 h IOP pattern is independent of central corneal thickness, corneal hysteresis and corneal resistance factor.

CONCLUSION: An understanding of 24 h IOP can further augment the clinical management of glaucoma. Careful selection and appropriate dosing of medication may help produce sustained IOP reduction, not only during the diurnal period, but also during night-time hours. Laser trabeculoplasty may be effective in targeting nocturnal IOP in patients already receiving medical therapy. Unlike IOP, corneal biomechanical properties do not exhibit 24 h rhythm or influence 24 h variation of IOP.

Article English Current Opinion in Ophthalmology 2009, 2009 Harmohina Bagga, John H.K. Liu and Robert N. Weinreb

Department of Ophthalmology, Hamilton Glaucoma Center, University of California San Diego, La Jolla, California, USA

Selective Laser Trabeculoplasty Versus Argon Laser Trabeculoplasty in Patients With Uncontrolled Open-Angle Glaucoma

PURPOSE: To compare the efficacy of selective laser trabeculoplasty (SLT) to argon laser trabeculoplasty (ALT) as treatment and retreatment to lower intraocular pressure (IOP) in patients with uncontrolled open-angle glaucoma (OAG) on maximally tolerated medication therapy with a follow-up of 12 months.

METHODS: A total of 120 eyes of 120 patients with uncontrolled OAG were enrolled in the study. Group A included patients with IOP >22 mmHg on maximal medical therapy. A total of 43 eyes underwent SLT treatment and 41 eyes underwent ALT treatment. At the end of the follow-up IOP was 20 mmHg at 3 months follow-up after SLT or ALT treatment. These patients were retreated randomly, 18 with SLT and 18 with ALT.

RESULTS: In Group A at the end of the follow-up there was no statistically significant difference in IOP lowering between SLT (6.01 mmHg) and ALT (6.12) (p=0.794). In Group B at the end of the follow-up patients undergoing SLT presented IOP lowering statistically significant to ALT treatment (6.24 mmHg and 4.65 mmHg, respectively, p<0.01).

DISCUSSION: SLT is effective as treatment for patients with OAG and appears to be equivalent to ALT in IOP lowering at 12 months only in patients without a prior treatment. In case of retreatment SLT appears to be better than ALT in IOP lowering.

Article English Eur J Ophthalmol 2009; 19: 429 - 434 2009 Vincenzo Russo, Antonio Barone, Annesa Cosma, Andrea Stella, Nicola Delle Noci

Institute of Ophthalmology, University of Foggia, Foggia, Italy

Selective Laser Trabeculoplasty Versus Argon Laser Trabeculoplasty in Patients With Uncontrolled Open-Angle Glaucoma.

PURPOSE: To compare the efficacy of selective laser trabeculoplasty (SLT) to argon laser trabeculoplasty (ALT) as treatment and retreatment to lower intraocular pressure (IOP) in patients with uncontrolled open-angle glaucoma (OAG) on maximally tolerated medication therapy with a follow-up of 12 months.

METHODS: A total of 120 eyes of 120 patients with uncontrolled OAG were enrolled in the study. Group A included patients with IOP >22 mmHg on maximal medical therapy. A total of 43 eyes underwent SLT treatment and 41 eyes underwent ALT treatment. At the end of the follow-up IOP was 20 mmHg at 3 months follow-up after SLT or ALT treatment. These patients were retreated randomly, 18 with SLT and 18 with ALT.

RESULTS: In Group A at the end of the follow-up there was no statistically significant difference in IOP lowering between SLT (6.01 mmHg) and ALT (6.12) (p=0.794). In Group B at the end of the follow-up patients undergoing SLT presented IOP lowering statistically significant to ALT treatment (6.24 mmHg and 4.65 mmHg, respectively, p<0.01).

DISCUSSION: SLT is effective as treatment for patients with OAG and appears to be equivalent to ALT in IOP lowering at 12 months only in patients without a prior treatment. In case of retreatment SLT appears to be better than ALT in IOP lowering.

Peer-Review English Eur J Ophthalmol. 2009 May-Jun;19(3):429-34. 2009 Russo V, Barone A, Cosma A, Stella A, Delle Noci N.

Institute of Ophthalmology, University of Foggia, Foggia, Italy.

Selective Laser Trabeculoplasty For Glaucoma After Penetrating Keratoplasty.

PURPOSE: Postoperative intraocular pressure elevation is the most common complication to occur after penetrating keratoplasty (PKP). When topical antiglaucoma drops or oral systemic medication cannot lower this pressure, surgical intervention is necessary. However, surgery cannot yet be performed that does not adversely affect the graft, and better surgical treatments are required.

METHODS: A 62-year-old man had undergone PKP to treat bullous keratopathy in the left eye. Secondary glaucoma occurred early postoperation and was controlled through topical antiglaucoma eye drops, medication, and the decreasing use of topical steroids. However, 7 months postsurgery, intraocular pressure (IOP) in the eye re-elevated to 42 mm Hg (Goldmann applanation tonometer). Selective laser trabeculoplasty was performed inferiorly for 6 h and then added selective laser trabeculoplasty performed superiorly for 6 h, 1 week later. Complete slit lamp biomicroscopy, visual acuity, IOP, gonioscopy, and mydriatic funduscopy were performed pre- and post-treatment for 6 months.

RESULTS: IOP decreased from 42 to 27 mm Hg 1 week after selective laser trabeculoplasty (SLT) (inferior 180 degrees). After an additional superior 180 degrees SLT performed 2 weeks after this, IOP decreased to 15 mm Hg. Six months later, IOP was stable at 18 mm Hg, and graft rejection, new peripheral anterior synechiae, and visual acuity disturbance were not observed.

CONCLUSION: IOP elevation after PKP was successfully treated with SLT. SLT will become a valuable therapeutic method that limits invasive surgery for treatment of secondary glaucoma after PKP.

Peer-Review English Optom Vis Sci. 2009 Apr;86(4):e404-6 2009 Nakakura S, Imamura H, Nakamura T.

Department of Ophthalmology, Saiseikai Gose Hospital, Mimuro, Gose, Japan. shunsukenakakura@yahoo.co.jp

Intraocular Pressure Control And Fluctuation: the Effect of Treatment With Selective Laser Trabeculoplasty.

AIMS: To evaluate the effect of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) control and diurnal tension curves of patients with open-angle glaucoma (OAG) and ocular hypertension (OHT), and to compare this effect with that of latanoprost.

METHODS: Forty patients were randomised to receive either SLT or latanoprost. IOP control was evaluated by comparing pre-treatment values with post-treatment measurements on day 3, week 1, month 1 and 4-6 months; success was defined as 20% decrease in IOP. Tension curves were plotted prior to treatment and 4-6 months afterwards; success was 50% reduction in fluctuation.

RESULTS: SLT decreased pressure by 4.7 mm Hg on average (95% CI 3.6 to 5.7 mm Hg; p<0.01). The reduction was similar for latanoprost at all follow-ups except month 1; 75% of SLT patients and 73% of latanoprost patients achieved success in IOP control (p = 0.4). SLT significantly reduced IOP fluctuation, but latanoprost was more effective (3.6 mm Hg, 95% CI 3.2 to 3.9 mm Hg vs 2.5 mm Hg, 95% CI 2.2 to 2.9 mm Hg for SLT; p = 0.04). Success in fluctuation reduction was 50% for SLT and 83% for latanoprost (p = 0.045).

CONCLUSION: Both SLT and latanoprost had a significant impact on IOP control and fluctuation. While latanoprost may be more likely to reduce IOP fluctuation, SLT has the benefit of being a one-time intervention not requiring ongoing patient compliance.

Peer-Review English Br J Ophthalmol. 2009 Apr;93(4):497-501. Epub 2008 Dec 23 2009 Nagar M, Luhishi E, Shah N.

Clayton Hospital, The Mid Yorkshire Hospitals NHS Trust, 1 Woodthorpe Park Drive, Sandal, Northgate, Wakefield WF2 6HY, UK. madhunagar@hotmail.com

A Comparison of the Intervisit Intraocular Pressure Fluctuation After 180 And 360 Degrees of Selective Laser Trabeculoplasty (SLT) As A Primary Therapy in Primary Open Angle Glaucoma And Ocular Hypertension.

OBJECTIVE: To determine and compare the effect of 180 and 360 degrees of selective laser trabeculoplasty (SLT) treatment as a primary therapy on the intervisit intraocular pressure (IOP) fluctuation in patients followed up for a period of 2 years without any further medical or surgical intervention.

METHODS: Retrospective chart review of patients with ocular hypertension and primary open angle glaucoma who received SLT as primary therapy without any subsequent medical or surgical intervention. IOP before SLT and post-laser IOP at all the visits during the follow-up period of months 6 to 24 was determined. The standard deviation (SD) of the mean IOP was used as a surrogate for IOP fluctuation.

RESULTS: Forty-one eyes were treated by SLT, 19 eyes in the 180-degree group and 22 eyes in the 360-degree group. The mean reduction in IOP at 2 years was 28% in 180-degree group and 35% in 360-degree SLT group. After the SLT, the 360-degree SLT group had a lower IOP fluctuation compared with the 180-degree SLT group over the follow-up period of months 6 to 24. The percentage of eyes with intervisit IOP fluctuation (SD) <or=2 mm Hg during the same follow-up period was significantly greater in 360-degree SLT treatment group (86%) than in the 180-degree SLT treatment group (52%), P=0.03. The odds of achieving IOP fluctuation <or=2 mm Hg were 5.7 times greater with 360 degrees than with 180-degree SLT during the follow-up period of months 6 to 24.

CONCLUSION: This study suggests that 360-degree SLT is more efficacious in achieving smaller IOP fluctuations than treatment with 180-degree SLT.

Peer-Review English J Glaucoma. 2009 Feb;18(2):157-60. 2009 Prasad N, Murthy S, Dagianis JJ, Latina MA.

Massachusetts Eye and Ear Infirmary, Boston, MA, USA.

Intraocular Pressure Reduction in the Untreated Fellow Eye After Selective Laser Trabeculoplasty.

ABSTRACT OBJECTIVE: To investigate the effect of selective laser trabeculoplasty (SLT) on the intraocular pressure (IOP) of untreated fellow eyes in patients with open-angle glaucoma.

STUDY DESIGN: Retrospective chart review.

PATIENTS AND METHODS: Charts of all patients who underwent SLT at the University of Texas Southwestern Medical Center at Dallas between September 2003 and May 2006 were reviewed. Each patient had IOP measurements by Goldmann applanation tonometry in both eyes preoperatively, and at 1 hour, 2 weeks, 3 months, and 6 months postoperatively. Patient age, gender, diagnosis, central corneal thickness (CCT), previous intraocular surgeries, and degrees of laser treatment were tabulated for each patient. Patients with a history of previous glaucoma surgery in either eye were excluded as were those who underwent any change in glaucoma medications or further laser or surgical intervention in either eye within 6 months of SLT. Data were analyzed using a paired two-tailed t-test, an unpaired two-tailed t-test, ANOVA, and linear regression.

RESULTS: A total of 43 patients were included through 6 months of follow-up. Mean reduction in IOP in the treated eye was 3.9 +/- 0.6 mmHg or 18.8% (p < 0.001) at final exam. Mean IOP reduction in the fellow untreated eye was 2.1 +/- 0.5 mmHg or 11.2% (p < 0.01). Patients with higher preoperative IOPs had a greater reduction in IOP in both eyes (p < 0.001 for treated eyes, and p = 0.02 for untreated eyes). Patients who were on a larger number of glaucoma medications preoperatively had a greater response in both eyes (treated eye p = 0.002, untreated eye p = 0.008). There was no significant difference in IOP response in either eye based on age, gender, CCT, degrees of treatment, or phakic status.

CONCLUSION: SLT produces a sustained and statistically significant IOP reduction in the fellow untreated eyes of patients with open-angle glaucoma. The results of our study support a biological mechanism of action for SLT. Limitations of this study include its retrospective design, relatively small sample size, a possible effect of increased compliance with medical therapy following SLT, and an inherent bias of excluding patients who underwent a change in medications or further laser or surgical therapy during the period under review.

Peer-Review English Curr Med Res Opin. 2009 Feb 10. [Epub ahead of print] 2009 Rhodes KM, Weinstein R, Saltzmann RM, Aggarwal N, Kooner KS, Petroll WM, Whitson JT.

University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.

The Effect of Laser Peripheral Iridotomy in Vietnamese Patients With Primary Angle-Closure

PURPOSE: To investigate the effect of laser peripheral iridotomy (LPI) on controlling intraocular pressure (IOP) and progression of angle closure in Vietnamese.

METHODS: Medical records of Vietnamese patients who were examined during the period from January 2004 to November 2008, and diagnosed as primary angle-closure suspect (PACS), primary angle-closure (PAC), or primary angle closure glaucoma (PACG) and who had received LPI, were reviewed. Clinical outcomes and ocular features were analyzed.

RESULTS: Two hundred patients (372 eyes) with a mean follow-up period of 8.0

Poster Presentation English ARVO 2009 2009 P.-H. Peng1,2, N. Nguyen1,3, H. Nguyen3, S. Lin1

1Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, CA; 2Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 3Ngoc Nguyen Eye Clinic, San Jose, USA

Selective Laser Trabeculoplasty–New Possibilities in Glaucoma Treatment

The authors introduced into the clinical practice their own modification of the treatment by means of selective laser trabeculoplasty (SLT) in glaucoma patients. The SLT spots are burn in the extent of 270 degrees circumferentially in the anterior chamber angle (1.0 mJ, 80 spots, 400 microm). In the first group of 569 eyes with primary open angle glaucoma (POAG), followed up retrospectively and irregularly, at the control visit one year after the treatment, it was in 357 eyes possible, due to favorable decrease of the intraocular pressure (IOP), to decrease the medication from combined therapy to monotherapy, or to decrease the frequency of the application of antiglaucomatics, or to decrease their concentration. In other 197 eyes, the IOP was stabilized, but it was not possible to change the therapy, and in 15 cases, due to dissatisfactory effect of the treatment, the trabeculectomy was necessary. In the second group of POAG patients (133 eyes) followed up prospectively 1, 3, 6 and 12 months after the treatment, the decrease of the IOP from 21.1 +/- 4.5 mm Hg to 17.8 +/- 3.2 mm Hg after one month (P <0.0001), to 18.6 +/- 3.6 mm Hg after 3 months, to 17.8 +/- 3.1 mm Hg after 6 months, and to 17.7 +/- 2.8 mm Hg after 12 months was established. Good effect to the decrease the IOP was proved in pseudoexfoliative glaucoma as well. In the pigmentary glaucoma, the decrease of the IOP was found to be temporary, and on the contrary, in two cases, shortly after the SLT, considerable elevation of the IOP was found with the necessity to perform the trabeculectomy. The SLT may be used as the primary treatment in newly diagnosed POAG with advance, as well as possibility to terminate the treatment in cases when the glaucoma diagnosis is dubious.

Peer-Review Czech Cesk Slov Oftalmol. 2009 Jan;65(1):8-11. 2009 V

Ocn

Topical Prostaglandin Analogues Do Not Affect Selective Laser Trabeculoplasty Outcomes.

PURPOSE: To investigate the effect of topical prostaglandin analogue use on the efficacy of selective laser trabeculoplasty (SLT) intraocular pressure (IOP) lowering in patients with open-angle glaucoma.

PATIENTS AND METHODS: This retrospective study included 123 consecutive patients who underwent 180 degrees SLT for the first time. Eyes were grouped into those that received prostaglandin analogues before and after SLT (n=74) and those that did not (n=49). The main outcome measure was IOP lowering after SLT. Success was defined as >/=20% reduction in IOP without further glaucoma intervention.

RESULTS: There was no significant difference in IOP lowering at 6 months post-laser between the prostaglandin and non-prostaglandin groups (3.9+/-4.8 vs4.6+/-3.6 mm Hg, P=0.43). Long-term SLT success rates were also not significantly different between the treatment groups (Kaplan-Meier survival analysis, P=0.68). IOP lowering at 6 months was similar in eyes that received no glaucoma medications, monotherapy with or without a prostaglandin analogue, or combination therapy with or without prostaglandin analogues (P=0.81). Logistic regression analysis showed that various patient characteristics including age, sex, type of glaucoma, previous glaucoma surgery, and other glaucoma risk factors did not predict a successful SLT outcome. However, higher pre-operative IOP was found to predict SLT success (odds ratio=1.12, 95% CI=1.02-1.24, P=0.02).

CONCLUSION: The IOP lowering efficacy of SLT is not influenced by the use of topical prostaglandin analogues. Eye advance online publication, 30 January 2009; doi:10.1038/eye.2009.1.

Article English Eye. 2009 Jan 30. [Epub ahead of print] 2009 Singh D, Coote MA, O'Hare F, Walland MJ, Ghosh S, Xie J, Ruddle JB, Crowston JG.

Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia.

Two-Year Outcomes of Selective Laser Trabeculoplasty in Open-Angle Glaucoma And Ocular Hypertension

BACKGROUND: Selective laser trabeculoplasty (SLT) is a relatively new treatment strategy for the treatment of glaucoma. Its principle is similar to that of argon laser trabeculoplasty (ALT), but may lead to less damage to the trabecular meshwork.

METHODS: We assessed the 2-year efficacy of SLT in a non-comparative consecutive case series. Any adult patient either suspected of having glaucoma or with open-angle glaucoma, whose treatment was judged insufficient to reach target intraocular pressure (IOP), could be recruited. IOP and number of glaucoma treatments were recorded over 2 years after the procedure.

RESULTS: Our sample consisted of 44 consecutive eyes of 26 patients, aged 69+/-8 years. Eyes were treated initially on the lower 180 degrees. Three of them were retreated after 15 days on the upper 180. Fourteen eyes had ocular hypertension, 17 primary open-angle/normal-tension glaucoma, 11 pseudoexfoliation (PEX) glaucoma, and two pigmentary glaucoma. Thirty-six eyes had previously been treated and continued to be treated with topical anti-glaucoma medication, ten had had prior ALT, nine iridotomy, and 12 filtering surgery. The 2-year-follow up could not be completed for eight eyes because they needed filtering surgery. In the remaining 36 eyes, IOP decreased by a mean of 17.2%, 3.3 mmHg, (19.2+/-4.7 to 15+/-3.6 mmHg) after 2 years (p<0.001). As a secondary outcome, the number of glaucoma treatments decreased from 1.44 to 1.36 drops/patient. Other results according to subgroups of patients are analyzed: the greatest IOP decrease occurred in eyes that had never been treated with anti-glaucoma medication or with PEX glaucoma. SLT was probably valuable in a few eyes after filtering surgery; however, the statistical power of the study was not strong enough to draw a firm conclusion. When expressed in survival curves after 2 years, however, only 48% and 41% of eyes experienced a decrease of more than 3 mmHg or more than 20% of preoperative intraocular pressure, respectively.

CONCLUSION: SLT decreases IOP somewhat for at least 2 years without an increase in topical glaucoma treatment. However, it cannot totally replace topical glaucoma treatment. In the future, patient selection should be improved to decrease the cost/effectiveness ratio.

Peer-Review French J Fr Ophtalmol. 2008 Dec;31(10):981-6. 2008 Zaninetti M, Ravinet E.

H

Argon Laser Trabeculoplasty Versus Selective Laser Trabeculoplasty.

The clinical role of laser trabeculoplasty remains a controversial topic with many different opinions. In the following three viewpoints the authors have taken contrasting positions on whether argon laser trabeculoplasty remains the “gold standard” or has been supplanted by selective laser trabeculoplasty. Questions are raised regarding the position of laser trabeculoplasty within the stepping of the treatment paradigm for open-angle glaucoma. The appropriate use of laser trabeculoplasty at different stages of disease severity is analyzed. A broader perspective with new insights on laser trabeculoplasty from these articles will hopefully lead to a better understanding of its clinical role in practice.

Article English Surv Ophthalmol. 2008 Nov-Dec;53(6):641-6. 2008 Pham H, Mansberger S, Brandt JD, Damji K, Ramulu PY, Parrish RK.

Devers Eye Institute, Portland, Oregon, USA.

Selective Laser Trabeculoplasty: A Better Alternative

Selective laser trabeculoplasty (SLT) offers a safe and effective therapy for lowering IOP, and it provides a useful alternative to argon laser trabeculoplasty (ALT). SLT has gained widespread acceptance. Between 2002 and 2004 LTP rates increased, coinciding with its introduction. This technique requires considerably less energy than ALT (Table 1) and selectively targets pigmented cells within the trabecular meshwork so that the surrounding tissue is not damaged. Although further studies are needed, this may be important for patients who require repeat laser treatments or future medical and/or surgical therapies that rely on a functional trabecular meshwork. This article examines the evidence that compares the safety and efficacy of SLT to ALT, the use of SLT as first line therapy (vs. medications), and the use of SLT as adjunctive therapy as well as to decrease the burden associated with pharmacological treatment of glaucoma. It also touches on physician and patient perspectives with regard to SLT. It begins by providing a brief historical perspective on laser therapy of the trabecular meshwork, and a review of the underlying mechanism of laser-tissue interaction with SLT vs. ALT.

CONCLUSION: given the safety, efficacy, ease of use, markedly lower energy requirement, and selective targeting of the trabecular meshwork, SLT is a better alternative to ALT for most patients with primary open-angle glaucoma. SLT preserves meshwork architecture, and thus leaves open the possibility of additional medical, laser, or surgical treatment. With currently available evidence, it appears that 360 SLT offers an effective alternative to medication as first-line therapy. SLT may also be effective in patients who have failed previous ALT, although further studies are needed in this regard. Utilizing SLT to reduce the burden of medication in appropriate patients with OAG does seem justified. Future studies need to further define the treatment role of SLT, especially its repeatability, and to help determine its precise mechanism and duration of action relative to ALTand other glaucoma therapies.

Article English Surv Ophthalmol 53 (6) November--December 2008 2008 Karim F. Damji

The University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada

Selective Laser Trabeculoplasty For Primary Angle Closure With Persistently Elevated Intraocular Pressure After Iridotomy

PURPOSE: To determine whether selective laser trabeculoplasty (SLT) can lower intraocular pressure (IOP) in eyes with chronic primary angle closure, elevated IOP and a patent iridotomy.

PATIENTS AND METHODS: Patients with chronic angle closure that had underwent iridotomy, had an IOP greater than 21 mmHg and a gonioscopically visible pigmented trabecular meshwork for at least 90 degrees were enrolled. SLT was applied to open angle segments. Duration of follow-up was 6 months.

RESULTS: Sixty eyes of 60 patients were enrolled. The mean baseline IOP was 24.6

Peer-Review English Accepted for publication in Journal of Glaucoma on Nov. 4th, 2008 2008 Ching Lin Ho, MD,1 Jimmy S.M. Lai, MD,2 Mario V. Aquino, MD,3 Prin Rojanapongpun, MD,4 Hon

1 Singapore National Eye Center, Singapore

Matrix Metalloproteinases And Their Tissue Inhibitors After Selective Laser Trabeculoplasty in Pseudoexfoliative Secondary Glaucoma.

BACKGROUND: The aim of this study was to assess changes in metalloproteinases (MMP-2) and tissue inhibitor of metalloproteinases (TIMP-2) following selective laser trabeculoplasty (SLT) in patients with pseudoexfoliative glaucoma (PEXG).

METHODS: We enrolled 15 patients with PEXG and cataracts (PEXG-C group) and good intraocular pressure (IOP) controlled with beta-blockers and dorzolamide eye drops who were treated by cataract phacoemulsification and 15 patients with pseudoexfoliative glaucoma (PEXG-SLT group). The PEXG-SLT patients underwent a trabeculectomy for uncontrolled IOP in the eye that showed increased IOP despite the maximum drug treatment with beta-blockers and dorzolamide eye drops and after ineffective selective laser trabeculoplasty (SLT). The control group consisted of 15 subjects with cataracts. Aqueous humor was aspirated during surgery from patients with PEXG-C, PEXG-SLT and from matched control patients with cataracts during cataract surgery or trabeculectomy. The concentrations of MMP-2 and TIMP-2 in the aqueous humor were assessed with commercially available ELISA kits.

RESULTS: In PEXG-SLT group in the first 10 days after SLT treatment a significant reduction in IOP was observed: 25.8 +/- 1.9 vs 18.1.0 +/- 1.4 mm/Hg (p < 0.001), but after a mean time of 31.5 +/- 7.6 days IOP increased and returned to pre-treatment levels: 25.4 +/- 1.6 mm/Hg (p < 0.591). Therefore a trabeculectomy was considered necessary.The MMP-2 in PEXG-C was 57.77 +/- 9.25 microg/ml and in PEXG-SLT was 58.52 +/- 9.66 microg/ml (p < 0.066). TIMP-2 was 105.19 +/- 28.53 microg/ml in PEXG-C and 105.96 +/- 27.65 microg/ml in PEXG-SLT (p < 0.202). The MMP-2/TIMP-2 ratio in the normal subjects was 1.11 +/- 0.44. This ratio increase to 1.88 +/- 0.65 in PEXG-C (p < 0.001) and to 1.87 +/- 0.64 in PEXG-SLT (p < 0.001). There was no statistically significant difference between the PEXG-C and PEXG-SLT ratios (p < 0.671).

CONCLUSION: This case series suggest that IOP elevation after SLT can be a serious adverse event in some PEXG patients. The IOP increase in these cases would be correlated to the failure to decrease the TIMP-2/MMP-2 ratio.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN79745214.

Peer-Review English BMC Ophthalmol. 2008 Oct 21 2008 Cellini M, Leonetti P, Strobbe E, Campos EC.

Department of Surgery Science and Anesthesiology, Ophthalmology Service, University of Bologna, Italy

Development of A Prediction Rule To Estimate the Probability of Acceptable Intraocular Pressure Reduction After Selective Laser Trabeculoplasty in Open-Angle Glaucoma And Ocular Hypertension.

PURPOSE: To develop and validate a prediction rule to estimate the probability of acceptable intraocular pressure (IOP) reduction after selective laser trabeculoplasty (SLT) in ocular hypertension and open-angle glaucoma.

PATIENTS AND METHODS: The study population was derived from a cohort of 220 patients with ocular hypertension, open-angle glaucoma, or normal tension glaucoma. A > or =20% reduction in IOP (mm Hg) from the baseline IOP at 6 months after SLT was considered treatment success. Logistic multivariate regression modeling was performed to develop a prediction rule.

RESULTS: In multivariate logistic regression analyses, pre-SLT IOP and maximum IOP were identified as independent predictors for > or =20% IOP reduction at 6 months with adjusted odds ratios of 1.3 and 0.9, respectively, controlling for sex, diagnosis, pigment of anterior chamber, and washout of eye drops. The area under receiver operator characteristic curve was 0.716. Calibration of this prediction rule showed good agreement between predicted and observed probabilities of acceptable IOP reduction. If a probability of acceptable IOP reduction of 50% or greater is used as the minimal clinical threshold for treatment, the prediction rule had a sensitivity and specificity of 91.3% and 30.4%, respectively.

CONCLUSION: SLT efficacy is positively associated with IOP elevation before SLT treatment and adversely associated with the maximum IOP ever recorded in history. Pigmentation of the anterior chamber angle, diagnosis, washout of eye drops, and sex are not associated with SLT treatment efficacy. This prediction rule should be further validated with a comparable prospective clinical study cohort.

Peer-Review English J Glaucoma. 2008 Sep;17(6):449-54. 2008 Mao AJ, Pan XJ, McIlraith I, Strasfeld M, Colev G, Hutnik C.

Department of Ophthalmology, Ivey Eye Institute, St Joseph's Hospital, Lawson Health Research Institute, University of Western Ontario, USA

Preliminary Results of A Clinical Study On Efficacy of Selective Laser Trabeculoplasty (SLT) in Patients With Insufficient Control of Intraocular Pressure (IOP) Under Maximum Tolerated Drug Therapy

STUDY AIM: To measure the IOP lowering effect of SLT in patients with insufficient IOP control under maximum tolerated therapy. Open-label, non-controlled, prospective single center study.

INCLUSION CRITERIA: 30 patients planned, one eye per patient; primary open angle glaucoma (POAG) including normal tension glaucoma (NTG); pseudoexfoliation glaucoma (PEX); pigment dispersion glaucoma (PDG); former argon laser trabeculoplasty (ALT) allowed.

EXCLUSION CRITERIA: Previous intraocular surgery; narrow angle glaucoma and other than above mentioned glaucoma; unclear view of trabecular meshwork, any malformation blocking the trabecular meshwork (TM). Control of IOP, visual acuity, possible side effects. Control after 2 hours, and 1, 30, 90, 180, 360 days. Preoperative medication continued until 90 days visit.

SLT PROCEDURE: Preoperative administration of brimonidine eye drops; latina SLT lens (Ocular Instruments Bellevue, WA, USA); 360

Poster Presentation English XVI Congress of the ESCRS, 13.-17.September 2008 - Berlin 2008 Cornelia Hirn, Sandrine Zweifel, Annette Hediger, Jens Funk

University Hospital Zurich, Switzerland

Selective Laser Trabeculoplasty: A Review.

The introduction of selective laser trabeculoplasty (SLT) has renewed interest in laser trabeculoplasty for the reduction of intraocular pressure (IOP) in eyes with glaucoma. This review was undertaken to address frequently raised issues pertinent to SLT in clinical practice. On the basis of the peer-reviewed medical literature, SLT demonstrates equivalent efficacy and comparable safety to argon laser trabeculoplasty, and is also equally as effective as topical medical therapy. SLT’s safety profile includes mild and transient inflammation, ocular pain, and a small risk of moderate IOP elevations after the procedure. The mechanism of action of SLT is not known. SLT delivers less energy to the trabecular meshwork and generates less damage to angle tissues. Whether this renders SLT more repeatable than argon laser trabeculoplasty has not been evaluated in published data. SLT seems to be a safe and effective means of IOP reduction in eyes with glaucoma, and can reasonably be applied as primary or adjunctive therapy.

Article English J Glaucoma. 2008 Sep;17(6):497-502. 2008 Realini T.

Department of Ophthalmology, West Virginia University, Morgantown, WV 26505, USA

The Effect of Selective Laser Trabeculoplasty On Intraocular Pressure in Patients With Intravitreal Steroid-Induced Elevated Intraocular Pressure.

PURPOSE: To assess effectiveness of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced elevated IOP.

METHODS: 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 pre-existing open angle glaucoma; 2 patients had pre-existing 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 pre-laser; on the day of laser; within 3 weeks, and at 1, 3, and 6 months post-laser. Two-sample t test was used for analysis.

RESULTS: 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 (P0.080).

CONCLUSION: 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.

Peer-Review English J Glaucoma. 2008 Jun-Jul;17(4):287-92 2008 Rubin B, Taglienti A, Rothman RF, Marcus CH, Serle JB.

Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA.

Economic Evaluation Of

OBJECTIVE: Despite the significant clinical and economic burden associated with glaucoma, studies evaluating the long-term costs of existing treatments are limited. This study compared the 5-year costs of three treatment strategies: medication, laser trabeculoplasty, and filtering surgeries in managing patients with primary open-angle glaucoma whose intra-ocular pressures were not adequately controlled by two medications.

RESEARCH DESIGN AND METHODS: A Markov model was developed to simulate the transition of treatment progression over a 5-year period to evaluate the total treatment costs associated with each strategy. In the medication arm, medications were the only available treatment, whereas in the laser trabeculoplasty and surgery arms, patients would receive concomitant medications both at the time of the procedure and in subsequent years. Treatment states were determined by the rate of success in controlling patients

Peer-Review English Current medical research and opinion 2008 Louis B. Cantora,

Indiana University School of Medicine, Department of Ophthalmology, Indianapolis, IN, USA.

Selective Laser Trabeculoplasty (SLT) And Argon Laser Trabeculoplasty (ALT) As Initial Therapy For Glaucoma

BACKGROUND: Selective Laser Trabeculoplasty (SLT) represents a new approach to the treatment of open angle glaucoma. SLT utilizes a pulsed Q-switched Nd:YAG laser emitting at 532 nm which preserves the trabecular meshwork (TM) architecture and functionality by selectively targeting pigmented trabecular meshwork cells, without inducing collateral thermal or structural damage to surrounding cells or structures. By specifically and selectively targeting cells, a biological response within the trabecular meshwork is induced, which results in a lowering of intraocular pressure. This is in contrast to Argon Laser Trabeculoplasty (ALT) which utilizes a continuous wave laser which causes coagulation damage to the trabecular meshwork and surrounding structures. The lack of thermal damage to the TM by SLT has important clinical implications, specifically the use of SLT as primary therapy.

DISCUSSION: Recent clinical studies by Nagar et al, Melamed et al, and Latina, et al and McIlraith, et al. demonstrate the efficacy of SLT as primary therapy. Clinical studies with one to five year follow-up, demonstrate response rates in the range of 80-90%, and reports of minimal adverse effects. The SLT-MED study (Katz, Schuman et al) demonstrated equivalent IOP reduction in patients treated with SLT (6.7 mm Hg IOP reduction) compared to Prostaglandins as primary therapy (7.6 mm Hg). While ALT was also shown to be as effective as medications as primary therapy in the Glaucoma Laser Trial, ALT has not been widely accepted as a primary modality to treat glaucoma. How SLT may shape the future management of glaucoma will be discussed.

Paper presentation English ISOPT 2008 2008 M. LatinaMD

1 Ophthalmology, Tufts University Medical School, Boston, MA, USA;

Selective Laser Trabeculoplasty – Why Do We Need It?

BACKGROUND: Laser trabeculoplasty has been proposed as a potential first line therapy in open angle glaucoma. This option has been explored due to concerns with long term medical therapy such as adherence, side effects, and cost of drugs.

AIMS: To examine the initial therapy with selective laser trabeculoplasty in comparison with conventional medical therapy. Endpoint efficacy measures would include magnitude of intraocular pressure (IOP) reduction and attainment of target IOP levels.

METHODS: Prospective, randomized, multicenter trial comparing SLT versus medical therapy with one year of follow-up.

RESULTS: Data for at least 8 months of follow-up was available for 47 patients (94 eyes):
? 29 (58 eyes) Group 1 (SLT)
? 18 (36 eyes) Group 2 (medical)
IOP reduction in Group 1 was 6.7 mmHg with 7.6 in Group 2.

CONCLUSION: SLT may be a viable option as the first treatment for patients that have difficulty in adhering to the medical therapy: forgetful, economic burden, side effect concerns.

Paper presentation English ISOPT 2008 2008 L.J. Katz

Glaucoma Service, Wills Eye Institute, Philadelphia, PA, USA

Can Selective Laser Trabeculoplasty Substitute Medical Therapy of Primary Open-Angle Glaucoma?

OBJECTIVE: To investigate the influence of selective laser trabeculoplasty (SLT) on mean diurnal intraocular pressure (IOP) and diurnal IOP fluctuation in primary open-angle glaucoma.

METHODS: Baseline diurnal IOP curve was obtained for 26 eyes of 13 patients before SLT. The IOP curve was repeated at months 3 and 6 for eyes not requiring medical therapy.

RESULTS: In 5 eyes, office-time IOP decreased by =20%. No similar decrease was seen for the mean diurnal IOP in any case. Introduction of IOP-lowering medication was required for 11 eyes before the month-3 visit. Baseline diurnal IOP was higher for these eyes than for the others (p=0.002). Compared to baseline, for the eyes without medication a significant decrease was seen for mean IOP at the month-6 visit (p=0.017), and for IOP fluctuation at both visits (p<0.001 and p=0.004, respectively).

CONCLUSION: Though no eyes showed mean diurnal IOP reduction of =20%, SLT resulted in a significant decrease of diurnal IOP fluctuation amplitude.

Paper presentation English ISOPT 2008 2008 P. Kothy, M. Toth, G. Hollo

Department Of Ophthalmology, Semmelweis University, Budapest, Hungary

Primary Treatment of Glaucoma: Is Drug Therapy Ethical?

Primary treatment of glaucoma consisted of drug therapy for over a century. In spite of IOP being the only modifiable risk factor in glaucoma, IOP reduction being effective in preventing deterioration of visual function and the ready availability of potent IOP-lowering drugs, the rate of glaucoma blindness and visual incapacitation hardly decreased in recent years.

This lack of success is probably due to the dramatic lack of compliance with glaucoma drug therapy even in ophthalmologically well-served communities. Most recent surveys report compliance rates less than 50%, sometimes much lower. Similar disappointing results were found when prescription refill rates were measured.
Should a treatment modality which is effective in less than half the cases be used when laser trabeculoplasty provides similar IOP-lowering results while completely solving the compliance problem?
Recently published SLT results show that it is as efficacious in lowering IOP as a single drug therapy without any severe or permanent complications. Consequently, when compliance is taken into account, SLT is much more effective than drug therapy.

It thus seems more reasonable to use SLT as primary therapy of glaucoma and reserve drug therapy to the cases in which SLT does not provide sufficient IOP reduction.

Paper presentation English ISOPT 2008 2008 M. Belkin

Goldschleger Eye Research Institute, Tel Aviv University, Tel Hasomer, Israel

Selective Laser Trabeculoplasty in Correction of Ophthalmotonus in Pseudophakic Eyes in Patients With Previously Operated Open-Angle Glaucoma

PURPOSE: To evaluate an efficacy of selective laser trabeculoplasty (SLT) in correction of ophthalmotonus in pseudophakic eyes in patients with previously operated open-angle glaucoma.

MATERIALS AND METHODS: There were in follow-up 30 patients (35 eyes) with primary previously operated open-angle glaucoma (POAG). Cataract phacoemulsification with flexible IOL implantation was carried out 1-6 months after glaucoma surgery. The IOP subcompensation from 22 to 32 mm Hg (mean 26

Paper presentation English ISOPT 2008 2008 E.R. Tumanyan, E.S Ivanova, T.S. Lyubimova, E.E. Farazheva

The S. Fyodorov Eye Microsurgery Complex / Federal State Institution, Moscow, Russia

Our Initial Experience of Selective Laser Trabeculoplasty in A Clinic Setting

BACKGROUND AND AIMS: Selective laser trabeculoplasty (SLT) is a novel treatment for open angle glaucomas. The purpose of the study was to evaluate the initial safety and efficacy of the Coherent Selecta 7000 laser in patients with open angle glaucomas in a clinic setting.

METHOD: A retrospective case note review was carried out on consecutive patients. All underwent 360 degrees of meshwork treatment with a fixed spot size of 400 micrometers and pulse duration of 3nseconds. The power was titrated for the Champagne bubble response (0.6-1.2mJ).

RESULTS: Of 33 eyes of 33 patients ranging from 45

Paper presentation English ISOPT 2008 2008 M. Ramchandani1,2, A. Gupta1, A. Sampson1, C. Davison1

1 The Eye Unit, Royal Bournemouth Hospital, Bournemouth, UK

Combined Laser Interventions By the Selective Laser Trabeculoplastic in Treatment of Patients With Narrow- And Open Angle Glaucoma

BACKGROUD: Selective laser trabeculoplastic (SLT) should be considered as either a first or second line treatment in open-angle glaucoma patients with uncontrolled IOP. SLT may safer that ALT because it delivers less energy to the TM, causing less post-therapy IOP spikes (M. Goldenfeld, S. Melamed, 2006).

PURPOSE: Development of safety complex systems of combined lasers interventions in treatment of patients with narrow (low-profile) and open-angle glaucoma.

MATERIAL AND METHODS. From 2006 to 2007 – 630 patients with narrow-and open angle glaucoma were treated according to the suggested method. Preliminarily a simultaneous YAG-laser iridotomy was performed in case of narrow profile of the anterior chamber angle (23 % of cases the glaucoma). In case of insufficient IOP normalization after YAG-laser iridotomy in patients with recurrent elevation of ophthalmic underwent SLT – in original methods.

RESULTS: Use of the combined lasers treatment: YAG-laser iridotomy and the SLT, in case the narrow profile of the anterior chamber angle, allowed to significantly decrease the quantity of the penetrating types operations. In long-term follow-up period a mean IOP reduction of 8.0 mm Hg and was compensated in 84 % of cases.

CONCLUSION: Combined laser interventions of micro-invasive types: YAG-laser iridotomy and SLT – or the basis of which was created a complex system of the patients suffering from the main forms of glaucoma, that safety and excludes complications of the knife-glaucoma surgery.

Paper presentation English ISOPT 2008 2008 N.N. Ereskin, A.B. Zahidov

Glaucoma Department of IRTK, Moscow, Russia

SLT Vs ALT At Five Years

Selective Laser Trabeculoplasty (SLT) has been used for over 10 years to lower intraocular pressure (IOP) in patients with open angle glaucoma (OAG) as well as ocular hypertension (OHT). Studies have demonstrated that SLT is a safe and effective means of treatment, and comparable in these respects to Argon Laser Trabeculoplasty (ALT), but how does SLT fare against ALT in the long-term? It was our mission to establish this.

As part of our randomized, controlled trial, which compared SLT with ALT in OAG patients, including pseudoexfoliation and pigmentary glaucoma patients, we wanted to evaluate outcomes over five years.1

The study begins

Article English Ophthalmology Times Europe, 02 June 2008 2008 Amy M. Bovell, COMT, Karim F. Damji, MD, FRCSC, MBA

University of Ottawa Eye Institute and Ottawa Health Research Institute, Canada

Evaluation of A Modified Protocol For Selective Laser Trabeculoplasty.

PURPOSE: To compare the intraocular pressure (IOP) response to a modified protocol for selective laser trabeculoplasty (SLT) to standard protocols for SLT and argon laser trabeculoplasty (ALT).

MATERIALS AND METHODS: A retrospective study of 318 eyes of 284 patients diagnosed with either primary open angle, pigmentary or pseudoexfoliation glaucoma who underwent laser trabeculoplasty from September 1997 to September 2005. One hundred and two patients, who underwent a modified SLT protocol with 100 overlapping laser spots over 180 degrees of trabecular meshwork were compared with 89 patients who received SLT with 100 non-overlapping spots over 360 degrees and another 127 patients who received ALT with 50 spots over 180 degrees. IOPs were measured at baseline and postoperatively at 1 hour, 6 weeks, 4 months, and 14 months. Regression models, based on the observed data, were used to predict the fall in IOP in the 3 groups, controlling for differences in baseline pressure.

RESULTS: The IOP response to overlapping SLT was significantly worse than to non-overlapping SLT or ALT, both of which had similar responses. Baseline IOP was the only preoperative factor that predicted response to ALT (P<0.0001) and non-overlapping SLT (P=0.0019) at all follow-up times. There were no statistically significant predictive factors for IOP reduction in the overlapping SLT group.

CONCLUSION: Overlapping application of SLT results in a poorer IOP response compared with ALT and non-overlapping SLT.

Peer-Review English J Glaucoma. 2008 Apr-May;17(3):197-202. 2008 George MK, Emerson JW, Cheema SA, McGlynn R, Ford BA, Martone JF, Shields MB, Wand M

Department of Ophthalmology and Visual Science, Yale University School of Medicine New Haven, CT, USA

SLT A New Option For Pseudoexfoliative Glaucoma

To better evaluate the response to SLT in eyes with PXFG, a retrospective chart review of patients who underwent SLT from January 2000 to December 2005 was performed (571 eyes in total). Of those, 24 eyes of 21 patients (11 male, 10 female; mean age 72 years) had either PXFS or PXFG and were available for analysis.

Of the 21 patients treated, three received SLT treatment in both eyes, whilst the remaining 18 patients were treated in one eye. 17 eyes in total underwent 180

Article English Ophthalmology Times Europe, Jan/Feb 2008 2008 Madhu Nagar, MS Ophth, FRCS Ophth

Clayton Eye Centre, Mid Yorkshire Hospital Trust, Wakefield, UK

Symposium: Medical Versus Laser Treatment

Laser treatment of the trabecular meshwork is considered as an intermediate step between medications and surgery in the therapeutical algorythm of open angle glaucomas. This strategy was mostly supported by studies designed in the 80ies and comparing argon laser trabeculoplasty with the medical treatments (mostly beta blockers and miotics) available at that time. Nowadays, new lasers (as well as new classes of drugs) have come into the

Article English December issue of Int. Glaucoma Review 2007 Stefano Gandolfi (chair; Parma), Ted Krupin (chair; Chicago),

Not Specified

Selective Laser Trabeculoplasty.

Despite extended and substantial clinical experience with laser trabeculoplasty, it is used relatively infrequently. Reasons include associated significant tissue disruption with consequent reluctance from re-treatment, lack of full understanding of the mechanism by which intraocular pressure (IOP) is reduced, and known complications. Selective laser trabeculoplasty results in selective absorption of energy by trabecular pigmented cells, sparing adjacent cells and tissues from thermal damage. Morphologic studies demonstrated minimal tissue alteration following treatment with selective laser trabeculoplasty. Clinical studies suggest it is efficacious in lowering IOP, as initial treatment or when medical therapy is insufficient, with response rates after 1 year ranging from 59% to 96%. Average reduction in IOP has been reported from 18% to 40%. Comparative studies suggested similar IOP reduction by argon laser trabeculoplasty and selective laser trabeculoplasty. Observed side effects have been mostly transient and minor. We review the current knowledge of the mechanisms and clinical outcome of selective laser trabeculoplasty.

Peer-Review English Surv Ophthalmol. 2007 Nov-Dec;52(6):634-54. Links 2007 Barkana

Glaucoma Unit, Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel.

Clinical Results of Selective Laser Trabeculoplasty As Adjunctive Treatment For Primary Open-Angle Glaucoma Patients

PURPOSE: We retrospectively investigated the intraocular pressure (IOP) lowering effects of selective laser trabeculoplasty (SLT) as adjunctive treatment for glaucoma patients receiving maximal medical therapy.

METHODS: Thirty-four eyes of 34 patients with primary open-angle glaucoma who had no prior surgical therapy and has received SLT for the first time were included in this study. The results of their laser treatment were analyzed retrospectively. The age of patients was 61.1 +/- 13.0 (mean +/- standard deviation) years, the follow-up period was 7.1 +/- 4.8 months, and the number of medications before SLT was 3.5 +/- 0.7. A total of 57.0 +/- 11.5 spots were placed over 180 degrees of the trabecular meshwork at energy levels ranging from 0.5 to 1.4 mJ per pulse.

RESULTS: The IOP significantly decreased from 20.9 +/- 3.4 mmHg at baseline to 18.7 +/- 4.6 mmHg at 1 month after SLT (p < 0.01). Kaplan-Meier survival analysis showed that success rates at 6 and 12 months after SLT were 48.6% and 23.2%, respectively.

CONCLUSION: Although SLT significantly decreased the IOPs in Japanese patients with primary open-angle glaucoma receiving maximal medical therapy, the effects may be for a limited time only, as adjunctive treatment.

Peer-Review Japanese Nippon Ganka Gakkai Zasshi. 2007 Dec;111(12):953-8 2007 Saito

Department of Ophthalmology and Visual Science, Kanazawa University School of Medical Science, Japan. saito-yo@med.kanazawa-u.ac.jp

Predictive Factors of Successful Selective Laser Trabeculoplasty in Open-Angle Glaucoma

BACKGROUND: The aim of this study was to determine factors that predict successful selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG).

PATIENTS AND METHODS: In 122 eyes suffering from OAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66, 72, 78 and 84 months thereafter. Success was defined as an IOP reduction exceeding 20 % of the pre-treatment IOP. Correlations between successful SLT and baseline IOP, age, sex, hypertension, diabetes mellitus, family history of glaucoma, previous anterior segment surgery, the grade of trabecular meshwork pigmentation, laser energy used, and local antiglaucoma therapy were determined.

RESULTS: The mean follow-up time was 43.4 months (SD: 25.6). The mean pre-treatment IOP was 22.5 mmHg (SD: 2.8). The success rate after 12 months determined from the Kaplan-Meier survival analysis was 88 %, after 24 months 79 %, after 36 months 67 %, after 48 months 58 %, after 60 months 49 % and after 84 months 48 %. We found statistically significant negative correlation betweens successful SLT and the grade of trabecular meshwork pigmentation(r = -0.234; p = 0.01), I14:I19diabetes mellitus (r = -0.223; p = 0.014). We found no statistically significant correlations between successful SLT and baseline IOP, age, sex, hypertension, family history of glaucoma, previous anterior segment surgery, laser energy used, local antiglaucoma therapy.

CONCLUSION: SLT success in OAG with a mean follow-up time of 43.4 months was significantly predicted by the lower grade of trabecular meshwork pigmentation and the absence of diabetes mellitus.

Peer-Review German Klin Monatsbl Augenheilkd. 2007 Dec;224(12):922-6. 2007 Gracner

Universit

Selective Laser Trabeculoplasty Retreatment After Prior Argon Laser Trabeculoplasty: 1-Year Results.

BACKGROUND: Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are treatments for open-angle glaucoma. Many patients have previously received ALT but could benefit from further treatment. The purpose of this study was to examine whether SLT provided clinical benefit for patients who had previously received complete argon treatment.

METHODS: This was a prospective, partially randomized, comparison study. The study compared the effect after 1 year of SLT in patients with open-angle glaucoma (primary, pigmentary, or pseudoexfoliation) who had previously received 360 degrees of ALT with the effect of laser treatment (ALT or SLT) given for the first time in patients with this condition. Ninety-six subjects were given 180 degrees of laser trabeculoplasty. When both eyes qualified for treatment, the first eye treated was included in the analysis. Twenty-seven subjects were treated with SLT after previously receiving 360 degrees of ALT therapy; the remainder were given their first laser treatment, 30 being randomly assigned by coin toss to receive SLT and 39 to receive ALT.

RESULTS: The mean intraocular pressure (IOP) before treatment was 21.5 mm Hg (SLT after ALT), 22.9 mm Hg (SLT), and 22.0 mm Hg (ALT), with no statistical difference among the groups (p > 0.05). The mean IOP at 1 year was 16.7 mm Hg (SLT after ALT), 17.1 mm Hg (SLT), and 16.4 mm Hg (ALT). The IOP for all 3 groups was statistically significantly lower than at baseline (p 0.05). At 1 year, the percentage IOP reductions from baseline were 23% (SLT), 19.3% (SLT after ALT), and 24% (ALT). There were no differences among the groups in the number of medications used before the laser, although there was a small but statistically significant decrease in the number of medications used before or after the laser treatment in both the SLT and the SLT after ALT group, but not the ALT group.

INTERPRETATION: SLT retreatment can produce a clinically useful decrease in IOP at 1 year, similar to that obtained by ALT, in patients who have had prior argon laser treatment. SLT may be a useful adjunctive therapy when 360 degrees of ALT has already been performed.

Peer-Review English Can J Ophthalmol. 2007 Oct;42(5):715-9 2007 Birt

Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada. c.birt@utoronto.ca

Selective Vs Argon Laser Trabeculoplasty: Controversy in Evolution.
Peer-Review English Am J Ophthalmol. 2007 Jul;144(1):120-1. 2007 Girkin

Department of Ophthalmology, School of Medicine, and University of Alabama at Birmingham, Birmingham, Alabama, USA

Selective Laser Trabeculoplasty in Fertile Women With Open Angle Glaucoma Or Ocular Hypertension

PURPOSE: To investigate the efficacy and safety of selective laser trabeculoplasty (SLT) in pregnant and lactating women who have primary open-angle glaucoma and ocular hypertension.

METHODS: From January 2006 to August 2006 SLT was performed in fertile female patients with primary open-angle glaucoma and ocular hypertension. Intraocular pressure (IOP) was measured at 1 hour, 1 day, 1 week, 1 month, 3 months, and 6 months after SLT. Anterior chamber reaction and ocular pain were checked on postoperative day 1. Peripheral anterior synechia was examined at postoperative 6 months. Any anti-glaucoma drug was discontinued after SLT procedure, and restarted when needed.

RESULTS: 22 patients (40 eyes) of primary open-angle glaucoma (40 eyes) and ocular hypertension (10 eyes) were included. The mean baseline intraocular pressure was 31.6 mmHg. The mean IOP was 15.7 mmHg and the mean number of anti-glaucoma drug was 1.3

Peer-Review Korean J Korean Ophtalmol Soc 48(11): 1494-1499, 2007 2007 Myoung Hee Park, M.D., Jung-Il Moon, M.D.

Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea

A Comparison of Efficacy And Safety Between 90

PURPOSE: To compare the intraocular pressure-lowering effect and safety between 180

Peer-Review Korean J Korean Ophthalmol Soc 48(11):1500-1505, 2007 2007 Myoung Hee Park, M.D., Jung-Il Moon, M.D.

Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Compliance With Topical Glaucoma Treatment in Syria During Ramadan

AIM OF THE STUDY AND METHODS: to assess compliance of Muslim patients with their topical glaucoma medication during Ramadan. A questionnaire survey was conducted amongst Muslim patients attending the Glaucoma clinic at the Eye Surgical Hospital in Damascus, Syria during the month of Ramadan in 2005. The questionnaire assessed the patients

Paper Presentation English MEACO 2007 2007 Basel Al Faouri M.D.; CSO.; CABO.

The Eye Surgical Hospital, Damascus, Syria

Effect of Topical Prostaglandin Analog Use On Outcome Following Selective Laser Trabeculoplasty

PURPOSE: The aim of this study was to determine the effect of prostaglandin analog use on postoperative intraocular pressure (IOP) and treatment success following selective laser trabeculoplasty (SLT).

METHODS: Records from 113 eyes with open angle glaucoma who underwent SLT were reviewed retrospectively. Eyes were categorized as to whether they were receiving a topical prostaglandin analog (n 78) or other classes of glaucoma medications (n 35) before and following SLT. IOP was measured before (baseline) and at 1 h, 1 day, 1 week, and 1 month following SLT.

RESULTS: Baseline IOP (standard error [SE]) did not differ between prostaglandin analog users (18.0 0.48 mmHg) and nonusers (17.5 0.71 mmHg). One (1) month after SLT, average IOP decrease (SE) was greater (P 0.02) among prostaglandin analog users (3.4 0.4 mmHg), compared to nonusers (1.6 0.5 mmHg). Also at 1 month, average percent IOP decrease (SE) was greater (P 0.015) among prostaglandin analog users (16.5 2.0%), compared to nonuser (7.9 2.7%). At 1 h, 1 day, and 1 week after SLT, there were no differences in average IOP decrease or percent IOP decrease between prostaglandin analog users and nonusers. The percentage of eyes with a 20% or greater decrease in IOP was greater (P 0.015) among prostaglandin analog users (44.9%), compared to nonusers (22.9%), 1 month after SLT. Also, 48.7% of prostaglandin analog users had an IOP decrease of 3 mmHg or greater, compared to 31.4% of nonusers, 1 month after SLT (P 0.05). Retreatment rate among prostaglandin analog users (11.5%) was less (P 0.005) than nonusers (34.3%).

CONCLUSION: Prostaglandin analog use during the perioperative period prior to and 1 month after SLT is associated with greater average IOP decrease and percent IOP decrease 1 month postoperatively, compared to eyes not receiving these agents. Prostaglandin analog use is also associated with a greater likelihood of treatment success and a lesser likelihood of requiring retreatment 1 month postoperatively.

Peer-Review English JOURNAL OF OCULAR PHARMACOLOGY AND THERAPEUTICS 2007 Scherer

Montgomery Eye Center, Naples, FL, USA

Review of SLT Literature: Where We Are Today
Paper Presentation English IGS 2007 Athens 2007 MICHAEL BELKIN

TEL AVIV UNIVERSITY, SHEBA MEDICAL CENTER, ISRAEL

Selective Laser Trabeculoplasty: Repeated Treatment Results

Repeatability of the 90 degrees Selective Laser Trabeculoplasty (SLT) was investigated in a retrospective study. SLT with 25 laser effects on 90 degree of trabecular meshwork was performed as adjunctive therapy in 76 eyes of 76 patients. SLT was carried out twice in 48 eyes, and triply in 15 eyes. The intervals between the laser treatment and the loss of IOP control were analyzed with a Kaplan-Meier survival analysis. The intervals of IOP control among repeated SLT treatments were compared. The effect of age, the previous ALT, the exfoliation and the pigmentation of the trabecular meshwork on the period of IOP control was investigated.

The mean interval of IOP control after a first-time SLT treatment was 296 days (95% confidence interval 228 to 364 days). Repeated SLT had similar duration of IOP regulation (p = 0.10). The age, the previous ALT, the exfoliation and the pigmentation of the trabecular meshwork did not influence the period of IOP control.

Paper Presentation English IGS 2007 Athens 2007 ENPING CHEN

GLAUCOMA SERVICE, ST. ERIK

Selective Laser Trabeculoplasty (SLT) As A Primary And Adjunctive Treatment For Secondary Glaucoma Patients

TITLE: Selective Laser Trabeculoplasty (SLT) as a primary and adjunctive treatment for secondary glaucoma patients.

AUTHORS: Vukosavljevic, M., Aleksic, P., Milivojevic, M., Jojic-Savicevic, Z., Civcic, N., Mrdja-Radosavljevic, T.

INSTITUTION: Eye Clinic Medical Military Academy, Belgrade, Serbia.

AIM: To evaluate SLT hypotensive effects with secondary glaucoma patients.

METHODS: We examined 106 eyes in 54 patients with secondary glaucoma. 72 eyes (29 patients) were with capsulary glaucoma, 8 eyes (4 patients) with pigmentary glaucoma, 23 eyes (18 patients) were with secondary glaucoma caused by silicon oil post-operatively, and 3 eyes (3 patients) were with increased IOP due to post uveitic reaction. We performed SLT as a primary therapy for 32 eyes (six eyes with pigmentary glaucoma, 19 eyes with silicon oil after pars plana vitrectomy-VPP, and 7 eyes with capsulary glaucoma). In all other cases SLT was additional therapy. We performed SLT on inferior part of the pigmented trabecular meshwork at an energy level from 0.5 mJ for heavily pigmented eyes to 1.1. mJ per pulse for poorly pigmented eyes and eyes with silicon oil. We measured IOP at selected intervals; one hour post-operatively, one week, one month, three months and six months post-operatively.

RESULTS: In each patient group we had an overall reduction of IOP, ranging from 18% to 35%, with only 4 eyes remaining without effect. We observed the best results with SLT when used as a primary therapy with capsulary and pigmentary glaucoma. This reduction was 33% and we achieved controlled IOP without medical therapy. In eyes with glaucoma caused by silicon oil the base line IOP was very high (mean 42 mmHg) and post-operatively we got significant reduction of 54%. However, this effect is short termed (eight weeks) and for these patients we planned evacuation of silicon oil in three months after VPP.

CONCLUSION: SLT is very useful and highly effective treatment for secondary glaucoma patients. Our results suggest that it is more effective as a primary therapy, especially in patients with initially high IOP. Further, SLT is a safe therapy even for eyes with silicon oil and presents a solid intermediary solution until surgical removal of silicon oil.

Paper Presentation English IGS 2007 Athens 2007 MIROSLAV VUKOSAVLJEVIC

EYE CLINIC MEDICAL MILITARY ACADEMY, BELGRADE, SERBIA

SLT For PACG: Results of A Multi-Center Study

PURPOSE: To assess the efficacy and safety of Selective Laser Trabeculoplasty (SLT) as a treatment for Primary Angle Closure glaucoma (PACG).

METHODS: All the visible pigmented trabecular meshwork of 67 eyes with PACG, a patent peripheral iridotomy and a clear view of at least 90 degrees of the angle were treated by SLT.

RESULTS: From a mean baseline IOP of 24.7

Paper Presentation English IGS 2007 Athens 2007 PRIN ROJANAPONGPUN

Dr. Prin Rojanapongpun, Chulalongkorn University & Hospital, Thailand

The Future For SLT

The classical

Paper Presentation English IGS 2007 Athens 2007 IVAN GOLDBERG

EYE ASSOCIATES, SYDNEY EYE HOSPITAL, AUSTRALIA

SLT As First Line Therapy For Primary Open-Angle Glaucoma And Long-Term Results

PURPOSE: Selective Laser Trabeculoplasty (SLT) is increasingly being used to lower IOP in clinical practice. Preliminary published evidence suggests that this is an effective and a safe procedure, with minimal, transient and self-limiting side effects but jury is out on long term results.

METHODS: Retrospective case study of all the patients undergoing SLT: 2000

Paper Presentation English IGS 2007 Athens 2007 Madhu Nagar

Wakefield, UK

Baseline Factors Predictive of SLT Response: A Prospective Study

BACKGROUND AND AIMS: Determine whether angle pigmentation and other baseline patient characteristics may be predictive of IOP lowering response of SLT.

METHODS: Patients were prospectively examined and angle pigmentation was graded using a standardized scale. Baseline demographic and eye characteristics were noted. Patients then underwent 180 degree of SLT, and IOP lowering of the same eye, as well as IOP lowering as compared to the contralateral eye, were noted at the 1 month, 6 month and 1 year visits post SLT. Statistical analyses including ANOVA and Pearson correlation coefficients were examined.

RESULTS: 74 eyes of 60 patients were examined. SLT response was independent of age, gender, degree of angle pigmentation and whether ALT had been previously performed, or whether patients had OHT, or NTG as compared to POAG. Pseudophakes had a smaller decrease in IOP at all time points (0 vs -3mmHg, p=0.01), and patients with PXF also had a marginally lower IOP response at months 1 and 6 (-0.5 vs -3.3 mmHg, p=0.06, Figure 1). Patients on prostaglandin analog treatment prior to SLT had a smaller decrease in IOP, even when corrected for baseline IOP (-2.5 vs -4.5 mmHg, p=0.006).

CONCLUSION: Pseudophakes, pseudo-exfoliators and prostaglandin users, may have a smaller IOP lowering effect after SLT.

Paper Presentation English IGS 2007 Athens 2007 P.J. Harasymowycz , P. Roy, M.R. Lesk

Montreal , Quebec, Canada

SLT And Its Evolving Role in the Management of Glaucoma

The use of Selective Laser Trabeculoplasty (SLT) has become more widespread and the role of SLT in the management of glaucoma continues to evolve. A variety of SLT clinical studies will be presented with emphasis on the safety and efficacy of SLT as primary therapy, use of SLT to reduce the need for anti-glaucoma medications, repeatability of SLT, and the effect of SLT on IOP fluctuation. A paradigm shift in glaucoma management towards earlier treatment of glaucoma with SLT will be discussed.

Paper Presentation English IGS 2007 Athens 2007 M.A. Latina

Reading, MA, USA

Selective Laser Trabeculoplasty As Adjunctive Treatment For Open-Angle Glaucoma

PURPOSE: To investigate the efficacy and safety of selective laser trabeculoplasty (SLT) as adjunctive treatment of open-angle glaucoma (OAG).

MATERIALS AND METHODS: A prospective non-randomized clinical trial was performed in the Department of Ophthalmology in Afyon Kocatepe University. Patients diagnosed OAG were assigned to selective laser treatment. All patients underwent complete ophthalmic evaluation before and at intervals after treatment. A total of approximately 50 spots were placed over 180

Paper Presentation English IGS 2007 Athens 2007 F. Ozturk , U. Inan, S. Ermis

Afyon, Turkey

SLT- Biological, Biochemical And Physiological Studies

PURPOSE: To test the hypothesis that trabecular meshwork endothelial cells (TMEs) regulate aqueous outflow by actively releasing ligands that upon binding to Schlemm’s canal endothelial cells (SCEs) increase transendothelial flow, thereby facilitating the egress of aqueous.

METHODS: We tested our hypothesis by (1) activating the TMEs in vitro using a laser procedure known to increase aqueous outflow in vivo; (2) demonstrating that lasered TMEs become activated at the genome-wide level and synthesize ligands; (3) ascertaining that media conditioned by laser-activated TMEs and ligands therein increase transendothelial flow when added to SCEs; and (4) determining that ligands identified as synthesized by TMEs increase permeability when added to SCEs.

RESULTS: Adding either media conditioned by lasered TMEs or ligands synthesized by TMEs to na

Paper Presentation English IGS 2007 Athens 2007 J. Alvarado

San Francisco, CA, USA

Comparison of Selective Laser Trabeculoplasty (SLT) Vs. Medical Therapy For Initial Therapy For Glaucoma Or Ocular Hypertension

PURPOSE: To compare selective laser trabeculoplasty with medical therapy for the initial treatment of open angle glaucoma

DESIGN: Prospective, multi-center (17 sites) randomized double-arm trial. Both eyes of eligible patients were randomized to receive either SLT in both eyes (Group 1) or medical therapy (Group 2).

Participants: 47 patients (94 eyes) with open angle glaucoma on no medical therapy or previous laser trabeculoplasty or eye surgery
Target intraocular pressure (IOP) was determined by a formula developed for the Collaborative Initial Glaucoma Treatment Study (CIGTS) based on the starting IOP and severity of the baseline perimetry visual field results. Failure was called if the IOP exceeded 2 mmHg above the target IOP range and the next step in the treatment paradigm was SLT repeated in the SLT arm and changes in the medical regime in the medicine group.
Main Outcome Measures: Goldmann applanation tonometry before and at least 8 months after treatment initiated. The mean IOP was obtained for both groups and individual success was determined by falling within the calculated target IOP range. Serial perimetry and optic nerve evaluation were performed to detect any
glaucomatous progression which also signaled failure and the need for additional treatment.

RESULTS: After a follow-up interval of at least 8 months there was a near IOP reduction of 7.6 mmHg in the medical treatment group (36 eyes) and 6.7 mmHg in the eyes following SLT (58 eyes). The number of steps in the treatment paradigm was 1.1 for the SLT group and 1.3 for the medical group suggesting that target IOP range was achieved in the majority of eyes in both groups.

CONCLUSION: Selective laser trabeculoplasty is an effective first line option in the treatment of open angle glaucoma.

Paper Presentation English IGS 2007 Athens 2007 L.J. Katz , W.C. Steinmann, G. Marcellino, SLT/MED Study Group

Philadelphia, PA, USA

Efficacy of 270

PURPOSE: To determine the efficacy of 270

Paper Presentation English IGS 2007 Athens 2007 P. Sebesta , P. Vyborny, J. Pasta

Prague, Czech Republic

Selective Laser Trabeculoplasty in Previously Operated Eyes For Cataracts And/Or Glaucoma

OBJECTIVE: To evaluate effectiveness and safety of selective laser trabeculoplasty in previously operated eyes for cataract and/or glaucoma (trabeculectomy) needed for ocular hypotensive medication.

METHODS: A prospective study of 21 eyes (10 eyes operated for cataract, 10 operated for glaucoma and 1 eye for both) of 14 patients with follow-up time of 9 months who underwent to SLT

Poster Presentation English IGS 2007 Athens 2007 Ben

Hospital General del S.A.S. de Jerez, Jerez (C

Influence of Selective Laser Trabeculoplasty (SLT) On Diurnal IOP Fluctuation in Poag

Aims: To investigate the influence of SLT on mean diurnal IOP (mean-IOP) and diurnal IOP fluctuation.

METHODS: Twenty-six eyes of 13 POAG patients underwent a 4-week washout before baseline diurnal IOP curve. Standard 360-degree SLT was performed. The IOP curve was repeated after 3 and 6 months. IOP lowering medication was started (failure) if mean-IOP was higher than 22 mmHg or any single IOP value exceeded 26 mmHg at any visit.

RESULTS: Post-treatment IOP elevation >5 mm Hg was found in 16 eyes (62%). An at least 20% decrease of the mean-IOP was not reached. Medication was introduced in 16 eyes. Baseline mean-IOP and diurnal IOP fluctuation (mean

Paper Presentation English IGS 2007 Athens 2007 G. Hollo , P. Kothy, M. Toth

Budapest, Hungary

IOP Reduction After Repeat And Enhancement of SLT

Prospective

Poster Presentation English Poster AAO 2007 2007 Madhu Nagar

Not specified

Selective Laser Trabeculoplasty in Phakic And Pseudophakic Eyes.

BACKGROUND AND OBJECTIVE: To evaluate the effect of pseudophakia on the success of selective laser trabeculoplasty in lowering intraocular pressure (IOP).

PATIENTS AND METHODS: In this retrospective, nonrandomized clinical trial, a chart review of all patients who underwent selective laser trabeculoplasty from September 2002 to June 2004 using a frequency-doubled Q-switched 532-nm Nd:YAG laser was performed. Changes in IOP and statistical significance were determined at each follow-up period. Average decrease in IOP and success rates for phakic and pseudophakic eyes were compared statistically at each time period.

RESULTS: In the phakic group, mean IOP decreased from 18.1 to 15.5 mm Hg (P < .0005) and mean glaucoma medication use decreased from 2.1 to 1.6 medications after 24 months of follow-up. In the pseudophakic group, mean IOP decreased from 18.3 to 15.2 mm Hg (P .05). No significant complications occurred in either group.

CONCLUSION: Selective laser trabeculoplasty is effective in lowering IOP in both phakic and pseudophakic patients.

Peer-Review English Ophthalmic Surg Lasers Imaging. 2007 May-Jun;38(3):182-8. 2007 Werner

University of Florida, Department of Ophthalmology, 1600 SWArcher Rd., Gainesville, FL 32610, USA.

What Should We Think? Is Selective Trabeculoplasty More Effective Than Conventional Argon Laser Trabeculoplasty?

The long-term effectiveness of selective laser trabeculoplasty is equivalent to argon laser trabeculoplasty. Easy to use and relatively safe, selective laser trabeculoplasty is a good alternative for medical treatment, particularly in cases of poor compliance.

Peer-Review French J Fr Ophtalmol. 2007 May;30(5 Pt 2):3S74-8. 2007 Lefran

Unit

Selective Laser Trabeculoplasty in the Treatment of Primary Open-Angle Glaucoma

OBJECTIVE: To investigate the efficacy and safety of selective laser trabeculoplasty (SLT) in the treatment of primary open angle glaucoma (POAG).

METHODS: In a prospective non-randomized clinical study, 63 patients (85 eyes) with POAG and medically uncontrolled intraocular pressure (IOP) underwent SLT. A total of 50 +/- 5 adjacent but non-overlapping spots were placed over inferior 180 degrees of the trabecular meshwork using a 532 nm, Q-switched, Nd: YAG laser at energy levels ranging from 0.6 approximately 1.8 mJ per pulse. After SLT, the eyes continued to receive the identical drug regimen. All patients were observed before and 1, 2 hours, 1, 7 and 14 days, and 1, 2, 3, 6, 9, 12, 18, and 24 months after the treatment.

RESULTS: The average pre-operative IOP was (25 +/- 4) mm Hg (1 mm Hg = 0.133 kPa). The mean IOP reduction from baseline were 8.1 mm Hg (32.0%) 1 day after the SLT, 5.6 mm Hg (22.1%) 7 days after the SLT, 4.7 mm Hg (18.6%) 14 days after the SLT, 5.5 mm Hg (21.7%) 1 month after the SLT, 5.1 mm Hg (20.2%) 2 months after the SLT, 5.9 mm Hg (23.3%) 3 months after the SLT, 5.2 mm Hg (20.6%) 6 months after the SLT, 4.0 mm Hg (15.8%) 9 months after the SLT, 4.2 mm Hg (16.6%) 12 months after the SLT, 3.8 mm Hg (15.0%) 18 months after the SLT, and 3.3 mm Hg (13.0%) 24 months after the SLT (P < 0.01 or 0.05). Adverse reactions were minimal, including conjunctival injection, mild anterior chamber reaction, and transient pressure spike.

CONCLUSION: SLT is a safe and effective method of reducing IOP in POAG patients.

Peer-Review Chinese Zhonghua Yi Xue Za Zhi. 2007 Jan 9;87(2):118-20 2007 Qian

Eye & ENT Hospital, Fudan University, Shanghai 200031, China

Selective Laser Trabeculoplasty Versus Argon Laser Trabeculoplasty: Results From A 1-Year Randomised Clinical Trial.

AIMS: To compare selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT), in terms of intraocular pressure (IOP) lowering, in patients with open-angle glaucoma.

METHODS: 176 eyes of 152 patients were enrolled in this study, 89 in the SLT and 87 in the ALT groups. Patients were randomised to receive either SLT or ALT treatment to 180 degrees of the trabecular meshwork. Patients were followed up to 12 months after treatment. The main outcome measured was IOP lowering at 12 months after treatment, compared between the SLT and ALT groups.

RESULTS: No significant difference (p = 0.846) was found in mean decrease in IOP between the SLT (5.86 mm Hg) and ALT (6.04 mm Hg) groups at 1 year or at any other time points, nor were there any significant differences in the rate of early or late complications between the two groups.

CONCLUSION: SLT is equivalent to ALT in terms of IOP lowering at 1 year, and is a safe and effective procedure for patients with open-angle glaucoma.

Peer-Review English Br J Ophthalmol. 2006 Dec;90(12):1490-4. Epub 2006 Aug 9. Links 2006 Damji KF, Bovell AM, Hodge WG, Rock W, Shah K, Buhrmann R, Pan YI.

Not specified

Hyphema Occurring During Selective Laser Trabeculoplasty.

The first case of hyphema occurring during selective laser trabeculoplasty in an eye without neovascularization is described. A 77-year-old man with uncontrolled open-angle glaucoma received selective laser trabeculoplasty in both eyes for high intraocular pressure with maximally tolerated medical treatment. Hyphema occurred during selective laser trabeculoplasty in the left eye. This resolved spontaneously without sequelae. Successful intraocular pressure control was achieved. Hyphema and bleeding can happen during selective laser trabeculoplasty. Although this was transient and uneventful in one patient, careful monitoring of intraocular pressure and anterior chamber reaction is advised.

Peer-Review English Ophthalmic Surg Lasers Imaging. 2006 Sep-Oct;37(5):432-3. 2006 Shihadeh WA, Ritch R, Liebmann JM.

Not specified

Long-Term Follow-Up of Selective Laser Trabeculoplasty in Primary Open-Angle Glaucoma

BACKGROUND: Our aim was to investigate the outcomes of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in a prospective clinical study.

PATIENTS AND METHODS: In 90 eyes suffering from POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66 and 72 months after. A failure was defined as an IOP reduction of less than 20 % of the pre-treatment IOP, or a progression of visual field or optic disc damage requiring filtering surgery. The hypotensive medication during the study period remained unchanged.

RESULTS: The mean follow-up time was 41.2 months (SD 20.0). The mean pre-treatment IOP was 22.4 mmHg (SD 2.3). At one month of follow-up, the mean IOP reduction was 5.0 mmHg (SD 2.3) or 22.3 % and at 6 months 5.2 mmHg (SD 2.4) or 23.2 %. At 12 months of follow-up, the mean IOP reduction was 5.4 mmHg (SD 2.4) or 24.0 % and at 24 months 5.8 mmHg (SD 2.3) or 25.5 %. At 36 months of follow-up, the mean IOP reduction was 5.7 mmHg (SD 2.1) or 25.1 % and at 48 months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 1.9) or 23.1 %. At 60 months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 2.0) or 22.6 % and at the end of 72 months of follow-up, the mean IOP reduction was 5.4 mmHg (SD 2.3) or 22.8 %. The success rate after 12 months determined by Kaplan-Meier survival analysis was 94 %, after 24 months 85 %, after 36 months 74 %, after 48 months 68 % and after 72 months 59 %.

CONCLUSION: SLT is an effective procedure offering an additional therapy option for the treatment of POAG, but the effect diminishes over time.

Peer-Review German Klin Monatsbl Augenheilkd. 2006 Sep;223(9):743-7. Links 2006 Gracner T, Falez M, Gracner B, Pahor D

Not specified

Trabeculoplastia Selectiva Una Alternativa Multifuncional Al Tratamiento Del Glaucoma De

Long term evaluation of SLT on different groups of patients

Paper Presentation English SEO Spain September 2006 2006 M. Javier Gonz

Not specified

Randomised Clinical Trial

AIMS: To compare selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT), in terms of intraocular pressure (IOP) lowering, in patients with open-angle glaucoma.

METHODS: 176 eyes of 152 patients were enrolled in this study, 89 in the SLT and 87 in the ALT groups. Patients were randomised to receive either SLT or ALT treatment to 180 degrees of the trabecular meshwork. Patients were followed up to 12 months after treatment. The main outcome measured was IOP lowering at 12 months after treatment, compared between the SLT and ALT groups.

RESULTS: No significant difference (p = 0.846) was found in mean decrease in IOP between the SLT (5.86 mm Hg) and ALT (6.04 mm Hg) groups at 1 year or at any other time points, nor were there any significant differences in the rate of early or late complications between the two groups.

CONCLUSION: SLT is equivalent to ALT in terms of IOP lowering at 1 year, and is a safe and effective procedure for patients with open-angle glaucoma.

Peer-Review English bjo.2006.098855 2006 Ralf Buhrmann and Yi I. Pan

Not specified

Is Selective Laser Trabeculoplasty the First Line Treatment of Open-Angle Glaucoma?

SLT in early stages yields better results SLT makes compliance less of an issue

Article English EuroTimes July 2006; Vol 11 (1); 8-9 2006 Geipert, N. Porta, A. (Italy) Ahemd, I. (Canada)

Italy

Selective Laser Trabeculoplasty: Effect of Enhancement And Repeatability On IOP

INTRODUCTION: Selective Laser Trabeculoplasty is a new safer alternative to Argon laser trabeculoplasty and for non-compliant patients on medical therapy. Its key features are minimal damage to surrounding tissue hence minimal and transient side effects but response to repeat treatment is not yet established.

PURPOSE: To determine the long term effect of selective laser trabeculoplasty enhancement (treating previously untreated area) and repeatability (re-treating previously treated area) on IOP control.

METHOD: Retrospective analysis of case notes.

RESULT: 27 eyes had enhancement of SLT and 15 eyes had repeat SLT. Average SLT life after enhancement was 18.26 months and after repeat treatment was 17.47 months. SLT enhancement success rate was 70.37% after 1 year, 55.55% after 2 years and 25.93% after 3 years. With repeat treatment success rate was 70.37% at 1 year and 53.33% after 2 years.

CONCLUSION: Enhancement and Retreatment with SLT is effective in reducing IOP.

Paper Presentation English AAO 06 2006 Madhu Nagar

Wakefield, UK

Selective Laser Trabeculoplasty: Is Retreatment A Viable Option?
Paper Presentation English ESCRS London 2006 2006 Madhu Nagar

Wakefield, UK

Selective Laser Trabeculoplasty: Long Term Results
Paper Presentation English ESCRS London 2006 2006 Madhu Nagar

Wakefield, UK

Selective Laser Trabeculoplasty: Replacement For Medical Treatment in Glaucoma Patients

SLT is an accepted treatment modality for Open Angle Glaucoma. It lowers IOP as effectively as drug therapy, is relatively non-invasive and safe, and above all, can obviate, or at least reduce need for years of treatment with expensive glaucoma medications.

SLT is an effective alternative, medical treatment was reduced following SLT and so did compliance and target IOP was achieved in majority of patients

Paper Presentation English AAO 06 2006 Madhu Nagar

Wakefield, UK

Selective Laser Trabeculoplasty: Replacement Therapy For Medical Treatment
Paper Presentation English ESCRS London 2006 2006 Madhu Nagar

Wakefield, UK

Selective Laser Trabeculoplasty As Initial And Adjunctive Treatment For Open-Angle Glaucoma

Study results support contention that SLT should be the preferable initial glaucoma therapy SLT safe and efficacious OAG primary and adjunctive therapy

Peer-Review English J Glaucoma 2006;15:124 2006 McIlraith, I et al.,

USA

Argon Laser Trabeculoplasty And Reduction of Ocular Hypotensive Medication Used By Glaucoma Patients

ALT (and, by inference, SLT) can reduce chronic drug use Implications of: 1. better compliance with less drugs 3. monetary saving 4. less medical complications. e.g., oral acetazolamide occasionally has severe systemic complications, pilocarpine reduces vision at the cataract age group, timolol is relatively contraindicated in many patients at the relevant age-group.

Peer-Review English Can J Ophthalmol 2006;41:44 2006 Vaidergorn, P. et al.

Not specified

Argon Versus Selective Laser Trabeculoplasty

PURPOSE: To compare conventional argon laser trabeculoplasty (ALT) with selective laser trabeculoplasty (SLT) in terms of their efficiency in lowering the intra-ocular pressure.

METHODS: In this retrospective study, 56 eyes from 44 patients with primary open angle glaucoma, ocular hypertension, pseudo-exfoliative (PXF) or pigment dispersion glaucoma (PDG) were included. Patients underwent either ALT (n=18) or SLT (n=38). The intraocular pressure (IOP) was measured immediately prior to and 3 to 5 weeks after the theraPY.

RESULTS: At 3 to 5 weeks the lOP-reduction was 22.4% after ALT and 15.5% after SLT (p = 0.141). Of note, of the four patients with PDG 2 underwent ALT and 2 SLT. Remarkably, both patients who had had SLT showed a paradoxical rise in lOP after the procedure (+15.5%). When these patients were excluded from the analysis, a similar hypotensive efficacy was found between ALT (-19%) and SLT (-17.9%) (p = 0.836). A small additional study with lower energy levels (< 0.9 mJ) confirmed the paradoxical IOP rise in 6 patients with heavily pigmented angles (2 with PDG and 2 with PXF) (+19.2%). It occurred in the absence of steroid treatment and persisted until 12 weeks after treatment.

CONCLUSION: The short term efficacy of ALT and SLT was similar. In this study, the patients with PDG who underwent SLT showed a paradoxical rise in IOR This finding may indicate that even lower energies (0.4 to 0.6 mJ) are required when performing SLT in patients with heavily pigmented trabeculae.

Peer-Review English Bull Soc Belge Ophtalmol. 2006;(299):5-10. 2006 Van de Veire S, Zeyen T, Stalmans I.

Not specified

Argon Laser Trabeculoplasty Or Selective Laser Trabeculoplasty in the Treatment of Open-Angle Glaucoma

Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are effective treatment modalities for intraocular pressure (IOP) lowering in open angle glaucoma patients. SLT and ALT produce equivalent IOP reduction. The choice of either option will depend on the state of glaucoma, previous and current treatment, side effects and patient’s reference. Preservation of the angle trabecular meshwork structures and effective retreatment for IOP lowering after ALT has failed, offer some theoretical advantage of SLT.

Peer-Review English Acta Med Croatica. 2006;60(2):97-9. 2006 Bojic L, Ivanisevic M, Mandic Z.

Not specified

Trial of SLT Laser Treatment Versus Prostaglandine in the Treatment of POAG
Poster Presentation English EVER Portugal 2006 2006 E. Ansari

Not specified

Effect of Selective Laser Trabeculoplasty And Prostaglandins On Diurnal IOP Fluctuations: Randomized Clinical Trial

It is well documented that the range of the daily fluctuations in IOP is greater in patients with glaucoma. A report by Asrani et al. suggested that the range of the diurnal fluctuation may be an independent risk factor for the progression of visual field loss and a single measurement in the ophthalmologist’s office may or may not reflect what the IOP is at other times of the day or night. Selective Laser Trabeculoplasty (SLT) is safe and effective in reducing IOP but its effect on diurnal IOP fluctuation is warranted. Selective Laser Trabeculoplasty is effective in reducing Intra Ocular Pressure (IOP) but its effect on diurnal IOP fluctuation is warranted.
SLT and Latanoprost significantly reduced IOP and IOP fluctuations.

Paper Presentation English AAO 06 2006 Madhu Nagar

Not specified

Effect of SLT On Diurnal Fluctuation As Compared To Xalatan

Prospective

Poster Presentation English Poster AAO 2006 2006 Madhu Nagar

Not specified

Projected Cost Comparison of Selective Laser Trabeculoplasty Versus Glaucoma Medication in the Ontario Health Insurance Plan.

BACKGROUND: The projected 6-year cost comparison of primary selective laser trabeculoplasty (SLT) versus primary medical therapy in the treatment of open-angle glaucoma for Ontario patients aged 65 years or more is presented. Costs are taken from the perspective of the Ontario Health Insurance Plan at a per-patient level.

METHODS: The cost of each medication was obtained from the 2003 Ontario Drug Benefits formulary. The average annual cost of medications was determined by estimating the provincial prescription rate of glaucoma medications, with reference to both a volume-per-bottle study of these drugs and a study of pharmacy claims reports. A representative provincial prescription rate was calculated by reviewing 707 patient charts selected randomly from 5 ophthalmologic practices across Ontario. Medication therapies were categorized into mono-, bi-, and tri-drug therapy groups. The cost of SLT was analyzed under the following 2 scenarios. SLT rep 2y assumed a duration of 2 years before repeat SLT was necessary. SLT rep 3y assumed a duration of 3 years before repeat SLT was necessary. Bilateral 180 degrees SLT treatment and repeatability of SLT was assumed. The cost of surgery for patients who fail SLT or medical therapy was not accounted for in this study nor was the cost of patients who required medical therapy in conjunction with SLT.

RESULTS: In the SLT rep 2y scenario, the use of primary SLT over mono-, bi-, and tri-drug therapy produced a 6-year cumulative cost savings of 206.54 dollars, 1668.64 dollars, and 2992.67 dollars per patient, respectively. In the SLT rep 3y scenario, the use of primary SLT over mono-, bi-, and tri-drug therapy produced a 6-year cumulative cost savings of 580.52 dollars, 2042.82 dollars, and 3366.65 dollars per patient, respectively.

INTERPRETATION: Our findings suggest that SLT as primary therapy, at a per-patient level, offers a modest potential cost saving over primary medical therapy in the management of open-angle glaucoma for Ontario patients aged 65 years or more.

Peer-Review English Can J Ophthalmol. 2006 Aug;41(4):449-56. 2006 Lee R, Hutnik CM.

Not specified

SLT in Secondary Glaucoma: Case Report

Retrospective analysis of case notes of patients with secondary glaucoma treated with SLT between 2000

Poster Presentation English APO 2006 Annual College Congress May 2006 2006 Madhu Nagar

Wakefield, UK

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

PURPOSE: 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.

METHODS: 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.

RESULTS: 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%.

CONCLUSION: Despite a declining success rate, SLT is an effective method to lower IOP over an extended period of time.

Peer-Review English Eur J Ophthalmol. 2006 Jan-Feb;16(1):100-4 2006 Weinand FS, Althen F.

Not specified

Early IOP Measurements For SLT

SLT effective over short observation period

Peer-Review English Br. J. Ophthalmol. Feb 2006 2006 Johnson, P. et al.

Not specified

SLT And Secondary Glaucoma – Case Series

Prospective

Paper Presentation English Manchester RCO 2006 2006 Madhu Nagar

Wakefield, UK

Selective Laser Trabeculoplasty Treatment For Medication-Refractory Open Angle Glaucoma

BACKGROUND: Selective laser trabeculoplasty (SLT) is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. The laser parameters are set to selectively target pigmented trabecular meshwork (TM) cells without damage to the adjacent non-pigmented tissue.

PURPOSE: A clinical retrospective study was conducted to evaluate the 12 months results of SLT in the treatment of medically uncontrolled open angle glaucoma.

PATIENTS AND METHODS: During the period March to September 2004, the authors performed a SLT in 50 patients (50 eyes) with open angle glaucoma uncontrolled on maximally tolerated medical therapy. Treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser 532 nm.(Selectra 7000 Laser Coherent, Inc., Palo Alto,CA). Approximately 85 to 90 non-overlapping laser spots were placed over 180 degrees of the trabecular meshwork at energy levels ranging from 0.6 to 1.4 mJ per pulse. In patients who required additional SLT therapy, the untreated 180 degrees was treated. During the follow-up period, patients were treated with antiglaucoma medications as required. The success rates were defined as decreases in intraocular pressure (IOP) of 3 mmHg or more with no additional medications, laser, or glaucoma surgery.

RESULTS: The mean IOP reduction from baseline 6 months after treatment was 21% and 20% after 12 months. The success rates were 66% after 6 months and 55% after 12 months. Four eyes (8%) did not respond to SLT. One hour after SLT, an increase in IOP of more than 5 mm Hg was detected in 5 eyes (10%). Seven patients (14%) required additional SLT.

CONCLUSION: SLT is efficient in lowering IOP in medication-refractory open angle glaucoma. It should be considered in such patients when surgery is contraindicated or refused.

Peer-Review English Harefuah. 2005 Nov;144(11):790-3, 822, 821. 2005 Geyer O, Wolf A, Levinger E, Orev T, Segev E.

Not specified

A Randomised, Prospective Study Comparing 90

AIM: To compare 90 degrees, 180 degrees, and 360 degrees selective laser trabeculoplasty (SLT, 532 nm Nd:YAG laser) with latanoprost 0.005% for the control of intraocular pressure (IOP) in ocular hypertension (OHT) and open angle glaucoma (OAG).

METHODS: A prospective, randomised clinical trial in the Department of Ophthalmology, St Thomas’s Hospital, London, and Clayton Eye Centre, Wakefield, West Yorkshire. 167 patients (167 eyes) with either OHT or OAG were randomised to receive 90 degrees , 180 degrees , and 360 degrees SLT or latanoprost 0.005% at night and were evaluated at 1 hour, 1 day, 1 week and 1, 3, 6, and 12 months.

RESULTS: The mean follow up was 10.3 months (range 1–12 months). Early, transient, complications such as postoperative ocular pain, uveitis, and 1 hour IOP spike occurred in a number of eyes after SLT, with pain being reported more frequently after 360 degrees than 90 degrees treatments (p>0.001). Success rates defined in terms of both a 20% or more and a 30% or more IOP reduction from baseline measurements with no additional antiglaucomatous interventions were better with latanoprost than 90 degrees (p<0.001) and 180 degrees SLT (p<0.02) treatments. Differences in success rates between latanoprost and 360 degrees SLT did not reach statistical significance (p<0.5). Success rates were greater with 180 degrees and 360 degrees compared to 90 degrees SLT (p20% IOP reduction and 59% a >30% reduction from baseline. Although success rates were better with 360 degrees than 180 degrees SLT treatments, differences did not reach statistical significance. There were no differences with regard to age, sex, race, pre-treatment IOP, OHT versus OAG, laser power settings, and total laser energy delivered between eyes which responded, in terms of a >20% and a >30% IOP reduction, and those that did not respond with 180 degrees and 360 degrees SLT treatments.

CONCLUSION: Success rates were higher with latanoprost 0.005% at night than with 90 degrees and 180 degrees SLT treatments. 90 degrees SLT is generally not effective. 360 degrees SLT appears to be an effective treatment with approximately 60% of eyes achieving an IOP reduction of 30% or more. Transient anterior uveitis with associated ocular discomfort is not unusual in the first few days after SLT. Late complications causing ocular morbidity after SLT were not encountered.

Peer-Review English Br J Ophthalmol. 2005 Nov;89(11):1413-7. 2005 Nagar M, Ogunyomade A, O'Brart DP, Howes F, Marshall J.

Not specified

High Failure Rate Associated With 180 Degrees Selective Laser Trabeculoplasty.

PURPOSE: To determine the efficacy of selective laser trabeculoplasty (SLT) in a tertiary care referral center.

PATIENTS AND METHODS: In this retrospective study of selective laser trabeculoplasty performed by five physicians, 94 eyes from 94 patients were included. A majority (83/92, 90%) underwent 180 degrees selective laser trabeculoplasty. Selective laser trabeculoplasty failure was defined in two ways: (1) IOP decrease <3 mm Hg (definition one), or (2) IOP decrease or =4 weeks after SLT.

RESULTS: Overall failure rates were 68% (64/94) and 75% (70/94) (by definitions one and two, respectively). By survival/life-table analysis, mean time to failure was 6 months and 5.5 months, by definitions one and two, respectively. By the end of the study (14.5 months), the failure rates were 86% and 92% by definitions one and two, respectively. By each definition, in both univariable and multivariable analysis, only lower baseline IOP was a significant predictor of failure.

CONCLUSION: Selective laser trabeculoplasty had an overall low success rate in our tertiary clinic population, with overall failure rates of 68% to 74% in those who underwent 180 degrees selective laser trabeculoplasty.

Peer-Review English J Glaucoma. 2005 Oct;14(5):400-8. Links 2005 Song J, Lee PP, Epstein DL, Stinnett SS, Herndon LW Jr, Asrani SG, Allingham RR, Challa P.

Not specified

Selective Laser Trabeculoplasty Effective in Lowering, Maintaining IOP

Retrospective chart review of 850 eyes Significantly reduced no. of medications over long-term<.

Article English Ocular Surgery News 2005 Oct 1. 2005 Kronemyer, B.

Not specified

Selective Laser Trabeculoplasty.

Selective laser trabeculoplasty (SLT) has been shown to be safe, well tolerated, and effective in intraocular pressure (IOP) reduction as therapy in several forms of open-angle glaucoma. The preservation of trabecular meshwork (TM) architecture and the demonstrated efficacy in lowering IOP make SLT a reasonable and safe alternative to argon laser trabeculoplasty (ALT). SLT may also be effective for cases of failed ALT and is a procedure that may also be repeatable, unlike ALT. SLT is also a simple technique for an ophthalmologist to learn as the large spot size eliminates the need to locate a particular zone of treatment on the TM. SLT has been demonstrated to be effective as primary treatment for open angle glaucoma and can be an effective adjunct in the early treatment of glaucoma. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or who are noncompliant with their glaucoma medications, without interfering with the success of future surgery.

Peer-Review English Ophthalmol Clin North Am. 2005 Sep;18(3):409-19, vi. 2005 Latina MA, de Leon JM.

Not specified

Baseline IOP Predicts Selective Laser Trabeculoplasty Success At 1 Year Post-Treatment: Results From A Randomised Clinical Trial.

BACKGROUND/AIMS: The efficacy and safety of selective laser trabeculoplasty (SLT) has been found to be equivalent to argon laser trabeculoplasty (ALT). Since SLT produces significantly less disturbance to the trabecular meshwork and is theoretically more repeatable than ALT, it has potential to replace ALT as the standard procedure to treat medically uncontrolled open angle glaucoma. This study’s objective is to determine factors that predict successful SLT at 1 year post-treatment.

METHODS: As part of a randomised clinical trial comparing the efficacy and safety of SLT to ALT, data on 72 SLT patients were collected, and successful SLT defined as having an SLT induced intraocular pressure (IOP) reduction of >or=20% at 1 year post-treatment follow up.

RESULTS: 43 out of the 72 patients who had completed their 1 year follow up visit had an IOP reduction of >or=20% from baseline. No glaucoma risk factors studied predicted successful SLT. The amount of trabecular meshwork pigmentation was not a significant predictor. However, it was discovered that baseline IOP strongly predicted SLT success (odds ratio=1.16; p=0.0001).

CONCLUSION: SLT success was significantly predicted by baseline IOP but not by age, sex, other glaucoma risk factors, type of open angle glaucoma, or by degree of trabecular meshwork pigmentation.

Peer-Review English Br J Ophthalmol. 2005 Sep;89(9):1157-60. 2005 Hodge WG, Damji KF, Rock W, Buhrmann R, Bovell AM, Pan Y.

Not specified

Selective Laser Trabeculoplasty As A Replacement For Medical Therapy in Open-Angle Glaucoma

PURPOSE: To evaluate selective laser trabeculoplasty (SLT) as a replacement for medical therapy in controlled open-angle glaucoma. DESIGN: Prospective, non-randomized, interventional clinical trial.

METHODS: SLT was performed inferiorly in 66 eyes of 66 patients with medically controlled primary open-angle glaucoma (OAG) or exfoliation glaucoma, and no history of glaucoma surgery. The primary outcome was number of medications at 6 and 12 months while maintaining a pre-determined target intraocular pressure (IOP).

RESULTS: The mean of the differences in medications from baseline was 2.0 (95% confidence interval = 1.8-2.3) at 6 months, and 1.5 (1.27-1.73) at 12 months (P < .0001). The group mean of medications was 2.8 +/- 1.1 at baseline, 0.7 +/- 0.9 at 6 months, and 1.5 +/- 0.9 at 12 months (P < .0001). Reduction in medications was attained in 64 of 66 eyes (97%) at 6 months, and 52 of 60 (87%) at 12 months.

CONCLUSION: SLT enabled a reduction in medicine in controlled OAG over 12 months.

Peer-Review English Am J Ophthalmol. 2005 Sep;140(3):524-5. Links 2005 Francis BA, Ianchulev T, Schofield JK, Minckler DS.

Not specified

Selective Laser Trabeculoplasty As A Replacement For Medical Therapy in Open-Angle Glaucoma

Prospective, non-randomized, interventional clinical trial 97% reduction in medications attained (64 of 66 eyes) SLT enabled reduction in medicine

Peer-Review English Am J Ophthalmol 2005 Sep 2005 Francis, B.A. et al.

Not specified

Comparison of Short-Term Outcomes of Argon Laser Versus Selective Laser Trabeculoplasty in Open-Angle Glaucoma

PURPOSE: To evaluate the pressure-lowering effects of selective trabeculoplasty versus these of Argon laser trabeculoplasty.

METHODS: Fifteen eyes of 15 patients with primary open-angle glaucoma and ocular hypertension, all with IOPs over 30 mm Hg received SLT and 30 eyes of 30 patients with the same diagnosis were treated with ALT. Patients were evaluated after laser treatments at 1 hour, 1 day, 1 week, 1 month, and 3 months using slit lamp examinations and Goldmann applanation tonometry.

RESULTS: At 3 months postoperative, the SLT group had a mean IOP of 16.9

Peer-Review Korean J Korean Ophthalmol Soc 46(12):2004-2009, 2005 2005 Hyun-Soo Lee M.D. Nam-Ho Baek M.D. Jung-Il Moon M.D.

Department of Ophthalmology College of Medicine, The Catholic University of Korea, Seoul, Korea

A New Insight Into the Cellular Regulation of Aqueous: How Trabecular Meshwork Endothelial Cells Drive A Mechanism That Regulates the Permeability of Outflow Schlemm

Substantiates hypothesis that trabecular endothelial cells secrete substances that increase transmission through Schlemm’s canal endothelium under normal circumstances. When SLT energy is applied, it activates the trabecular endothelium to secrete more of the substances, thus increasing aqueous outflow and reducing IOP.

Peer-Review English Br. J. Ophthalmol. 2005;89;1500-1505. 2005 Alvarado, JA et al.

USA

Associations Between Elevated Intraocular Pressure And Glaucoma, Use of Glaucoma Medications, And 5-Year Incident Cataract

Elevated IOP may increase the risk of nuclear cataract, but not that of other types. Use of glaucoma medications could magnify this risk – benefit of SLT given that it doesn’t cause cataract while reducing IOP.

Peer-Review English J Ophthalmol 2005 2005 Chandrasekara, S et al.

Not specified

SLT Compared With Latanoprost For OHT And OAG

Randomized, prospective study

Peer-Review English Br. J. Ophthalmol 2005. 89; 1413-1417. 2005 Nagar, M.

Wakefield, UK

Selective Laser Trabeculoplasty (SLT) Complicated By Intraocular Pressure Elevation in Eyes With Heavily Pigmented Trabecular Meshworks.

PURPOSE: To report and assess the complication of intraocular pressure (IOP) elevations after selective laser trabeculoplasty (SLT) in patients with heavily pigmented trabecular meshworks.

DESIGN: Non-comparative, observational case series.

METHODS: Retrospective analysis of the medical files of four glaucoma patients with heavily pigmented trabecular meshwork, who presented with IOP elevations after SLT.

RESULTS: All four glaucoma patients presented with post-SLT IOP elevations. Three had features of pigmentary dispersion syndrome, and the fourth had a heavily pigmented trabecular meshwork. Two patients had previous argon laser trabeculoplasty (ALT) in the same eye in which SLT was performed, and one had a previous ocular trauma. Eventually, three of the patients required surgical trabeculectomy.

CONCLUSION: This case series suggests that post-SLT IOP elevations can be a serious adverse event in some glaucomatous patients. It is recommended by the authors that patients with a deeply pigmented trabecular meshwork, taking multiple topical medications and having previous ALT treatment, should be considered at higher risk for this complication.

Peer-Review English Am J Ophthalmol. 2005 Jun;139(6):1110-3. Links 2005 Harasymowycz PJ, Papamatheakis DG, Latina M, De Leon M, Lesk MR, Damji KF.

Not specified

Evidence Supports Selective Laser Trabeculoplasty:
Article English ESCRS Euro times May 2004. 2005 Madhu Nagar, Latina M.

Not specified

Long-Term Results After Selective Laser Trabeculoplasty — A Clinical Study On 269 Eyes

BACKGROUND: Selective laser trabeculoplasty SLT is a new method to reduce intraocular pressure in eyes with primary open angle glaucoma. With a Q-switched, frequency-doubled Nd:YAG laser it targets the pigmented trabecular meshwork cells without visible damage to the adjacent non-pigmented tissue. SLT acts non-thermally, the intracellular micro-disruptions triggered by the laser are confined to the targeted cells, the laser pulses are so short that heat created within the targeted cells does not have time to spread to the surrounding tissue. A clinical prospective study was conducted to evaluate the long-term results, safety and efficacy of SLT in the treatment of open angle glaucoma.

PATIENTS AND METHODS: Since 2002, we have performed a selective laser trabeculoplasty in 269 eyes: in 17 eyes with ocular hypertension, in 239 eyes with primary open angle glaucoma, in 11 eyes with low tension glaucoma, while 2 eyes had a secondary glaucoma due to uveitis. In 22 eyes the primary initial treatment was SLT.

RESULTS: Three months after treatment, the mean IOP reduction from baseline was 3.4 mm Hg, respectively 15 %, after 12 months the mean IOP reduction was 3.0 mm Hg (12.9 %), and after 24 months 2.7 mm Hg or 12.1 %. The response curve of the eyes with ocular hypertension greatly resembled the eyes with primary open angle glaucoma and with low tension glaucoma.

CONCLUSION: SLT has shown reasonable efficacy in lowering IOP in eyes with primary open angle glaucoma and ocular hypertension, both as a first-line treatment and as a treatment in medication-refractory eyes. SLT is effective for patients who have had prior treatment with ALT. Long-term follow-up studies are needed to determine whether the IOP lowering effect is sustained over time, and to assess the efficacy of repeated SLT. The exact biological effect induced with the SLT is still not understood.

Peer-Review English Klin Monatsbl Augenheilkd. 2005 Apr;222(4):326-31. 2005 Best UP, Domack H, Schmidt V.

Not specified

Glaucoma Lasers: A Review of the Newer Techniques.

PURPOSE OF REVIEW: This paper serves to review the safety and efficacy of new laser techniques for the treatment of glaucoma with emphasis on those studies published within the past year.

RECENT FINDINGS: Recently published studies have reinforced the strong safety profile, and efficacy of selective laser trabeculoplasty (SLT). Endoscopic photocoagulation, while more technically challenging and more invasive, offers several advantages over transcleral cyclophotocoagulation including direct observation of treatment and therefore, fewer complications. Laser goniopuncture is a fledgling technology with, thus far, a good safety profile, and benefits that include conjunctival sparing and good treatment response. Many unanswered questions remain including long-term success rates and ideal treatment parameters.

SUMMARY: The benefits of laser in the treatment of glaucoma have been well established, and while some techniques will add to the ophthalmologists’ armamentarium, others will fall into disuse as the efficacy and safety profiles of these procedures become recognized. Novel laser modalities, as well as the more traditional ones, require continued evaluation to further refine treatment parameters and to determine their long-term benefits.

Peer-Review English Curr Opin Ophthalmol. 2005 Apr;16(2):89-93. 2005 Holz HA, Lim MC.

Not specified

SLT Fares Best as Early Intervention in Glaucoma
Article English Ophthalmology Times, April 15, 2005. 2005 Iwach, A.

USA

Trials Find SLT Safe, Effective in Different Populations.

Summarized studies presented by Dr. Goldberg and Dr. Lai at APAO 2005 SLT shown to be effective and safe in Asian and Australian populations

Article English Ocular Surgery News Supersite 2005 N/A

USA

Selective Laser Trabeculoplasty: A Silver Bullet For Glaucoma?

Highlights obsolescence of ALT due to emergence of SLT Demonstrated efficacy of SLT on patients who have already undergone ALT

Article English EyeWorld, February 2005. 2005 Realini, T, M.D.

USA

The Effect of Topical Glaucoma Medication On the Efficacy of SLT

The type of medication affects additional IOP lowering with SLT. SLT is more effective if eyes concomitantly receive aqueous suppressants vs. Prostaglandins SLT.

Peer-Review English Glaucoma Today Nov-Dec 2004; 31-33. 2004 Latina, M; De Leon, J.

USA

Comparison of Long-Term Outcomes of Selective Laser Trabeculoplasty Versus Argon Laser Trabeculoplasty in Open-Angle Glaucoma.

PURPOSE: To compare the long-term success rate of selective laser trabeculoplasty (SLT) versus argon laser trabeculoplasty (ALT).

DESIGN: Retrospective chart review.

PARTICIPANTS: One hundred ninety-five eyes of 195 patients with uncontrolled open-angle glaucoma (OAG), of which 154 eyes underwent ALT and 41 eyes underwent SLT and were followed up for a maximum of 5 years.

INTERVENTION: The SLT patients were treated with the frequency-doubled q-switched neodymium:yytrium-aluminum-garnet laser (532 nm). Approximately 50 to 55 non-overlapping spots were placed over 180 degrees of the trabecular meshwork at energy levels ranging from 0.6 to 1.0 mJ per pulse. The ALT patients were treated with the argon blue-green laser with between 45 to 55 adjacent, non-overlapping spots over 180 degrees of the trabecular meshwork at 470 to 1150 mW of energy per pulse.

MAIN OUTCOME MEASURES: The success rates were defined by criterion I and criterion II. Success by criterion I was defined as a decrease in intraocular pressure (IOP) of 3 mmHg or more with no additional medications, laser, or glaucoma surgery. Criterion II had the same requirements as criterion I, except that a 20% or more IOP reduction was required for success.

RESULTS: The mean follow-up time was 37.4+/-14.7 months for patients in the SLT group and 33.6+/-17.0 months for patients in the ALT group. The long-term success rate was not significantly different between the ALT and SLT groups by either criterion (Kaplan-Meier survival analysis log-rank P = 0.20 by criterion I and P = 0.12 by criterion II). When comparing patients with and without previous ALT, there was not a statistically significant difference in the patients treated with SLT by either criterion (log-rank P = 0.37 by criterion I and P = 0.39 by criterion II).

CONCLUSION: In eyes with primary OAG that are receiving maximally tolerated medical therapy, SLT was found to be as effective as ALT in lowering IOP over a 5-year period. However, long-term data reveal that many of the glaucoma patients treated with SLT and ALT required further medical or surgical intervention. Whether SLT has better long-term success than ALT in repeat laser trabeculoplasty treatments remains unclear.

Peer-Review English Ophthalmology. 2004 Oct;111(10):1853-9. 2004 Juzych MS, Chopra V, Banitt MR, Hughes BA, Kim C, Goulas MT, Shin DH.

Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan 48201-1423, USA. mjuzych@med.wayne.edu

SLT Safely Lowered IOP in Glaucoma Patients, Surgeon Says.

SLT used in conjunction with aqueous suppressants provides better IOP response Repeat SLT has higher response rate in first-time responders

Article English Ocular Surgery News: International Edition, October 2004. 28-31. 2004 Latina, Mark A.

USA

SLT Compared To Drugs as First Line Glaucoma Therapy.

Introduction to randomized trial comparing SLT to medical therapy as initial therapy for OAG.

Article English Ocular Surgery News Supersite, 26 October 2004. 2004 N/A

USA

Five-Year Follow Up of Selective Laser Trabeculoplasty in Chinese Eyes.

PURPOSE: To study the effectiveness and safety of selective laser trabeculoplasty (SLT) on primary open-angle glaucoma and ocular hypertension in Chinese eyes.

METHODS: This was a prospective randomized controlled clinical study in which 58 eyes of 29 patients with primary open-angle glaucoma or ocular hypertension were included. One eye of each patient was randomized to receive SLT (Group 1) and the fellow eyes received medical treatment (Group 2). Patients were evaluated after laser treatment at 2 h, 1 day, 1 week, 2 weeks, 1 month, 3 months, 6 months, and then yearly.

RESULTS: All patients (13 male, 16 female) were Chinese. The mean age was 51.9 +/- 14.7 years. The mean baseline intraocular pressure was 26.8 +/- 5.6 mmHg in group 1 and 26.2 +/- 4.2 mmHg in group 2 (P = 0.62). The failure rate, defined as intraocular pressure >21 mmHg with maximal medications, was 17.2% in group 1 and 27.6% in group 2 at 5-year follow-up (P = 0.53). Eight eyes (27.6%) in group 1 required medications to control the intraocular pressure to below 21 mmHg. There was no statistically significant difference in the intraocular pressure reductions between the two groups at all time intervals (P > 0.05). The mean number of antiglaucoma medications was significantly lower in the SLT than the medical treatment group up to 5 years of follow up (P

Peer-Review English Clin Experiment Ophthalmol. 2004 Aug;32(4):368-72. 2004 Lai

Department of Ophthalmology, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong, China. laism@ha.org.hk

Selective Laser Trabeculoplasty

The prospective clinical study of the selective laser trabeculoplasty (SLT) by means the Coherent Selecta 7000 laser (wave length 532 nm) was conducted. Totally 108.7 +/- 18.3 laser non-overlapping spots (mean energy level 1.04 +/- 0.22 mJ) along the whole circle of the trabecular meshwork in the anterior chamber angle were applied. The study included 258 eyes of 146 patients (50 of them were men) with glaucoma. The mean age of the whole group was 55.9 +/- 13.7 years. The group of unsuccessfully treated patients (30 patients, 41 eyes) in whom the intraocular pressure (IOP) elevated from 23.2 +/- 3.7 mm Hg in 4.7% (measured 493 +/- 474 days after the treatment) during the follow up, was removed from the study. In the group with good response to the SLT, 116 patients (217 eyes) were evaluated 650 +/- 405 days after treatment. Before treatment, in this group the IOP was 23.9 +/- 3.0 mm Hg, at the end of the study the IOP was lowered by 4.5 +/- 2.9 mm Hg, in total by 18.6%. IOP decrease was more pronounced in patients with higher level of IOP at the beginning. Immediately after SLT, no significant rising of the IOP level was recorded. Selective laser trabeculoplasty preserves the integrity of the trabecular meshwork of the anterior chamber angle, and is a safe and clinically effective method of treatment of different forms of glaucoma and ocular hypertension.

Peer-Review Czech Cesk Slov Oftalmol. 2004 Jul;60(4):267-74. 2004 Rozsival P, Kana V, Hovorkova M.

Ocni klinika Fakultni nemocnice, Hradec Kralove, Czech Republic

Comparative Study of the Efficacy of Selective Laser Trabeculoplasty For Pseudoexfoliation Glaucoma And Primary Open-Angle Glaucoma

BACKGROUND: To compare the efficacy of selective laser trabeculoplasty (SLT) as treatment of pseudoexfoliation glaucoma (PG) and primary open-angle glaucoma (POAG) in a prospective clinical study.

METHODS: Ten eyes of 10 patients suffering from uncontrolled PG (PG group) and 10 eyes of 10 patients with uncontrolled POAG (POAG group) were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The baseline characteristics were similar in both groups. The intraocular pressure (IOP) was measured before the treatment and 1day, 1 week, 1 month and 3, 6, 9, 12, 15, 18, 24, 30, and 36 months after the treatment. Success was defined as an IOP lowering, exceeding 20% of pre-treatment IOP. Any modification of hypotensive medication led to exclude the eye from the study. Statistical analysis comparing the two groups was carried out using the independent-sample t test for continuous variables and the Log-Rank test for survival analysis. All tests were conducted considering p< 0.05 as significant.

RESULTS: The mean follow-up time was 22.8 months (SD 12.5) for the PG group and 24.3 months (SD 10.8) for the POAG group (n. s.). No significant difference was found between the two groups for mean pre-treatment IOP (23.6 mm Hg [SD 5.7] in the PG group vs. 22.8 mm Hg [SD 2.4] in the POAG group) and for mean IOPs during the whole follow-up period. At all follow-up visits, the mean IOP reductions were smaller in the PG group than in the POAG group (7.0 mm Hg [SD 3.3] vs.7.7 mm Hg [SD 2.0] at 24 months). However such difference was statistically significant only at 36 months (4.7 mm Hg [SD 1.1] vs. 8.3 mm Hg [SD 1.5]). At all follow-up visits, the mean percent IOP reduction was smaller in the PG group than in the POAG group (27.6% [SD 7.1] vs. 32.1% [SD 7.1] at 24 months). Furthermore, such a difference was statistically significant at 9, 12, and 36 months (21.8% [SD 1.6] vs. 34.1% [SD 4.7]). According to the Kaplan-Meier survival analysis, the 36-month success rate was 47% in the PG group and 59% in the POAG group, but the differences between the two groups were non-significant (p> 0.05).

CONCLUSIONS: SLT is an effective procedure for lowering IOP, although within 3 years there has been a substantial failure rate in both PG and POAG eyes, and the success seems to decline faster in PG eyes.

Peer-Review English ZDRAV VESTN 2004; 73: 439 2004 Toma

Not specified

Comparison Between 90

SLT with 25 laser spots on 90

Peer-Review English J Glaucoma 2004; 13(1):62-65. 2004 Chen, Enping; Saeed, Glochin et al.

Sweden

Argon Versus Selective Laser Trabeculoplasty.

Address practical & theoretical differences between SLT and ALT in the treatment of OAG

Peer-Review English J Glaucoma 2004; 13(2):174-177. 2004 Latina, Mark; Cioffi et al.

USA

Selective vs Argon Laser Trabeculoplasty: Hypotensive Efficacy, Anterior Chamber Inflammation And Postoperative Pain

IOP-lowering effect similar for both treatments. Energy released during treatment and inflammation in postoperative period were significantly lower with SLT. SLT procedure better tolerated than ALT, producing less discomfort.

Peer-Review English Eye 2004; 18: 498-502. 2004 Martinez-de-la-Casa, JM; Castillo, A.

USA

SLT

SLT is suitable for primary OAG treatment.

Peer-Review English DOS Times 2004; 9 (9): 391-392. 2004 Tuli, Deven; Sihota, Ramanjit et al.

Not specified

Randomized Controlled Clinical Trial Finds Dose-Response Effect of SLT:
Article English Ophthalmology Times: Issue June 2004: 55-56 2004 Madhu Nagar

Not specified

Randomized Controlled Clinical Trial Finds Dose-Response Effect of SLT

SLT safe and efficacious alternative to ALT SLT repeatable due to lack of coagulation

Article English Ophthalmology Times, June 2004, 55-56. 2004 Nagar, M.

Wakefield, UK

Selective Vs Argon Laser Trabeculoplasty: Hypotensive Efficacy, Anterior Chamber Inflammation, And Postoperative Pain.

PURPOSE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Peer-Review English Eye. 2004 May;18(5):498-502. 2004 Martinez-de-la-Casa JM, Garcia-Feijoo J, Castillo A, Matilla M, Macias JM, Benitez-del-Castillo JM, Garcia-Sanchez J.

Instituto de Investigaciones, Oftalmologicas Ramon, Castroviejo Hospital Clinico, San Carlos, Universidad Complutense de Madrid, Madrid, Spain. martinezcasa@jazzfree.com

Selective Laser Trabeculoplasty: A Randomized Control Trial
Paper Presentation English Annual College Congress May Manchester 2004. 2004 Madhu Nagar

Wakefield, UK

Evidence Supports SLT

SLT is a safe and efficacious treatment for OAG.

Article English EuroTimes May 2004. 2004 Nagar, M.

Wakefield, UK

A Comparison Between 90 Degrees And 180 Degrees Selective Laser Trabeculoplasty.

PURPOSE: To compare two regimens of SLT, ie, SLT with 25 laser spots on 90 degrees of trabecular meshwork and SLT with 50 laser spots on 180 degrees of trabecular meshwork in patients with open-angle glaucoma.

PATIENTS AND METHODS: In a prospective clinical study, the authors compared pressure-lowering effect of SLT in 2 groups of patients; 1 group (32 patients) received SLT with 25 laser spots on 90 degrees of trabecular meshwork, the other group (32 patients) SLT with 50 laser spots on 180 degrees of trabecular meshwork.

RESULT: There was no difference in the pressure reduction between these two treatment regimens. Moreover, the pressure reduction was not influenced by previous ALT treatments. The pigmentation in the trabecular meshwork is related to a delayed effect on the pressure lowering after SLT.

CONCLUSION: SLT with 25 laser spots on 90 degrees of trabecular meshwork has a similar pressure-lowering effect to SLT with 50 laser spots on 180 degrees of trabecular meshwork. The new treatment regimen with less laser spots could increase the repeatability of SLT and reduce potential tissue damage in the trabecular meshwork.

Peer-Review English J Glaucoma. 2004 Feb;13(1):62-5. 2004 Chen E, Golchin S, Blomdahl S.

Glaucoma Service, St Erik's Eye Hospital, Stockholm, Sweden. enping.chen@sankterik.se

One-Year Follow-Up of Selective Laser Trabeculoplasty in Open-Angle Glaucoma.

BACKGROUND: Selective laser trabeculoplasty (SLT) targets the pigmented trabecular meshwork (TM) cells without damage to the adjacent non-pigmented tissue. A study was conducted to evaluate the efficacy and safety of SLT in the treatment of uncontrolled open-angle glaucoma.

METHODS: In a prospective non-randomized study 44 eyes of 31 patients with uncontrolled open-angle glaucoma were treated with a frequency-doubled, Q-switched Nd:YAG laser. A total of approximately 50 spots were placed over 180 degrees of the TM at energy levels ranging from 0.7 to 0.9 mJ. Intraocular pressure (IOP) was measured 1, 2, and 24 h, 1 and 2 weeks and 1, 2, 3, 6, 9, and 12 months after treatment.

RESULTS: The average pre-operative IOP was 25.6 (SD 2.6) mm Hg (range 22-34). The mean IOP reduction from baseline at 24 h, 3, 6 and 12 months was 7.1 mm Hg (SD 3.5) or 27.6%; 4.2 mm Hg (SD 3.5) or 16.4%; 4.7 mm Hg (SD 4.2) or 18.6%, and 4.4 mm Hg (SD 3.8) or 17.1%, respectively. The percent of eyes with IOP reduction of 3 mm Hg or more at 3, 6 and 12 months was 66, 78 and 62%. A pressure spike of 8 mm Hg or more was detected in 4 eyes (9.1%). Anterior chamber reaction was seen 1 h after SLT and was mild to moderate in 16 eyes (40.4%) and marked in 3 eyes (6.8%).

CONCLUSION: SLT has shown reasonable efficacy in lowering IOP over 1-year follow-up, but there was a tendency for IOP to increase with a longer follow-up. Long-term follow-up studies with a large sample size are needed to determine whether the IOP lowering effect is sustained over time, and to assess the efficacy of repeated SLT. Copyright 2004 S. Karger AG, Basel

Peer-Review English Ophthalmologica. 2004 Jan-Feb;218(1):20-5. 2004 Cvenkel B.

Eye Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia. barbara.cvenkel@kclj.si

Efficacy of Selective Laser Trabeculoplasty in the Treatment of Primary Open-Angle Glaucoma

BACKGROUND: Our aim was to investigate the efficacy of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in a prospective clinical study.

PATIENTS AND METHODS: In 36 eyes of 36 patients suffering from uncontrolled POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and one day, one week, one month and 3, 6, 12, 18, 24, 30, 36, 42 and 48 months after. A failure was defined as an IOP reduction of less than 20% from pre-treatment IOP, or a progression of visual field or optic disc damage requiring filtering surgery. The hypotensive medication during the study period remained unchanged.

RESULTS: The mean follow-up time was 34 months (SD 12.9). The mean pre-treatment IOP was 22.9 mm Hg (SD 2.1). At one month of follow-up, the mean IOP reduction was 5.3 mm Hg (SD 2.1) or 23.1% and at 6 months 5.6 mm Hg (SD 2.6) or 24.5%. At 12 months of follow-up, the mean IOP reduction was 5.6 mm Hg (SD 2.3) or 24.5% and at 24 months 6.2 mm Hg (SD 2.5) or 27%. At 36 months of follow-up, the mean IOP reduction was 6.4 mm Hg (SD 2.1) or 27.4% and at the end of 48 months of follow-up, the mean IOP reduction was 5.9 mm Hg (SD 2.0) or 25.4%. The success rate after 12 months determined from the Kaplan-Meier survival analysis was 97%, after 24 months 88%, after 36 months 76% and after 48 months 71%.

CONCLUSION: SLT is an effective procedure for the treatment of POAG.

Peer-Review German Klin Monatsbl Augenheilkd. 2003 Dec;220(12):848-52. 2003 Gracner T, Pahor D, Gracner B.

Augenabteilung des Lehrkrankenhauses Maribor, Slovenia. tomaz.gracner@sb-mb.si

SLT Equally Effective As ALT At 3-Year Follow-Up.

Refers to results from Karim and Damji

Article English Ocular Surgery News Supersite, October 2003. 2003 Piechocki, M. Study:

Not specified

Selective Laser Trabeculoplasty As Primary Treatment For Open-Angle Glaucoma: A Prospective, Nonrandomized Pilot Study.

OBJECTIVE: To examine the safety and efficacy of selective laser trabeculoplasty as primary treatment for patients with open-angle glaucoma.

METHODS: Forty-five eyes of 31 patients with open-angle glaucoma or ocular hypertension (intraocular pressure [IOP] >or=23 mm Hg on 2 consecutive measurements) underwent selective laser trabeculoplasty as primary treatment. All patients underwent complete ophthalmic evaluation before and at intervals after treatment. This evaluation included visual acuity, slit lamp examination, ophthalmoscopy, gonioscopy, and visual field analysis. The IOP was measured 1 hour, 1 day, 1 week, and 1, 3, 6, 12, 15, and 18 months postoperatively. During the follow-up period, patients were treated with topical antiglaucoma medications as required.

RESULTS: Mean +/- SD decreased by 7.7 +/- 3.5 mm Hg (30%), from 25.5 +/- 2.5 mm Hg to 17.9 +/- 2.8 mm Hg (P<.001). Only 2 eyes (4%) did not respond to selective laser trabeculoplasty, and 3 eyes (7%) required topical medications to control their IOP at the end of the follow-up period. Forty eyes (89%) had a decrease of 5 mm Hg or more. Visual acuity, visual fields, and gonioscopic findings remained unchanged. Complications included conjunctival redness and injection within 1 day postoperatively in 30 eyes (67%). One hour after selective laser trabeculoplasty, an increase in IOP of more than 5 mm Hg was detected in 5 eyes (11%), while an increase in IOP between 2 and 5 mm Hg was measured in 3 eyes (7%).

CONCLUSION: Selective laser trabeculoplasty is effective and safe as a primary treatment for patients with ocular hypertension and open-angle glaucoma.

Peer-Review English Arch Ophthalmol. 2003 Jul;121(7):957-60. 2003 Melamed S, Ben Simon GJ, Levkovitch-Verbin H.

Not specified

Is SLT A Better Choice Than ALT For Lowering IOP?

Points out that SLT has no clinical applications other than for OAG, therefore expensive acquisition?? Reports results from Juzych

Article English EyeWorld, July 2003. 2003 N/A

USA

Acute Ultrastructural Changes of the Trabecular Meshwork After Selective Laser Trabeculoplasty And Low Power Argon Laser Trabeculoplasty.

BACKGROUND AND OBJECTIVES: To compare the histopathological changes in the human trabecular meshwork after low power argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) with a Q-switched, frequency-doubled, neodymium:yttrium-aluminium-garnet (Nd:YAG) laser.

STUDY DESIGN/MATERIALS AND METHODS: In gonioscopically normal trabecular meshwork of three patients awaiting enucleation due to malignant melanoma of the choroid, SLT and ALT were performed 1-5 days prior to enucleation. In each eye, the lower half of trabecular meshwork received SLT, one quadrant low power (460 mW) ALT and one quadrant was left untreated. Specimens were evaluated with light and transmission electron microscopy.

RESULTS: A sharp demarcation line was visible between the laser treated and untreated intact trabecular meshwork after ALT and SLT. Both lasers caused disruption of trabecular beams, but the extent of the damage was smaller after SLT. The collagen component of trabecular beams was mostly amorphous, the long-spacing collagen was scanty after ALT, but more abundant after SLT. In the intertrabecular spaces fragmented cells and tissue debris with only a few pigmented cells were observed. Some endothelial cells were desquamated, but appeared slightly better preserved after SLT than ALT.

CONCLUSION: Our ultrastructural comparison of the morphological changes after low power ALT and SLT in patients demonstrated that both lasers caused splitting and fragmentation of the trabecular beams of the trabecular meshwork, but the extent of the damage was smaller and the preservation of long-spacing collagen better after SLT than after ALT. Copyright 2003 Wiley-Liss, Inc.

Peer-Review English Lasers Surg Med. 2003;33(3):204-8. Links 2003 Cvenkel B, Hvala A, Drnovsek-Olup B, Gale N.

Eye Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia. barbara.cvenkel@kclj.si

Selective Laser Trabeculoplasty And Retreatment:
Poster Presentation English American Academy of Ophthalmology, Anaheim 2003 2003 Madhu Nagar

Not specified

Selective Laser Trabeculoplasty: A Randomised Clinical Trial
Poster Presentation English ESCRS Munich, Germany Sept 2003 2003 Madhu Nagar

Not specified

Selective Laser Trabeculoplasty: A New Approach To Open Angle Glaucoma Management
Poster Presentation English Royal College of Ophthalmology Annual Congress Birmingham 2003. 2003 Madhu Nagar

Wakefield, UK

Dual Function Laser System Big Boon To Anterior Segment Surgeons.

Discusses the benefits and cost effectiveness of the SLT/YAG combination system

Article English Ophthalmology Times, January 2003. 2003 Guttman, C.

Not specified

Lowering Pressure Safely

Highlights four main benefits of SLT:
1). Selective
2). Non thermal
3). Repeatable
4). Effective for patient who have undergone prior ALT treatment

Article English Ophthalmology Times, 2003. Insert: Spotlight on Technology & Technique. 2003 Kent, C.

Not specified

Selective Laser Trabeculoplasty For Glaucoma Therapy.

SLT is a viable, primary treatment alternative to medical therapy, especially for non-compliant [patients

Peer-Review English Review of Ophthalmol. 2003, June; 67-72. 2003 Katz, J.

USA

Debate Over SLT Continues.

Latina and Wilson discuss benefits of SLT as opposed to ALT

Article English Ocular Surgery News Supersite, June 2003. 2003 Wolkoff, L.

USA

New Laser Options Exist For Patients With Glaucoma.

Introduction to SLT and Xe-CI excimer laser for glaucoma treatment Espouse benefit of potential repeatability with SLT

Article English Ocular Surgery News Supersite - Europe/Asia-Pacific Edition, June 2003. 2003 N/A

USA

Selective Laser Trabeculoplasty: A Randomised Control Trial
Paper Presentation English American Academy of Ophthalmology, Anaheim Nov 2003. 2003 Madhu Nagar

Not specified

SLT to be Tested as a First Line Therapy for Open-Angle Glaucoma.

Refers to Lumenis-sponsored SLT/Med study. Highlights problems of compliance, i.e. side effects and cost.

Article English EyeWorld, March 2003. 2003 Stephenson, M.

USA

Selective Laser Trabeculoplasty: A New And Successful Laser Treatment For Open Angle Glaucoma Management
Paper Presentation English International Congress of Glaucoma Surgery, Luxor in Feb 2003. 2003 Madhu Nagar

Wakefield, UK

Selective Laser Trabeculoplasty: A Review And Comparison To Argon Laser Trabeculoplasty
Article English Ophthalmic Practice Feb 2003; 21(2). 2003 Damji KF. et al.

USA

Long Term SLT Results Promise Valuable Primary Treatment

SLT suitable for primary OAG treatment

Article English ESCRS Euro times Jan 2003 2003 Nagar M, Howes FW.

Not specified

Long Term SLT Results Promise Valuable Primary Treatment

SLT suitable for primary OAG treatment

Article English EuroTimes, January 2003. 2003 Nagar, M.

Wakefield, UK

Primary Therapy With SLT Has Potential For Durable Efficacy

Patients with primary open-angle glaucoma, pseudoexfoliation glaucoma can maintain IOP control

Article English Ophthalmology Times 2002, June; 43. 2002 Guttman, Cheryl.

USA

SLT A Safe Alternative To ALT.

Positions SLT as a suitable first line treatment for OAG

Article English Ophthalmology Times, May 2002. 2002 Scerra, Chet.

Not specified

Treating POAG: SLT A Safe Alternative To ALT

SLT – a safe alternative to ALT.

Article English Ophthalmology Times 2002, May 2002 Scerra, Chet.

Not specified

Selective Laser Trabeculoplasty As Initial And Adjunctive Treatment For Open-Angle Glaucoma

PURPOSE: To investigate the efficacy and safety of selective laser trabeculoplasty as an initial treatment for newly diagnosed open-angle glaucoma, and its role as adjunctive therapy.

PATIENTS AND METHODS: A prospective multicenter nonrandomized clinical trial was performed. Patients with newly diagnosed open-angle glaucoma or ocular hypertension were assigned to the primary (selective laser trabeculoplasty) treatment group or the control (latanoprost) group according to patient choice. Both groups were followed up at 1, 3, 6, and 12 months. A secondary treatment group was also included to study the efficacy of selective laser trabeculoplasty for patients intolerant of medical therapy or in whom such therapy was unsuccessful, with or without a history of previous argon laser trabeculoplasty.

RESULTS: One hundred eyes (61 patients) were enrolled, 74 in the primary treatment group and 26 in the control group. The average absolute and percent reductions in intraocular pressure for the primary treatment group were 8.3 mm Hg or 31.0%, compared with 7.7 mm Hg or 30.6% for the control group (P = 0.208 and P = 0.879). The responder rates (20% pressure reduction) were 83% and 84% for the primary and control groups, respectively. There were no differences in intraocular pressure lowering with selective laser trabeculoplasty on the basis of angle pigmentation. A modest contralateral effect was observed in the untreated fellow eyes of patients undergoing selective laser trabeculoplasty.

CONCLUSION: Selective laser trabeculoplasty was found to be equally efficacious as latanoprost in reducing intraocular pressure in newly diagnosed open-angle glaucoma and ocular hypertension over 12 months, independent of angle pigmentation. Non-steroidal anti-inflammatory therapy had similar efficacy to steroids after laser therapy. These findings support the consideration of selective laser trabeculoplasty as a first-line treatment for newly diagnosed open-angle glaucoma or ocular hypertension.

Peer-Review English J Glaucoma. 2006 Apr;15(2):124-30. 2002 McIlraith I, Strasfeld M, Colev G, Hutnik CM.

Not specified

Intraocular Pressure Response of Capsular Glaucoma And Primary Open-Angle Glaucoma To Selective Nd:YAG Laser Trabeculoplasty: A Prospective, Comparative Clinical Trial.

PURPOSE: To evaluate the intraocular pressure (IOP) response to selective laser trabeculoplasty (SLT) in the treatment of uncontrolled primary open-angle glaucoma (POAG) in a prospective clinical study. SLT is a new laser procedure that selectively targets trabecular meshwork (TM) cells without coagulative damage to the TM.

METHODS: 50 eyes with uncontrolled POAG were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). A total of approximately 50 nonoverlapping spots were placed over 180 degrees of the TM at energy levels ranging from 0.40 to 0.92 mJ/pulse. After SLT, the eyes were maintained with the identical hypotensive medical therapy as that before treatment. IOP was estimated before and 1 day, 7 days, 1 month, 3 months and 6 months after treatment.

RESULTS: The mean pre-treatment IOP was 22.48 mm Hg (SD 1.84). At the end of 1 month of follow-up IOP was reduced with a mean of 4.86 mm Hg (SD 2.38) or 21.6%; after 3 months, IOP was reduced with a mean of 5.66 mm Hg (SD 2.40) or 25.2%; at the end of 6 months of follow-up, IOP was reduced with a mean of 5.06 mm Hg (SD 2.37) or 22.5%.

CONCLUSION: SLT is an effective method for lowering IOP in the treatment of POAG. Copyright 2001 S. Karger AG, Basel

Peer-Review English Eur J Ophthalmol. 2002 Jul-Aug;12(4):287-92. Links 2002 Gracner T.

Department of Ophthalmology, Maribor Teaching Hospital, Slovenia.

Selective Laser Trabeculoplasty: A New Treatment Option For Open Angle Glaucoma.

Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering the intraocular pressure in patients with open angle glaucoma. The preservation of the trabecular meshwork architecture and the demonstrated efficacy in lowering intraocular pressure makes the SLT a reasonable and safe alternative to argon laser trabeculoplasty. In addition, SLT is a potentially repeatable procedure because of the lack of coagulation damage to the trabecular meshwork and the demonstrated efficacy in patients with previously failed argon laser trabeculoplasty treatment. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or are noncompliant with their glaucoma medications, while not interfering with the success of future surgery. Due to its non-destructive properties and low complication rate, SLT has the potential to evolve as an ideal first-line treatment in open angle glaucoma.

Peer-Review English Curr Opin Ophthalmol. 2002 Apr;13(2):94-6. Links 2002 Latina MA, Tumbocon JA.

Glaucoma Fellow, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. jtumbocon@aol.com

Selective Laser Trabeculoplasty: Predictive Value of Early Intraocular Pressure Measurements For Success At 3 Months.

AIM: To determine the predictive value of the 2 week post-selective laser trabeculoplasty (SLT) intraocular pressure (IOP) by comparing it to the 4 week and 3 month values.

METHODS: A retrospective chart review of eyes that underwent SLT between 2001 and 2004 was performed. The primary outcome measure was IOP. Demographic and medical data were collected for correlational analysis.

RESULTS: 132 eyes of 95 patients were identified, none was excluded. Of the eyes that exhibited a decrease in IOP of >1 mm Hg at 2 weeks postoperatively, 99.24% continued to show a lowered IOP at the 4 week and 3 month visits. For these patients, the Pearson’s r value between 2 weeks and 4 weeks was 0.708 (p value = 0.01) while the r value between 2 weeks and 3 months was 0.513 (p value = 0.01).

CONCLUSION: The 2 week visit post-SLT predicted the 4 week and 3 month visits if the 2 week visit demonstrated a decrease in IOP. These findings suggest that those patients who had a decreased IOP at 2 weeks and are at their goal IOP may not need to be screened until 3 months postoperatively.

Peer-Review English Br J Ophthalmol. 2006 Jun;90(6):741-3. Epub 2006 Feb 7. 2001 Johnson PB, Katz LJ, Rhee DJ.

Not specified

Selective Laser Trabeculoplasty For Intraocular Pressure Elevation After Intravitreal Triamcinolone Acetonide Injection.

PURPOSE: Intravitreal injection of triamcinolone acetonide has increasingly become a therapeutic option for neovascular, inflammatory, and edematous intraocular diseases. A common side effect of this treatment is a steroid-induced elevation of intraocular pressure. In most of these patients, the rise in intraocular pressure can be treated topically. Those cases that cannot be treated medically have been treated with filtering surgery. This report presents a case of intraocular pressure elevation after intravitreal triamcinolone acetonide injection that was successfully treated with selective laser trabeculoplasty.

CASE REPORT: A 63-year-old white man presented with brow ache on the right side approximately 3 months after undergoing intravitreal injection of triamcinolone acetonide for diabetic macular edema in the right eye. Applanation tonometry revealed an intraocular pressure of 45 mm Hg in the involved eye. After initial treatment with topical medications, the patient underwent selective laser trabeculoplasty. Now, 6 months post-laser treatment, the intraocular pressure in the involved eye is stable at 15 mm Hg without topical medications.

CONCLUSION: A steroid-induced elevation of intraocular pressure is a common and widely reported side effect of treatment with intravitreal triamcinolone acetonide. This case report suggests that selective laser trabeculoplasty has potential as first- or second-line therapy for intraocular pressure elevation after intravitreal triamcinolone acetonide injection.

Peer-Review English Optom Vis Sci. 2006 Jul;83(7):421-5. 2001 Rachmiel R, Trope GE, Chipman ML, Gouws P, Buys YM.

Not specified

Intraocular Pressure Reduction After Selective Laser Trabeculoplasty in Primary Open Angle Glaucoma.

The aim of this prospective clinical study was to investigate the intraocular pressure (IOP) reduction after selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG). SLT represents a new method in the treatment of POAG. Fifty eyes with uncontrolled POAG were treated with a frequency doubled, Q-switched Nd:YAG laser (532 nm). The pattern of treatment was applying approximately 50 burns to 180 degrees of the trabecular meshwork at energy levels ranging from 0.40-0.92 mJ per pulse. After SLT eyes were maintained with the identical hypotensive medical therapy as that before treatment. IOP was measured before treatment, 1 and 7 days after treatment and 1, 3, 6 and 12 months after treatment. The mean pre-treatment IOP was 22.48 (SD 1.84) mm Hg. At the end of 1 month follow-up period the mean reduction of IOP was 4.86 (SD 2.38) mmHg or 21.6%; after 3 months the mean reduction was 5.66 (SD 2.40) mmHg or 25.2%; after 6 months the mean reduction of IOP was 5.06 (SD 2.37) mmHg or 22.5%; at the end of 12 months follow-up period the mean reduction was 4.92 (SD 2.58) mmHg or 21.9%. It can be concluded that SLT presents a new and effective method of IOP reduction in the treatment of POAG.

Peer-Review English Coll Antropol. 2001;25 Suppl:111-5. 2001 Gracner T.

General Hospital Maribor, Department of Ophthalmology, Maribor, Slovenia.

IOP Response To Selective Laser Trabeculoplasty in the Treatment of POAG.

At one month follow-up IOP was reduced with a mean of 4.86 mmHg At the end of six months IOP was reduced by a mean of 5.06 mmHg

Peer-Review English Ophthalmologica 2001; 215: 267-270. 2001 Gracner, Tomaz.

Not specified

SLT Evolves As A Treatment For Open-Angle Glaucoma.

SLT a safe and efficacious alternative to ALT SLT repeatable due to lack of coagulation.

Peer-Review English Review of Ophthalmol. 2001; 113-118. 2001 Latina, Mark A; Tumbocon, Joseph AJ.

USA

Laser Trabeculoplasty Trends With the Introduction of New Medical Treatments And Selective Laser Trabeculoplasty

PURPOSE: To correlate trends of laser trabeculoplasties (LTPs) with the introduction of medical therapies for glaucoma and to assess whether these trends changed after the introduction of selective laser trabeculoplasty (SLT) in 2001.

METHODS: A retrospective analysis of LTP numbers, filtration surgeries, glaucoma medications dispensed, and population distribution by age in Ontario, Canada, between April 1992 and March 2005.

RESULTS: The number of LTP per 1,000 persons estimated to have primary open angle glaucoma (POAG) increased from 138.05 in 1992 to a maximum of 149.23 in 1996 (8.1% increase, 1.96% annual increase) and then steadily decreased to 70.65 in 2001 (47.3% decrease, 14% annual decrease). From 2001 to 2004, the LTP rate increased to 162.54 (230% increase, 32% annual increase). The number of filtration surgeries per 1,000 persons estimated to have POAG steadily decreased from 1996 to 2004 by 21.42% (2.4% annual decrease). The number of glaucoma medications dispensed in Ontario increased from 1992 to 2004 by 91.5% (10.5% annual increase). There were no significant correlations between the LTP rates and the new glaucoma medications rates (r=-0.35 to 0.09; P=0.34 to 0.82) or filtration surgeries rates (r=0.007; P=0.98).

CONCLUSION: There was a substantial reduction in the number of LTP between 1997 and 2001 coinciding, but not correlated with the introduction of medications for the treatment of glaucoma. Between 2002 and 2004 the LTP rates increased, coinciding with the introduction of SLT.

Peer-Review English J Glaucoma. 2006 Aug;15(4):306-9 2001 Rachmiel R, Trope GE, Chipman ML, Gouws P, Buys YM.

Not specified

Increase of Free Oxygen Radicals in Aqueous Humour Induced By Selective Nd:YAG Laser Trabeculoplasty in the Rabbit.

PURPOSE: To investigate the impact of selective Nd:YAG laser trabeculoplasty on free oxygen radicals and antioxidant enzymes of the aqueous humour in the rabbit.

METHODS: One eye of 18 rabbits was subjected to 360 degrees selective laser trabeculoplasty (LT) with a frequency-doubled Nd:YAG laser (532 nm). The anterior chamber aqueous humour was aspirated 3, 12 hours and 1, 3, 7, 10 days after treatment. Lipid peroxide (LPO) and glutathione S transferase (GST) levels and superoxide dismutase (SOD) activities of aqueous humour were measured.

RESULTS: Concentrations of LPO in the aqueous humour of the treated eyes were significantly higher than the untreated eyes until the 7th day. Aqueous SOD activity significantly decreased 3 hours after LT and remained low until day 7. Aqueous GST levels were significantly decreased between 12 hours and 7 days after the LT.

CONCLUSION: Selective LT was followed by an immediate increase in the aqueous humour LPO concentration and decreases of SOD and GST in the rabbit, probably due to photovaporization and photodisruption caused by the frequency-doubled Nd:YAG laser. The increased aqueous LPO levels suggest that free oxygen radicals are formed in the pigmented trabecular meshwork during LT, and may be responsible for the inflammatory complications of this procedure.

Peer-Review English Eur J Ophthalmol. 2001 Jan-Mar;11(1):47-52. 2001 Guzey M, Vural H, Satici A, Karadede S, Dogan Z.

Department of Ophthalmology, Faculty of Agricolture, Harran University, Sanliurfa, Turkey. guzey@turk.net

Is Trabeculoplasty Still Indicated?

Trabeculoplasty was introduced in 1979 to decrease intra ocular pressure. Long-term results have been unsatisfactory compared to the first publications, because of the repeated relapse of initially successfully treated eyes. However, the technique may be particularly useful in numerous clinical conditions: pseudo exfoliation syndrome, pigmentary dispersion, slight cataract waiting for combined surgery, and in elderly patients. Developing new energy sources (i.e., selective laser trabeculoplasty) could extend the indications of this method, with longer-lasting results and/or completely harmless retreatments.

Peer-Review French J Fr Ophtalmol. 2001 Dec;24(10):1100-2. 2001 Sellem E.

Not specified

Intraocular Pressure Response To Selective Laser Trabeculoplasty in the Treatment of Primary Open-Angle Glaucoma.

PURPOSE: To evaluate the intraocular pressure (IOP) response to selective laser trabeculoplasty (SLT) in the treatment of uncontrolled primary open-angle glaucoma (POAG) in a prospective clinical study. SLT is a new laser procedure that selectively targets trabecular meshwork (TM) cells without coagulative damage to the TM.

METHODS: 50 eyes with uncontrolled POAG were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). A total of approximately 50 non-overlapping spots were placed over 180 degrees of the TM at energy levels ranging from 0.40 to 0.92 mJ/pulse. After SLT, the eyes were maintained with the identical hypotensive medical therapy as that before treatment. IOP was estimated before and 1 day, 7 days, 1 month, 3 months and 6 months after treatment.

RESULTS: The mean pre-treatment IOP was 22.48 mm Hg (SD 1.84). At the end of 1 month of follow-up IOP was reduced with a mean of 4.86 mm Hg (SD 2.38) or 21.6%; after 3 months, IOP was reduced with a mean of 5.66 mm Hg (SD 2.40) or 25.2%; at the end of 6 months of follow-up, IOP was reduced with a mean of 5.06 mm Hg (SD 2.37) or 22.5%.

CONCLUSION: SLT is an effective method for lowering IOP in the treatment of POAG.
Copyright 2001 S. Karger AG, Basel

Peer-Review English Ophthalmologica. 2001 Jul-Aug;215(4):267-70. 2001 Gracner T.

Department of Ophthalmology, General Hospital Maribor, Slovenia.

Comparison of the Morphologic Changes After Selective Laser Trabeculoplasty And Argon Laser Trabeculoplasty in Human Eye Bank Eyes.

OBJECTIVE: To compare the histopathologic changes in the human trabecular meshwork (TM) after argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) with a Q-switched, frequency-doubled, neodymium:yttrium-aluminum-garnet laser. DESIGN: Human “in vitro” experimental study.

TISSUE AND CONTROLS: Eight human autopsy eyes were obtained within 18 hours of death from persons aged 71 to 78 years. METHODS: The anterior segment of autopsy eyes was isolated, and one half of each trabecular meshwork underwent SLT and the other half ALT. Specimens were evaluated with scanning and transmission electron microscopy.

MAIN OUTCOME MEASURES: Structural changes in the TM were detected by scanning electron microscopy, and cellular or intracellular changes were seen with transmission electron microscopy.

RESULTS: Evaluation of the TM after ALT revealed crater formation in the uveal meshwork at the junction of the pigmented and nonpigmented TM. Coagulative damage was evident at the base and along the edge of craters, with disruption of the collagen beams, fibrinous exudate, lysis of endothelial cells, and nuclear and cytoplasmic debris. Evaluation of the TM after SLT revealed no evidence of coagulative damage or disruption of the corneoscleral or uveal trabecular beam structure. Minimal evidence of mechanical damage was present after SLT, and the only ultrastructural evidence of laser tissue interaction was cracking of intracytoplasmic pigment granules and disruption of trabecular endothelial cells.

CONCLUSION: SLT applied “in vitro” to the TM of human eye bank eyes seemed to cause no coagulative damage and less structural damage to the human TM when compared with ALT and, therefore, may be a safer and more repeatable procedure.

Peer-Review English Ophthalmology. 2001 Apr;108(4):773-9. 2001 Kramer TR, Noecker RJ.

Emory Eye Center, Emory University School of Medicine, 1365-B Clifton Road N.E., Atlanta, GA 30322, USA.

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 x 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 approximately 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.

Peer-Review English Jpn J Ophthalmol. 2000 Sep 1;44(5):574-575. 2000 Kajiya S, Hayakawa K, Sawaguchi S.

Department of Ophthalmology, University of Ryukyu Faculty of Medicine, Ryukyu, Japan

One-Year Follow-Up of Laser Trabeculoplasty Using Q-Switched Frequency-Doubled Nd:YAG Laser

SLT shown efficacy and safety over a one year period Mean IOP reduction of 4.94 mmHg at 12 months

Peer-Review English Ophthalmic Surgery & Lasers 2000; 31(5): 394-399. 2000 Kim, Yong J; Moon, Chul S.

Korea

International Clinical Experience With SLT.

SLT safe as both primary and adjunctive therapy

Article English Ocular Surgery News 2000 Mar.17 2000 Kaulen P.

Not specified

A Review of Argon And Selective Laser Trabeculoplasty As Primary Treatments of Open-Angle Glaucoma.

It is generally accepted within the ophthalmic community that medical therapy is the preferred primary treatment in open-angle glaucoma, followed by laser trabeculoplasty if the medical therapy is unsuccessful, with surgery employed more as an end-stage option when these avenues have been exhausted. This review discusses the efficacy of argon laser trabeculoplasty, alone and in comparison with medical therapy as a primary treatment of glaucoma. It will also discuss the new laser technique, selective laser trabeculoplasty.

Peer-Review English Clin Exp Optom. 1999 Nov;82(6):225-229. 1999 Sanfilippo P.

96 Nellie Street, Queensland, 4012, Australia.

Selective Laser Trabeculoplasty V Argon Laser Trabeculoplasty: A Prospective Randomised Clinical Trial.

AIMS: To compare the effectiveness of selective laser trabeculoplasty (SLT, a 532 nm Nd:YAG laser) with argon laser trabeculoplasty (ALT) in lowering the intraocular pressure (IOP) in patients with medically uncontrolled open angle glaucoma.

METHODS: A prospective randomised clinical trial was designed. Patients were randomised to treatment with either SLT or ALT and were evaluated at 1 hour, 1 week, 1, 3, and 6 months post-laser.

RESULTS: There were 18 eyes in each group. Baseline characteristics were similar in both groups. In the SLT group the mean IOP at baseline, 1, 3, and 6 months was 22.8 (SD 3.0), 20.1 (4.6), 19.3 (6.0), and 17.8 (4.8) mm Hg, respectively. In the ALT group, the mean IOP at baseline, 1, 3, and 6 months was 22.5 (3.6), 19.5 (4.7), 19.6 (5.6), and 17.7 (3.3) mm Hg, respectively. There was a greater anterior chamber reaction, 1 hour after SLT v ALT (p< 0.01). Patients with previous failed ALT had a better reduction in IOP with SLT than with repeat ALT (6.8 (2. 4) v 3.6 (1.8) mm Hg; p = 0.01).

CONCLUSION: SLT appears to be equivalent to ALT in lowering IOP during the first 6 months after treatment. There is a slightly greater anterior chamber reaction 1 hour after SLT. Patients with previous failed ALT had a significantly greater drop in IOP when treated with SLT v ALT. These results need to be confirmed with a larger sample size.

Peer-Review English Br J Ophthalmol. 1999 Jun;83(6):718-22. 1999 Damji KF, Shah KC, Rock WJ, Bains HS, Hodge WG.

University Of Ottawa Eye Institute, Ottawa Hospital, Ottawa, Ontario, Canada.

Selective Laser Trabeculoplasty Vs. Argon Laser Trabeculoplasty

SLT equivalent to ALT Patients with previous failed ALT had a much greater drop in IOP when treated with SLT vs. ALT

Peer-Review English Br J Ophthalmol 1999 Jun; 83(6): 718-722. 1999 Damji, Karim F; Shah, Kirtida C et al.

USA

Immediate Intraocular Pressure Response To Selective Laser Trabeculoplasty.

BACKGROUND/AIMS: Selective laser trabeculoplasty targets the pigmented trabecular meshwork cells without damage to the trabecular meshwork architecture in vitro. A study was conducted in vivo of eight eyes with uncontrolled open angle glaucoma to ascertain the immediate intraocular response to selective laser trabeculoplasty.

METHODS: The trabecular meshwork of each eye was treated 360 degrees with a frequency doubled Q-switched Nd:YAG laser. Intraocular pressure was measured 1, 2, 24 hours and 1, 4, 6 weeks after treatment.

RESULTS: The average preoperative intraocular pressure was 26.6 (SD 7) mm Hg (range 18-37). Two hours and 6 weeks respectively after selective trabeculoplasty intraocular pressure was reduced in all the eyes treated with an average fall of 10.6 (5.2) mm Hg or 39.9%. A pressure spike of 10 mm Hg verified in one eye 1 hour after treatment.

CONCLUSION: Selective laser trabeculoplasty decreased intraocular pressure by an amount similar to that achieved with standard trabeculoplasty. Additional study is needed to determine whether the beneficial effect is sustained over a longer period of follow up.

Peer-Review English Br J Ophthalmol. 1999 Jan;83(1):29-32. 1999 Lanzetta P, Menchini U, Virgili G.

Department of Ophthalmology, University of Udine, Italy.

Q-Switched 532-Nm Nd:YAG Laser Trabeculoplasty (Selective Laser Trabeculoplasty): A Multicenter, Pilot, Clinical Study.

OBJECTIVE: To investigate the safety and efficacy of a new laser procedure using a q-switched 532-nm neodymium (Nd):YAG laser, also called “selective laser trabeculoplasty,” to lower intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). The laser parameters were set to selectively target pigmented trabecular meshwork (TM) cells without coagulative damage to the TM structure or non-pigmented cells.

DESIGN: Nonrandomized, prospective, clinical trial.

PARTICIPANTS: Thirty eyes of 30 patients with uncontrolled OAG (OAG group) and 23 eyes of 23 patients with uncontrolled OAG treated previously with argon laser trabeculoplasty (ALT group) were observed for 4 to 26 weeks. Forty-four of the 53 eyes were observed for 26 weeks.

INTERVENTION: Patients were treated with the Coherent Selecta 7000 (Coherent, Inc, Palo Alto, CA) frequency-doubled q-switched Nd:YAG laser (532 nm). A total of approximately 50 non-overlapping spots were placed over 180 degrees of the TM at energy levels ranging from 0.6 to 1.2 mJ per pulse. After surgery, patients were maintained with the identical drug regimen as that before treatment.

RESULTS: Both the OAG and ALT groups showed similar IOP reductions over time. Seventy percent of patients in each group responded to treatment with an IOP reduction of least 3 mmHg. At 26 weeks of follow-up, mean IOP reduction was 5.8 mmHg (23.5%, P < 0.001) for the OAG group and 6.0 mmHg (24.2%, P < 0.001) for the ALT group. The untreated eye showed a 9.7% (P < 0.001) reduction of IOP at 26 weeks. However, the IOP difference between the treated and untreated eyes was statistically significant at P < 0.003. Transient IOP elevation of 5 mmHg or greater was seen in 24% of patients.

CONCLUSION: The selective laser trabeculoplasty appears to be a safe and effective method to lower IOP in patients with OAG and patients treated previously with ALT. A reduction of IOP can be achieved without coagulation of the TM.

Peer-Review English Ophthalmology. 1998 Nov;105(11):2082-8; discussion 2089-90. 1998 Latina MA, Sibayan SA, Shin DH, Noecker RJ, Marcellino G.

Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Selective Targeting of Trabecular Meshwork Cells: in Vitro Studies of Pulsed And CW Laser Interaction.

Demonstrated selective targeting of pigmented TM cells (one of the first foundation papers)

Peer-Review English Exp Eye Res 1995; 60: 359-372. 1995 Latina, MA; Park C.

USA

The Glaucoma Laser Trial (GLT) And Glaucoma Laser Trial Follow Up Study: Results of ALT vs Topical Medicines

Randomized clinical trials involving 271 patients ALT safe and efficacious OAG treatment alternative to topical medications.

Peer-Review English Am J Ophthalmol. 1995; 120: 718-731. 1995 The Glaucoma Laser Trial Research Group.

Not specified

Selective Targeting of Trabecular Meshwork Cells: in Vitro Studies of Pulsed And CW Laser Interactions.

The purpose of the present study was to selectively target pigmented trabecular meshwork cells without producing collateral damage to adjacent non-pigmented cells or structures. The ability to selectively target trabecular meshwork cells without coagulation, while preserving the structural integrity of the meshwork, could be a useful approach to study whether the biological response of non-coagulative damage to the trabecular meshwork and trabecular meshwork cells is similar to that seen with coagulative damage to the trabecular meshwork which occurs with argon laser trabeculoplasty. This approach also may be useful to non-invasively deplete trabecular meshwork cells while preserving the structural integrity of the trabecular meshwork in an animal model. A mixed cell culture of pigmented and non-pigmented trabecular meshwork cells were irradiated with Q-switched Nd-YAG and frequency-doubled Nd-YAG lasers, microsound pulsed dye-lasers, and an argon ion laser in order to define a regime where laser absorption would be confined to pigmented trabecular meshwork cells, thereby permitting selective targeting of these cells without producing collateral thermal damage to adjacent non-pigmented cells. Pulse durations ranged from 10 nsec to 0.1 sec. A fluorescent viability/cytotoxicity assay was used to evaluate laser effects and threshold energies, and cells were examined morphologically by light and TEM. Selective targeting of pigmented trabecular meshwork cells was achieved with pulse durations between 10 nsec and 1 microsec and 1 microsec without producing collateral thermal or structural damage to adjacent non-pigmented trabecular meshworks cells when examined by light and transmission electron microscopy. Pulse durations greater than 1 microsec resulted in non-selective killing of non-pigmented trabecular meshwork cells. Threshold radiant exposures were as low as 18 mJ cm-2, and increased at longer wavelengths, longer pulse durations and lower melanin contents within the cells. It is concluded that selective targeting of pigmented trabecular meshwork cells can be achieved using pulsed lasers with low threshold radiant exposures avoiding collateral thermal damage to adjacent non-pigmented trabecular meshwork cells. This approach can be readily applied in vivo.

Peer-Review English Exp Eye Res. 1995 Apr;60(4):359-71. 1995 Latina MA, Park C.

Wellman Laboratories, Massachusetts General Hospital, Boston 02114, USA.