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SLT Bibliography

The online bibliography contains the full range of 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.

Title
Language
Date
 
Details
Source
Author(s)
Laser trabeculoplasty as first-line glaucoma treatment.
English
2019

Details Peer-Review
Source Lancet. 2019 Apr 13;393(10180):1479-1480. doi: 10.1016/S0140-6736(18)32553-4. Epub 2019 Mar 9.
Author(s) Young JW, Caprioli J.
Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial.
English
2019

Background
Primary open angle glaucoma and ocular hypertension are habitually treated with eye drops that lower intraocular pressure. Selective laser trabeculoplasty is a safe alternative but is rarely used as first-line treatment. We compared the two.
Methods
In this observer-masked, randomised controlled trial treatment-naive patients with open angle glaucoma or ocular hypertension and no ocular comorbidities were recruited between 2012 and 2014 at six UK hospitals. They were randomly allocated (web-based randomisation) to initial selective laser trabeculoplasty or to eye drops. An objective target intraocular pressure was set according to glaucoma severity. The primary outcome was health-related quality of life (HRQoL) at 3 years (assessed by EQ-5D). Secondary outcomes were cost and cost-effectiveness, disease-specific HRQoL, clinical effectiveness, and safety. Analysis was by intention to treat. This study is registered at controlled-trials.com (ISRCTN32038223).
Findings
Of 718 patients enrolled, 356 were randomised to the selective laser trabeculoplasty and 362 to the eye drops group. 652 (91%) returned the primary outcome questionnaire at 36 months. Average EQ-5D score was 09 (SD 08) in the selective laser trabeculoplasty group versus 00 (SD 06) in the eye drops group, with no significant difference (difference 01, 95% CI _01 to 03; p=03). At 36 months, 74% (95% CI 698) of patients in the selective laser trabeculoplasty group required no drops to maintain intraocular pressure at target. Eyes of patients in the selective laser trabeculoplasty group were within target intracoluar pressure at more visits (93%) than in the eye drops group (91%), with glaucoma surgery to lower intraocular pressure required in none versus 11 patients. Over 36 months, from an ophthalmology cost perspective, there was a 97% probability of selective laser trabeculoplasty as first treatment being more cost-effective than eye drops first at a willingness to pay of 20_000 per quality-adjusted life-year gained.
Interpretation
Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice.

Details Peer-Review
Source Lancet. April 2019;393(10180):1505-16. DOI:https://doi.org/10.1016/S0140-6736(18)32213-X.
Author(s) Gazzard G, Konstantakopoulou E, Garway-Heath D, et al.
Selective laser trabeculoplasty: past, present, and future.
English
2018

Over the past two decades, selective laser trabeculoplasty (SLT) has increasingly become an established laser treatment used to lower intraocular pressure in open-angle glaucoma and ocular hypertensive patients. In this review we trace the origins of SLT from previous argon laser trabeculoplasty and review the current role it has in clinical practice. We outline future directions of SLT research and introduce emerging technologies that are further developing this intervention in the treatment paradigm of glaucoma.

Details Peer-Review
Source Eye (Lond). 2018 May;32(5):863-876. doi: 10.1038/eye.2017.273. Epub 2018 Jan 5.
Author(s) Garg A, Gazzard G.
A Retrospective Review Comparing the Safety and Efficacy of 120 Versus 160 Applications of Selective Laser Trabeculoplasty.
English
2018

PURPOSE:
To compare the effectiveness and safety of 120 applications versus 160 applications of selective laser trabeculoplasty (SLT) at reducing intraocular pressure (IOP) from baseline in glaucoma patients over a 1-year period.

METHODS:
A retrospective chart review was conducted, comprising 376 eyes from 199 patients who underwent SLT treatment performed by the same glaucoma subspecialist from 2014 to 2015. Data were obtained on patients' clinical features, management, and outcomes. Patients were treated with either 120 applications or 160 applications of SLT per 360 degrees of trabecular meshwork over 2 sessions. Statistical analyses were performed comparing baseline IOP with IOP at 6 weeks and 1-year follow-up after completion of treatment. The incidence and severity of transient IOP rises immediately post-SLT was also recorded.

RESULTS:
Both SLT regimes were effective at reducing IOP. Univariate t tests showed that the 160 applications group had significantly greater mean reduction of IOP from baseline at both 6 weeks (4.6 vs. 3.6_mm_Hg, P=0.015) and 1-year time points (4.1 vs. 2.8_mm_Hg, P=0.019). However, when multivariate analyses were used to account for the effects of clustering and include other covariates such as age, baseline IOP, history of previous SLT there was no significant difference between success rates of the 2 treatment groups at either time points. Higher baseline IOP was associated with greater IOP reduction at 6 weeks (P<0.001) and 1 year (P<0.001) for both treatment groups. There was no statistical difference in incidence and severity of IOP spikes at 1-hour post-SLT between the 2 treatment groups.

CONCLUSIONS:
SLT produces a significant IOP-lowering effect and treatment with 160 applications per 360 degrees may be more effective than 120 applications per 360 degrees. Furthermore, 160 applications of SLT does not increase the risk of transient IOP spikes.

Details Peer-Review
Source J Glaucoma. 2018 Jan;27(1):94-99. doi: 10.1097/IJG.0000000000000828.
Author(s) Wong C, Tao LW, Skalicky SE.
Efficacy of selective laser trabeculoplasty following incisional glaucoma surgery.
English
2018

AIM
To evaluate the efficacy of selective laser trabeculoplasty (SLT) in glaucomatous eyes with previous incisional glaucoma surgery.

METHODS
A retrospective cohort of eyes that underwent SLT at a single institution from 2013-2015 were followed for 1y. Reduction in intraocular pressure (IOP) following SLT was evaluated in eyes with prior trabeculectomy with ExPress mini shunt (Alcon, Ft Worth, TX, USA), Ahmed valve (New World Medical, Cucamonga, CA, USA), or combined phacoemulsification-trabeculectomy. A control group was included with eyes without prior surgery that underwent SLT. Success was defined as >20% drop in IOP from pre-SLT baseline.

RESULTS
One-hundred and six eyes were included with 53 in both the prior glaucoma surgery (PGS) and no prior glaucoma surgery (NPGS) groups. Mean pre-SLT IOP was 19.24.3 and 20.66.0 mm Hg for PGS and NPGS groups, respectively (P=0.17). Both groups produced statistically significant IOP reductions at 1 and 6mo (P<0.04). At 6mo, mean IOP reduction reached 7.3% and 10.8% for the PGS and NPGS groups, respectively (P=0.42). Overall, 27.9% and 31.7% of eyes in PGS and NPGS groups met success criteria at 1y (P=0.70). In the PGS group, eyes with baseline IOP 21 mm Hg had IOP reductions of 18.1% (P<0.001), 16.7% (P<0.01), and 8.4% (P=0.31) compared to eyes with baseline IOP <21 mm Hg who had IOP reductions of 2.3% (P=0.39), 3.4% (P=0.19), and 1.1% (P=0.72) at 1, 6mo, and 1y, respectively.

CONCLUSION
SLT is efficacious in eyes with prior incisional glaucoma surgery and results in similar IOP reductions compared to eyes without PGS. A larger IOP reduction is observed following SLT in eyes with higher pre-SLT IOP.

Details Peer-Review
Source Int J Ophthalmol. 2018;11(1):71. doi: 10.18240/ijo.2018.01.13.
Author(s) Sharpe RA, Kammerdiener LL, Williams DB, et al.
Exploring topical anti-glaucoma medication effects on the ocular surface in the context of the current understanding of dry eye.
English
2018

PURPOSE:
To assess tear film parameters, ocular surface characteristics, and dry eye symptomology in patients receiving topical anti-glaucoma medications.

METHODS:
Thirty-three patients with a diagnosis of open angle glaucoma or ocular hypertension, receiving unilateral topical anti-glaucoma medication for at least 6 months, were recruited in a cross-sectional, investigator-masked, paired-eye comparison study. Tear film parameters, ocular surface characteristics, and dry eye symptomology of treated and fellow eyes were evaluated and compared.

RESULTS:
The mean__SD age of the participants was 67__12 years, and the mean__SD treatment duration was 5.3__4.4 years. Treated eyes had poorer non-invasive tear film breakup time (p_=_0.03), tear film osmolarity (p_=_0.04), bulbar conjunctival hyperaemia (p_=_0.04), eyelid margin abnormality grade (p_=_0.01), tear meniscus height (p_=_0.03), and anaesthetised Schirmer value (p_=_0.04) than fellow eyes. There were no significant differences in dry eye symptomology, meibomian gland assessments, and ocular surface staining between treated and fellow eyes (all p_>_0.05).

CONCLUSIONS:
Adverse changes in tear film stability, tear osmolarity, conjunctival hyperaemia, and eyelid margins were observed in treated eyes. This suggests that inflammatory mechanisms may be implicated in the development of dry eye in patients receiving long term topical anti-glaucoma therapy.

Details Peer-Review
Source Ocul Surf. 2018 Jul;16(3):289-293. doi: 10.1016/j.jtos.2018.03.002. Epub 2018 Mar 3.
Author(s) Wong ABC, Wang MTM, Liu K, et al.
Recent Advances in the Surgical Management of Glaucoma in Exfoliation Syndrome.
English
2018

Surgical and laser procedures traditionally used in the management of exfoliation glaucoma (XFG) include laser trabeculoplasty, trabeculectomy, and glaucoma drainage implant surgery. Having demonstrated similar safety and efficacy in XFG compared with primary open-angle glaucoma, trabeculectomy remains the most commonly performed surgery in XFG. Recent trends in practice patterns in developed nations demonstrate a shift towards glaucoma drainage implant surgery, which is currently the procedure of choice in XFG for many, particularly in developed nations. In addition, cataract surgery alone may significantly decrease intraocular pressure in patients with XFG, may prevent glaucoma development in patients with exfoliation syndrome, and is recommended to be performed early in the course of the disease. With the relatively recent introduction of nonpenetrating glaucoma surgery and the ongoing evolution of minimally invasive glaucoma surgery, several other surgical procedures have now become part of the glaucoma surgeon's armamentarium when treating XFG, including the Ex-PRESS shunt, deep sclerectomy, viscocanalostomy, Trabectome, as well as angle procedures. These techniques have demonstrated promising results in various types of glaucoma. More research is, however, needed to establish the safety and efficacy of these procedures in XFG.

Details Peer-Review
Source J Glaucoma. 2018 Jul;27 Suppl 1:S95-S101. doi: 10.1097/IJG.0000000000000918.
Author(s) Sayed MS, Lee RK.
Histopathologic Examination of Trabecular Meshwork Changes After Trabecular Bypass Stent Implantation.
English
2018

PURPOSE:
The purpose of this article was to evaluate how human trabecular meshwork (TM) is influenced by the chronic presence of trabecular bypass implants.

METHODS:
Human TM samples were obtained intraoperatively from 3 patients who had previously undergone implantation of a trabecular micro-bypass stent. Trabecular strips were obtained with a goniotomy blade from areas directly adjacent to the stent after stent removal. Tissue samples were preserved, processed, cut, and stained according to standardized laboratory protocol. Harvested samples were compared with human cadaveric TM from an eye without ocular disease as well as TM obtained from a glaucomatous eye without prior stent placement.

RESULTS:
In all samples, a significant increase in the amount of fibrous material compared with cellular material was noted when compared with controls. In a single strip, a basement membrane-like structure was noted, which correlated with a semiopaque membrane noted intraoperatively overlying the stent and adjacent TM. Further, TM cells were absent from areas adjacent to the stent implantation site with related collapse of collagen beams.

CONCLUSIONS:
These findings indicate that inflammatory and fibrotic changes are present surrounding the device with clear differences noted when compared with both healthy and glaucomatous controls. These changes suggest a possible etiology for device failure over time. Further studies are necessary to tease out differences in TM tissue reaction to various implant materials as well as to make comparisons to procedures that excise TM.

Details Peer-Review
Source J Glaucoma. 2018 Jul;27(7):606-609. doi: 10.1097/IJG.0000000000000968.
Author(s) Capitena Young CE, Ammar DA, Seibold LK, et al.
Predictors of Outcome in Selective Laser Trabeculoplasty: A Long-term Observation Study in Primary Angle-closure Glaucoma After Laser Peripheral Iridotomy Compared With Primary Open-angle Glaucoma.
English
2018

PURPOSE:
To evaluate the efficacy of selective laser trabeculoplasty (SLT) for patients with primary angle-closure glaucoma (PACG) following a YAG laser peripheral iridotomy (PI) in comparison with primary open-angle glaucoma (POAG) and to assess the predictors of outcome of SLT.

PATIENTS AND METHODS:
In retrospective study 68 patients with PACG after PI (68 eyes) and 74 POAG patients (74 eyes) were observed for 6 years. The effectiveness of SLT (20% reduction of intraocular pressure) was assessed using Kaplan-Meier survival analysis. The parameters for distinguishing the eyes with success and failure of SLT were detected by means of area under receiver operating characteristic curve (AUC). The predictive factors affecting SLT outcome were determined using Cox-regression analysis.

RESULTS:
The success ratio was 87% in both groups in 1 year and dropped to 4% in PACG and to 6% in POAG in 6 years. Corneal hysteresis [odds ratio (_R)=0.367, _=0.005 for PACG, _R=0.446, _=0.008 for POAG] and age (OR=1.182, P=0.012 for PACG, OR=1.164, P=0.002 for POAG) were detected as the predictors of SLT outcome. In PACG pre-SLT anterior chamber depth was additional predictor (_R=0.242, _=0.001). The number of pre-SLT pressure-lowing medications was higher in the eyes with SLT failure (AUC, 0.794; P=0.0005 in PACG and AUC, 0.760; P=0.014 in POAG).

CONCLUSIONS:
One-year efficacy of SLT in POAG and PACG after PI was high, but it was reduced in long-term period. Corneal hysteresis, age, and number of pre-SLT hypotensive eye drops were significant prognostic factors for treatment success in both glaucoma forms. In PACG pre-SLT anterior chamber depth affected the SLT outcome.

Details Peer-Review
Source J Glaucoma. 2018 Oct;27(10):880-886. doi: 10.1097/IJG.0000000000001048.
Author(s) Kurysheva NI, Lepeshkina LV, Shatalova EO.
A cost minimisation analysis comparing iStent accompanying cataract surgery and selective laser trabeculoplasty versus topical glaucoma medications in a public healthcare setting in New Zealand.
English
2018

PURPOSE:
To produce an economic comparison of the iStent ab interno trabecular microbypass implant accompanying cataract surgery and selective laser trabeculoplasty (SLT) as first-line treatment versus topical medications for open-angle glaucoma in New Zealand in 2016.

METHODS:
The current annual costs of 19 available fully subsidised topical glaucoma medications by Pharmaceutical Management Agency (Pharmac) in 2016 were identified. Adjustments for pharmacist prescribing charges and previously described wastage levels were applied. The costs to perform iStent implantation and the cost to perform SLT were obtained from the local distributors, with the latter taking into account staff and consumable cost. Procedure costs divided by eye drops' cost produced a break-even level in equivalent years of eye drops use.

RESULTS:
The range of annual eye drop cost was NZD$42.25 to NZD$485.11, with an average of NZD$144.81. Comparison of annual eye drop cost with iStent cost revealed 3 of 19 (15.8%) drops breaking even within 5 years, 9 of 19 (47.3%) within 10 years, and 12 of 19 (63.2%) within 15 years. The cost of bilateral SLT performed by a consultant was NZD$102.30 (breaking even in 0.71 years). The equivalent cost for a registrar was NZD$97.59 (breaking even in 0.67 years).

CONCLUSION:
Economically, the iStent would appear to be a reasonably cost-effective treatment for glaucoma patients undergoing cataract surgery in a public healthcare setting in New Zealand, particularly for those using more expensive topical glaucoma medications, whilst SLT appears to be a worthwhile consideration as a first-line treatment for glaucoma in New Zealand.

Details Peer-Review
Source Graefes Arch Clin Exp Ophthalmol. 2018 Nov;256(11):2181-2189. doi: 10.1007/s00417-018-4104-8. Epub 2018 Aug 21.
Author(s) Ngan K, Fraser E, Buller S, et al.
Comparative study of the efficacy of selective laser trabeculoplasty as initial or adjunctive treatment for primary open-angle glaucoma.
English
2018

AIM:
The aim of this study is to compare the efficacy of selective laser trabeculoplasty as initial or adjunctive treatment for primary open-angle glaucoma in a retrospective chart review.

METHODS:
28 eyes of 28 patients with newly diagnosed primary open-angle glaucoma, who formed the initial selective laser trabeculoplasty group, and 31 eyes of 31 patients suffering from medical uncontrolled primary open-angle glaucoma, who formed the adjunctive selective laser trabeculoplasty group, were treated with 180 selective laser trabeculoplasty. Patients were evaluated 1, 3, 6, 12, 18 and 24_months after treatment. Success was defined as an intraocular pressure lowering exceeding 20% of pretreatment intraocular pressure.

RESULTS:
The mean follow-up time was 20.25_months (standard deviation_=_8.1) for the initial selective laser trabeculoplasty group and 18.87_months (standard deviation_=_8.8) for the adjunctive selective laser trabeculoplasty group (p_=_0.538). No significant difference was found between the two groups for mean pretreatment intraocular pressure (21.43_mmHg (standard deviation_=_3.2) vs 21.97_mmHg (standard deviation_=_2.6); p_=_0.766), for mean intraocular pressures and mean intraocular pressure reductions during whole follow-up period. At all follow-up visits, the mean percent intraocular pressure reduction was smaller in the adjunctive selective laser trabeculoplasty group than in the initial selective laser trabeculoplasty group, and such a difference was significant at 1_month (21.55% vs 26.79%; p_=_0.039) and 24_months (24.82% vs 28.10%; p_=_0.041). According to the Kaplan-Meier survival analysis, the 24-month success rate was 71.4% in the initial selective laser trabeculoplasty group and 71% in the adjunctive selective laser trabeculoplasty group, with no differences between the groups (p_=_0.913).

CONCLUSION:
Selective laser trabeculoplasty is equally efficient in reducing intraocular pressure as initial or adjunctive treatment for primary open-angle glaucoma over 24_months.

Details Peer-Review
Source Eur J Ophthalmol. 2018 Sep 19:1120672118801129. doi: 10.1177/1120672118801129.
Author(s) Gra_ner T.
Affordability of Glaucoma Treatment Around the Globe An Initial Step Toward Improving Universal Access to Glaucoma Treatment.
English
2018

Details Peer-Review
Source JAMA Ophthalmol. 2018 Nov 1;136(11):1279-1280. doi: 10.1001/jamaophthalmol.2018.3670.
Author(s) Blumberg DM.
A Worldwide Price Comparison of Glaucoma Medications, Laser Trabeculoplasty, and Trabeculectomy Surgery.
English
2018

IMPORTANCE:
Medical and surgical interventions for glaucoma are effective only if they are affordable to patients. Little is known about how affordable glaucoma interventions are in developing and developed countries.

OBJECTIVE:
To compare the prices of topical glaucoma medications, laser trabeculoplasty, and trabeculectomy relative with median annual household income (MA-HHI) for countries worldwide.

DESIGN, SETTING AND PARTICIPANTS:
Cross-sectional observational study. For each country, we obtained prices for glaucoma medications, laser trabeculoplasty, and trabeculectomy using government pricing data, drug databases, physician fee schedules, academic publications, and communications with local ophthalmologists. Prices were adjusted for purchasing power parity and inflation to 2016 US dollars, and annual therapy prices were examined relative to the MA-HHI. Interventions costing less than 2.5% of the MA-HHI were considered affordable.

MAIN OUTCOMES AND MEASURES:
Daily cost for topical glaucoma medications, cost of annual therapy with glaucoma medications, laser trabeculoplasty, and trabeculectomy relative to MA-HHI in each country.

RESULTS:
Data were obtained from 38 countries, including 17 developed countries and 21 developing countries, as classified by the World Economic Outlook. We observed considerable variability in intervention prices compared with MA-HHI across the countries and across interventions, ranging from 0.1% to 5% of MA-HHI for timolol, 0.1% to 27% for latanoprost, 0.2% to 17% for laser trabeculoplasty, and 0.3% to 42% for trabeculectomy. Timolol was the most affordable medication in all countries studied and was 2.5% or more of MA-HHI in only 2 countries (5%). The annual cost of latanoprost was 2.5% or more of MA-HHI in 15 countries (41%) (15 developing countries [75%] and no developed countries). The cost of laser trabeculoplasty was 2.5% or more of the MA-HHI in 15 countries (44%) (11 developing countries [65%] and 4 developed countries [24%]). The cost of trabeculectomy was 2.5% or more of the MA-HHI in 28 countries (78%) (18 developing countries [95%] and 10 developed countries [59%]). In 18 countries (53%), laser trabeculoplasty cost less than a 3-year latanoprost supply.

CONCLUSIONS AND RELEVANCE:
For many patients worldwide, the costs of medical, laser, and incisional surgical interventions were 2.5% or more of the MA-HHI. Successfully reducing global blindness from glaucoma requires addressing multiple contributing factors, including making glaucoma interventions more affordable.

Details Peer-Review
Source JAMA Ophthalmol. 2018 Nov 1;136(11):1271-1279. doi: 10.1001/jamaophthalmol.2018.3672.
Author(s) Zhao PY, Rahmathullah R, Stagg BC, et al.
Two-Year Clinical Results After Selective Laser Trabeculoplasty for Normal Tension Glaucoma.
English
2018

This article aims to investigate the clinical results at 2 years after selective laser trabeculoplasty (SLT) for normal tension glaucoma (NTG). This prospective cohort study recruited NTG patients taking antiglaucoma medication. Subjects were excluded if they had previous glaucoma surgery/laser or corneal pathologies. All subjects underwent a 1-month washout. A single session of SLT was performed to 360 of the trabecular meshwork. Medication was resumed at 1 month to achieve a targeted 30% intraocular pressure (IOP) reduction from the post-washout/pre-SLT IOP. IOP was measured every 3 months and medication use was recorded at 3, 6, 12, and 24 months. Subjects with a secondary SLT or cataract extraction were excluded from IOP and medication analyses. At 24 months, 34 of the initial 45 right eyes were eligible for analyses. There were significant IOP reductions at all time intervals (except at 1 week) following SLT when compared to the prestudy (without medication) or pre-SLT (post-washout) IOP (P < 0.0001). Medications were likewise significantly reduced at all time intervals following SLT (P < 0.0001). At 24 months, the IOP was 11.5% lower than the prestudy IOP, 22.0% lower than the pre-SLT IOP, and medication use was reduced by 41.1% (P < 0.0001). Six out of 45 eyes (13.3%) required a secondary SLT. Absolute success (IOP reduction >20% from pre-SLT, without medication) was achieved in 11.1% (5/45). Reductions in IOP and medication use were evident at 2 years following SLT for the treatment of NTG whereas 11% remained medication free.

Details Peer-Review
Source Medicine (Baltimore). 2015 Jun;94(24):e984. doi: 10.1097/MD.0000000000000984.
Author(s) Lee JWY, Shum JJW, Chan JCH et al.
Comparison between 90-degree and 360-degree selective laser trabeculoplasty (SLT): A 2-year follow-up.
English
2018

PURPOSE:
To compare the effect of 90- and 360-degree selective laser trabeculoplasty (SLT) as primary or supplement therapy in patients with glaucoma and ocular hypertension (OHT).

METHODS:
Patients (>30 years old) with OHT, primary open-angle glaucoma (OAG), pigmentary glaucoma or pseudoexfoliative glaucoma were enrolled in a prospective randomized clinical trial. Patients were sequentially randomized to either 90- or 360-degree SLT. Their intraocular pressure (IOP) was monitored.

RESULTS:
The survival periods (in days) of the two extents (90 or 360 degrees) of treatment were not statistically significantly different (p = 0.85); only pretreatment IOP level could predict survival of treatment (p = 0.02).

CONCLUSION:
The 90-degree SLT is as effective as 360-degree SLT. Further studies are warranted to confirm the findings. High baseline IOP could be a factor that predicts treatment success.

Details Peer-Review
Source Acta Ophthalmol. 2019 Jun;97(4):427-429. doi: 10.1111/aos.13949. Epub 2018 Oct 15.
Author(s) Tawfique K, Khademi P, Qurat L, et al.
Positive correlation between blood reflux in Schlemm's canal and the decrease of intraocular pressure after selective laser trabeculoplasty in primary open-angle glaucoma.
English
2018

The aim of the present study was to investigate the association between blood reflux in Schlemm's canal (SC) and the decrease of intraocular pressure (IOP) after selective laser trabeculoplasty (SLT) in primary open-angle glaucoma (POAG). To verify this, 35 eyes from 25 POAG patients were enrolled. All eyes underwent 360 whole-circle gonioscopy via a three-mirror lens, prior to undergoing 360 SLT. The four quadrants of the examined eye were individually compressed by the lens, and the presence of blood reflux in SC after removal of the pressure was recorded. Eyes with no blood reflux in any quadrant were assigned to the negative group, while the others were assigned to the positive group. Patients were evaluated at baseline, at 1 and 2 weeks, and at 1, 3 and 6 months after SLT. The results indicated that in the reflux-positive (21 eyes) and -negative (14 eyes) group, a significant IOP decrease was seen at 1 and 2 weeks, and at 1 and 3 months after SLT as compared with that pre-SLT IOP (P<0.01). In the negative group, the IOP at 6 months after SLT was not significantly different (P>0.05), while the positive group still exhibited a significant decrease in IOP compared with that at baseline (P<0.01). The positive group also presented with a greater decline in IOP at 1, 3 and 6 months compared with that in the negative group (P<0.05). A positive correlation between the number of quadrants with blood reflux in SC and the percentage decrease in IOP after SLT was identified in the positive group (P<0.05). In conclusion, blood reflux in SC was positively correlated with the decrease in IOP after SLT in POAG (Trialapproval number, K-2014-013).

Details Peer-Review
Source Exp Ther Med. 2018 Jun;15(6):5065-5069. doi: 10.3892/etm.2018.6051. Epub 2018 Apr 11.
Author(s) Gong JL, Al-Wesabi SA, Zhao Y, et al.
[Laser Trabeculoplasty in Modern Glaucoma Therapy - a Review].
German
2018

BACKGROUND:
Laser trabeculoplasty (LTP) is a well established treatment modality in the management of chronic open angle glaucoma. Nonetheless there is much variation in practice.

METHODS:
A literature search in the PubMed database was conducted and the most important evidence-based results were summarised.

RESULTS:
Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are safe and effective treatment modalities, achieving an IOP reduction of 20_-_30%. Similar success rates have been reported for both procedures. A 50% rate of failure occurs after 2_-_5 years. Repeat-ALT is associated with a lower IOP decrease and a shorter duration of treatment effect. Repetition of SLT after initial SLT seems to be associated with loss of efficiency as well. SLT has been shown to be successful after initial ALT, whereas there are no data on ALT after initial SLT. For advanced glaucoma on maximum medical therapy, low success rates have been reported with regard to additional interventions.

CONCLUSION:
LTP is a good option for initial and adjunctive treatment. In advanced glaucoma on maximum medical therapy, low target pressures are needed, and filtering surgery has to be considered.

Details Peer-Review
Source Klin Monbl Augenheilkd. 2018 Apr 11. doi: 10.1055/a-0577-7925.
Author(s) Greslechner R, Spiegel D.
A Review of the Clinical Usefulness of Selective Laser Trabeculoplasty in Exfoliative Glaucoma.
English
2018

In the last decade, selective laser trabeculoplasty (SLT) has been commonly used in the management of several different types of glaucoma, as either primary or adjunct therapy. The technique has an excellent safety profile and is at least as effective as argon laser trabeculoplasty. Although the actual mechanism of action of SLT remains unclear, evidence has shown that it does not induce morphologically evident trabecular meshwork alterations. SLT's non-disruptive mode of action offers the advantage of repeatability. Exfoliation glaucoma (XFG) is a secondary open-angle glaucoma with unfavorable intraocular pressure (IOP) characteristics, which typically carries a poorer long-term prognosis than primary open-angle glaucoma. Consequently, patients with XFG often need multiple medications to achieve IOP levels that prevent disease progression. Because complicated pharmacotherapy regimens undermine the long-term tolerability and compliance of patients with XFG, options such as SLT may decrease the burden of multiple therapies and ultimately improve prognosis. In fact, SLT may be a particularly attractive option in XFG because the pigment-laden trabecular tissue of these patients enhances the absorption of laser energy and thus augments the biologic effects induced by this treatment. The current article reviews the postulated mechanisms of action of SLT, discusses practical aspects of SLT therapy, and examines selected peer-reviewed literature pertaining to the clinical usefulness of this modality in XFG patients.

Details Peer-Review
Source Adv Ther. 2018 May;35(5):619-630. doi: 10.1007/s12325-018-0695-z. Epub 2018 Apr 11.
Author(s) Katsanos A, Konstas AG, Mikropoulos DG, et al.
[Predictors of Success of Selective Laser Trabeculoplasty Adjusted for Intraocular Pressure Variations].
Korean
2018

Purpose
To investigate the efficacy, and identify predictors of success of selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG) patients after adjusting for intraocular pressure (IOP) changes in the untreated fellow eye.

Methods
This retrospective chart review included 52 eyes of 52 OAG patients who underwent SLT in one eye and were followed-up for at least 1 year after the procedure. The IOP was measured before the treatment, at 1, 2, and 3 months posttreatment, and every 3 months thereafter. To account for the possible influence of IOP fluctuations on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed, after adjusting for IOP changes in the untreated fellow eye. Success was defined as an IOP decrease 20% of the pretreatment IOP. The success rate was determined based on Kaplan-Meier survival analysis and factors predictive of success were analyzed using the Cox proportional hazard model.

Results
The mean pretreatment IOP was 23.17 6.96 mmHg. The mean IOP reduction was 5.59 4.78 mmHg (29.7%) and the success rate was 65.4% at 1 year. The adjusted mean IOP reduction was 4.70 4.67 mmHg (23.9%) and the adjusted success rate was 53.9%. Pretreatment IOP was associated with SLT success; the higher the pretreatment IOP, the greater the post-laser IOP reduction (p = 0.025). Age and mean deviation index did not show a significant association with SLT success (p = 0.066 and p = 0.464, respectively).

Conclusions
SLT is a safe and effective alternative method of IOP reduction in OAG patients. Herein, pretreatment IOP was the only factor significantly associated with SLT success. IOP fluctuations of the untreated eye should be considered for a better understanding of the impact of treatment.

Details Peer-Review
Source J Korean Ophthalmol Soc. 2018 Dec;59(12):1166-72.
Author(s) Lee JS, Lee CE, Seo S, et al.
The Rationale for Selective Laser Trabeculoplasty in Africa.
English
2018

Glaucoma is the leading cause of irreversible blindness in Africa. The condition is treatable but not curable. There are numerous obstacles to glaucoma care in Africa, including availability, accessibility and affordability of treatments, as well as medication nonadherence among patients. Medical therapy is costly relative to the average income in Africa and it requires daily self-dosing by patients. Surgery is of limited availability in many regions in Africa, and a high proportion of patients refuse surgery because it is expensive. Selective laser trabeculoplasty (SLT) proves to be a favorable alternative to medical or surgical care, as it is highly effective and safe in people of African descent, more cost-effective than medical therapy, quick and easy to perform, and portable. The procedure also requires no postoperative care, thus obviates the issue of nonadherence. In uncontrolled studies, SLT has a high response rate and it lowers intraocular pressure by 30% to 40%, which exceeds the goal in international guidelines for initial therapies. The African Glaucoma Consortium (AGC), a member-driven stakeholder collective, has been formed in part to develop the infrastructure for continent-wide improvements in glaucoma care. It embraces SLT as a potential key tool in their development plans. The mission of AGC includes improving clinical care by educating existing and new health care professionals to expand the provider network, by conducting trials to identify optimal care strategies for glaucoma in Africa, and by facilitating the development of an integrated network of Centers of Excellence to bring SLT and other crucial glaucoma therapies to communities throughout Africa.

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Source Asia Pac J Ophthalmol (Phila). 2018 Nov-Dec;7(6):387-393. doi: 10.22608/APO.2018271. Epub 2018 Nov 28.
Author(s) Realini T, Olawoye O, Kizor-Akaraiwe N, et al.
Selective laser trabeculoplasty as replacement therapy in medically controlled glaucoma patients.
English
2018

Purpose: We examined selective laser trabeculoplasty (SLT) as a replacement therapy for medically controlled open-angle glaucoma (OAG) or ocular hypertensive patients.

Methods: A prospective randomized interventional clinical trial on 143 glaucoma patients. Patients were randomized to either receiving SLT or to the control group that continued on pressure lowering medication. Data were recorded 1 hr, 1 week, 1, 3, 6, 12 and 18 months after SLT. Primary outcome was number of medications at 12 and 18 months while maintaining a predetermined target intraocular pressure (IOP).

Results: Selective laser trabeculoplasty (SLT) reduced number of medications from a mean of 1.5 at baseline, to 0.35 after 12 months and 0.29 after 18 months. Meanwhile, SLT achieved more than 20% IOP lowering in 95% of eyes and more than 30% IOP lowering in 86% of eyes after 18 months. Seventyseven per cent of our eyes no longer needed any medication after SLT at 18 months.

Conclusion: Selective laser trabeculoplasty (SLT) enabled a reduction in number of medications while maintaining good IOP control. Selective laser trabeculoplasty (SLT) was able to completely replace medical therapy in 77% of eyes after 18 months. Selective laser trabeculoplasty (SLT) as replacement therapy may reduce local and systemic side-effects and prevent adherence issues.

Details Peer-Review
Source Acta Ophthalmol. 2018 Aug;96(5):e577-e581. doi: 10.1111/aos.13509. Epub 2017 Jun 21.
Author(s) De Keyser M, De Belder M, De Belder J, et al.
The Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. A multicentre randomised controlled trial: baseline patient characteristics.
English
2018

PURPOSE:
The laser in glaucoma and ocular hypertension (LiGHT) trial aims to establish whether initial treatment with selective laser trabeculoplasty (SLT) is superior to initial treatment with topical medication for primary open angle glaucoma (POAG) or ocular hypertension (OHT).

DESIGN:
LiGHT is a prospective unmasked, multicentre, pragmatic, randomised controlled trial (RCT).

PARTICIPANTS:
718 previously untreated patients with POAG or OHT were recruited at 6 UK centres between 2012 and 2014.

METHODS:
Patients were randomised to initial SLT followed by medical therapy or medical therapy without laser. Participants will be monitored for 3 years, according to routine clinical practice. The primary outcome is EQ-5D-5L. Secondary outcomes are treatment pathway cost and cost-effectiveness, Glaucoma Utility Index (GUI), Glaucoma Symptom Scale, Glaucoma Quality of Life (GQL), pathway effectiveness, visual function, safety and concordance.

RESULTS:
A total of 555 patients had POAG and 163 OHT; 518 patients had both eyes eligible. The mean age for patients with POAG was 64 years and for OHT 58 years. 70% of all participants were white. Median IOP for OHT eyes was 26_mm Hg and 23_mm Hg for POAG eyes. Median baseline visual field mean deviation was -0.81_dB for OHT eyes and -2.82_dB for POAG eyes. There was no difference between patients with POAG and patients with OHT on the EQ-5D-5DL; the difference between OHT and POAG on the GUI was -0.02 and 1.23 on the GQL.

CONCLUSIONS:
The LiGHT trial is the first RCT to compare the two treatment options in a real-world setting. The baseline characteristics of the LiGHT cohort compare well with other landmark glaucoma studies.

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Source Br J Ophthalmol. 2018 May;102(5):599-603. doi: 10.1136/bjophthalmol-2017-310870. Epub 2017 Oct 5.
Author(s) Konstantakopoulou E, Gazzard G, Vickerstaff V, et al.
Selective laser trabeculoplasty for primary open-angle glaucoma patients younger than 40 years.
English
2018

OBJECTIVE:
To evaluate the efficacy of selective laser trabeculoplasty (SLT) among patients with juvenile-onset primary open-angle glaucoma (JOAG).

METHODS:
Patients diagnosed with JOAG who were not controlled on medical therapy were offered a trial of SLT. The patients were followed up prospectively for 1, 3, 6, and 12 months postlaser to evaluate the efficacy of SLT as second-line therapy. Success was defined as an intraocular pressure (IOP) reduction of 20% at 12 months without the need for further medication, laser, or surgery. Factors associated with success/failure, prelaser IOP, age, and angle dysgenesis on gonioscopy were analysed.

RESULTS:
The average prelaser IOP in these JOAG eyes (n = 30) was 25.3 6.5 mm Hg, which reduced to 17.3 5.8 mm Hg at 12 months (p = 0.01). All patients were of Indian ethnicity. Out of 30 eyes, at 12 months post-SLT, 13 (43%) eyes had at least a 20% reduction in IOP. In the eyes that achieved success, the average reduction of IOP was 37.6%. There was no difference in the prelaser IOP between those with success (25.5 5.6 mm Hg) and those that failed (25.1 8 mm Hg; p = 0.8), nor was there a difference in the mean age between successful cases (34.4 9.4 years) and failures (31.6 8.9 years; p = 0.4). However, those without angle dysgenesis were 4 times (CI 1.1-15.2) more likely to succeed with SLT than those with angle dysgenesis (p = 0.03).

CONCLUSIONS:
A significant proportion of patients with JOAG can benefit from an IOP reduction after SLT. Those with gonioscopically normal-appearing angles are more likely to respond to SLT.

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Source Can J Ophthalmol. 2018 Feb;53(1):81-85. doi: 10.1016/j.jcjo.2017.07.023. Epub 2017 Sep 25.
Author(s) Gupta V, Ghosh S, Sujeeth M, et al.
Impact of laser pulse duration on the reduction of intraocular pressure during selective laser trabeculoplasty.
English
2018

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-nave patients with POAG, NTG or OHT.

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Source Int Ophthalmol. 2018 Feb;38(1):83-91. doi: 10.1007/s10792-016-0426-x. Epub 2016 Dec 31.
Author(s) Stunf Pukl S, Drnov_ek-Olup B.
SLT Vs ALT At Five Years.
English
2018

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

Details Article
Source Ophthalmology Times Europe, 01 June 2008
Author(s) Bovell AM, Damji KF.
Evaluating selective laser trabeculoplasty versus argon laser trabeculoplasty in pseudoexfoliation glaucoma patients.
English
2017

OBJECTIVE:
Laser trabeculoplasty effectively reduces intraocular pressure (IOP) in primary open angle glaucoma, with argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) showing equivalent outcomes. However, it is unclear which laser modality is more effective in pseudoexfoliation (PXE) glaucoma. This study aims to compare the effectiveness of ALT and SLT in PXE glaucoma.

DESIGN:
Retrospective cohort study.

METHODS:
A chart review evaluating patients diagnosed with PXE glaucoma and treated with laser trabeculoplasty from 2005-2015. Patients with previous glaucoma surgery, other forms of secondary glaucoma, ocular surgery within six months of initial trabeculoplasty or lacking preoperative IOP measurements were excluded. Post-laser measurements were recorded until 24 months after initial intervention. Follow-up data was censored if the patient underwent a subsequent trabeculoplasty different from initial laser treatment.

RESULTS:
We included 84 patients in the ALT group and 123 in the SLT group. The mean (SD) baseline IOP values were 22.7 (5.6) and 21.6 (4.8) respectively (p = 0.11), while number of medications were 2.0 (1.0) and 1.8 (1.3) for ALT and SLT groups respectively (p = 0.36). The mean IOP reduction for the ALT group at 6, 12 and 24 months were 5.2 (6.1), 5.4 (6.9), and 4.9(7.7) respectively. The corresponding values for the SLT group were 3.4 (5.2), 3.8 (4.6), and 4.6 (6.5). Comparison of both lasers at each time point revealed no significant differences (p > 0.05) in IOP reduction or reduction of glaucoma medication.

CONCLUSIONS:
Our study showed equivalent efficacy between ALT and SLT in patients with PXE glaucoma.

Details Peer-Review
Source Can J Ophthalmol. 2018 Feb;53(1):70-75. doi: 10.1016/j.jcjo.2017.07.004. Epub 2017 Sep 27.
Author(s) Song JSA, Vianna J, Shuba L, et al.
West Indies Glaucoma Laser Study (WIGLS): 1. 12-Month Efficacy of Selective Laser Trabeculoplasty in Afro-Caribbeans With Glaucoma.
English
2017

PURPOSE:
To characterize the 12-month intraocular pressure (IOP)-lowering efficacy of selective laser trabeculoplasty (SLT) as sole therapy for primary open-angle glaucoma (POAG) in an Afro-Caribbean population.

DESIGN:
Stepped-wedge trial.

METHODS:
Subjects in St. Lucia and Dominica with established POAG were randomized to prompt washout of IOP-lowering medications followed by SLT, 3-month delay followed by washout and SLT, or 6-month delay followed by washout and SLT. Baseline IOP was obtained on 2 different days after washout. Bilateral 360-degree SLT was performed in 1 session. Posttreatment assessments took place 1 hour, 1 week, and 3, 6, 9, and 12 months post-SLT. The main outcome measure was SLT success (defined as IOP target IOP in both eyes) at 12 months. Target IOP was a 20% or greater reduction in IOP from postwashout baseline.

RESULTS:
Overall, 72 patients underwent SLT treatment. Mean IOP at enrollment was 15.4 3.6 mm Hg in right eyes and 15.4 3.6 mm Hg in left eyes, which rose to 21.0 3.3 mm Hg and 20.9 3.0 mm Hg, respectively, after washout. Mean IOP at 3, 6, 9, and 12 months ranged from 12.5 mm Hg to 14.5 mm Hg (29.7% to 39.5%; P < .0001 in each eye at each time point). The 12-month success rate was 78%. Transient photophobia and discomfort were common.

CONCLUSIONS:
SLT monotherapy safely provides significant IOP reduction in Afro-Caribbean eyes with POAG. This treatment can play a significant role in preventing glaucoma vision loss and blindness in people of African descent living in resource-limited regions.

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Source Am J Ophthalmol. 2017 Dec;184:28-33. doi: 10.1016/j.ajo.2017.09.022. Epub 2017 Sep 28.
Author(s) Realini T, Shillingford-Ricketts H, Burt D, et al.
Corneal endothelial changes following a single session of selective laser trabeculoplasty for pseudoexfoliative glaucoma.
English
2017

PURPOSE:
To evaluate corneal endothelial cell parameters after a single session of selective laser trabeculoplasty (SLT) in pseudoexfoliative glaucoma (PEG) patients.

METHODS:
Corneal endothelial cell parameters of 18 PEG patients were compared with 18 healthy subjects following SLT treatment. All patients underwent SLT treatment to 180 degrees of inferior trabecular meshwork. Corneal measurements were performed using specular microscopy (Noncon Robo SP8000, Konan Medical, Hyogo, Japan). Endothelial cell density (ECD), hexagonal cell ratio (HEX), coefficient of variation (CV) of the corneal endothelial cell layer and central corneal thickness of the patients were measured at each visit.

RESULTS:
There was a statistically significant decrease in ECD (p = 0.004) and a statistically significant increase in CV (p = 0.041) at superior cornea 1 week after SLT. They returned to pre-SLT values at 1 month. One hour post-SLT HEX of inferior cornea was statistically significantly reduced (p = 0.01). At central cornea, there was a significant increase in HEX after 1 week (p = 0.001). Post-SLT IOP showed a significant positive correlation with CV and significant negative correlation with HEX at superior and inferior cornea. There was no correlation between total laser energy used and endothelial cell parameters.

CONCLUSION:
Effect of a single session of SLT on corneal endothelium of PEG patients appears to be transient, and superior cornea was more affected than central and inferior cornea. All parameters returned to pre-SLT values at 1 month after treatment.

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Source Int Ophthalmol. 2018 Dec;38(6):2327-2333. doi: 10.1007/s10792-017-0730-0. Epub 2017 Oct 13.
Author(s) rnek N, rnek K.
Selective Trabeculoplasty in the Management of Open Angle Glaucoma: Retrospective Analysis at 1 Year.
English
2017

Purpose
The objective of this study was to observe the 1-year pressure gain in a consecutive series of glaucoma patients treated by selective laser trabeculoplasty, along with the clinical and technical characteristics that influence the evolution of intraocular pressure after treatment.

Materials and methods
We carried out a retrospective study of all patients treated in the ophthalmology department of Nancy University Hospital between January 2015 and March 2016. Treatment was performed with a Q-Switched, frequency doubled Nd: YAG laser (Solutis - Quantel Medical, France), over 180 or 360 of the trabecular meshwork. The mean decreases in Intraocular pressure and the success rate (defined as a decrease in intraocular pressure of 20% at 1 year without increasing the medical treatment) were calculated. The impact of the different clinical and technical characteristics of each case on the decrease in pressure was also studied by bivariate analysis.

Results
One hundred and nineteen eyes, in 78 patients, were included. The decrease in IOP at 1 year was in mean of 4.2 mmHg (Standard Deviation = 5.37), and of 19.6% from baseline. The success rate was 46.7%. Only two minor and reversible complications occurred during the follow-up period.

Discussion
Selective trabeculoplasty is currently a therapeutic option called-upon at different stages in the progression of glaucoma. The duration of efficacy of this laser therapy, and the retreatment frequency are yet to be defined.

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Source Int J Ophthalmol Clin Res. 4(4):081. doi.org/10.23937/2378-346X/1410081.
Author(s) Boich M, Conart JB, Luc A, et al.
[The Limits of Selective Laser Trabeculoplasty in Glaucoma Therapy].
German
2017

Introduction: The aim of this study was to evaluate the efficacy of selective laser trabeculoplasty (SLT) in the University Eye Hospital Hamburg Eppendorf. Material and

Methods: We conducted a retrospective analysis of 113 eyes of 113 consecutively treated patients who underwent SLT treatment between 03/2011 and 01/2014 and had a follow-up of at least 4 months.

Results: Intraocular pressure was reduced by 1.08_mmHg (7_% reduction) on average. In 43.7_% of the treated eyes, additional medical or surgical glaucoma treatment was necessary within 12 months.

Conclusion: SLT is not effective as monotherapy in pre-treated eyes with low target pressure.

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Source Klin Monbl Augenheilkd. 2017 Mar;234(3):365-369. doi: 10.1055/s-0042-106900. Epub 2016 Sep 13.
Author(s) Filev FS , Gesser C, Kromer R, et al.
Why Should SLT be the First-Choice Treatment for Glaucoma?
English
2017

Glaucoma is a heterogeneous group of optic neuropathy characterized by damage to the optic nerve and visual-field damage. It is one of the most common causes of irreversible blindness worldwide. Early diagnosis and management are critical to prevent irreversible loss of vision. SLT as primary treatment is a safe and effective procedure in various types of glaucoma, including primary open-angle glaucoma (POAG), Ocular Hypertension, normal-tension glaucoma (NTG), pseudoexfoliation glaucoma (PXFG), steroid-induced glaucoma.

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Source JOJ Ophthal. 4(1): JOJO.MS.ID.555630.
Author(s) Abdelmseih M.
Selective Laser Trabeculoplasty vs. Fixed Combinations with Timolol in Practice: A Replacement Study in Primary Open Angle Glaucoma.
English
2017

Objectives:
To evaluate the potential of selective laser trabeculoplasty (SLT) in two arms (360vs. 180 as a replacement for fixed combinations (FCs) with timolol in primary open angle glaucoma over 6 months.

Materials and Methods:
Of 40 patients in a prospective, comparative, interventional case series, 18 eyes and 22 eyes were randomized to SLT 180 and SLT 360 groups, respectively, along with 40 fellow-control eyes. FC with timolol was discontinued on the day of treatment for the eye to be operated on, while ongoing therapy was not interrupted for the contralateral eye. Eyes were examined for intraocular pressure (IOP) elevation 1 hour and 1 day after SLT. The follow-up visits were then scheduled for 1 week, 1 month, 3 months, and 6 months after, during the which the IOP of both eyes and any possible complications were evaluated.

Results:
There were no statistically significant differences in mean IOPs through 6 months among the groups with exception of postlaser 1 hour and postlaser 1 day (p<0.001 and p=0.010, respectively). Multiple comparison analysis showed significantly higher IOP in both SLT 180 and SLT 360 subgroups compared to their controls at postlaser 1 hour (p=0.007, p<0.001) but significantly lower IOP only in SLT 360 subgroup compared to the controls at postlaser day 1 (p=0.013).

Conclusion:
SLT offers promising potential as a substitute equivalent to efficacy of FCs with timolol. However, SLT 360may not achieve additional IOP reduction.

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Source Turk J Ophthalmol. 2017 Aug;47(4):19804. Published online 2017 Aug 15. doi: 10.4274/tjo.87300.
Author(s) Tufan AK, Onur IU, Yi_it FU, et al.
Corneal topographic alterations after selective laser trabeculoplasty.
English
2017

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 8 mm were statistically significant (p = 0.03, 0.01, 0.02, and 0.04 respectively). On the other hand, the simulated K, anterior 3 mm K, anterior 5 mm K, posterior 3 mm K, posterior 5 mm K, anterior asphericity at 3 mm, posterior asphericity at 3 mm, 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).

CONCLUSION:
SLT can slightly alter pretreatment SCT findings in 3-6 months. Clinicians should wait for at least 6 months after SLT before performing any subsequent surgeries that depend on corneal parameters.

Details Peer-Review
Source Int Ophthalmol. 2017 Aug;37(4):905-910. doi: 10.1007/s10792-016-0348-7. Epub 2016 Sep 15.
Author(s) Atalay K, Kirgiz A, Serefoglu Cabuk K, et al.
[The Effectiveness of Selective Laser Trabeculoplasty in Patients with Medically Uncontrolled Open-angle Glaucoma].
Korean
2017

Purpose
To determine the effect of intraocular pressure (IOP) reduction of selective laser trabeculoplasty (SLT) on medically uncontrolled open-angle glaucoma (OAG) and the factors associated with the treatment result.

Methods
Forty-seven eyes of 47 OAG patients were enrolled for 180 SLT or 360 SLT, all under maximal tolerated medical therapy and with IOP above their target pressure. All patients were followed-up for at least 1 year after the procedure. Treatment success was defined as IOP reduction 20% from baseline at 12 months after SLT treatment without additional anti-glaucomatous intervention.

Results
The treatment success rate was 65.96%. Baseline IOP was 23.84 4.52 mmHg in the success group and 21.44 2.97 mmHg in the failure group (p = 0.035). Significant mean IOP reduction was observed at 6, 9, and 12 month follow-ups (p = 0.001 at 6 months; 0.041 at 9 months, and <0.001 at 12 months). The success rate did not vary significantly by sex (p = 0.362), age (p = 0.081), history of cataract surgery (p = 0.470), number of medications (p = 0.857), duration of medication (p = 0.613), or angular degree of SLT treatment (180 vs. 360) (p = 0.137). There was a positive correlation between mean baseline IOP and mean reduction of IOP from baseline in the success group (p < 0.001, r = 0.861), while there was no such correlation in the failure group (p = 0.272, r = _2.921).

Conclusions
SLT was an effective treatment for IOP reduction until 12 months in medically uncontrolled OAG patients. A greater amount of IOP reduction is expected in patients with higher baseline IOP in the success group.

Details Peer-Review
Source J Korean Ophthalmol Soc. 2017 Jul;58(7):828-835. Published online July 14, 2017. https://doi.org/10.3341/jkos.2017.58.7.828.
Author(s) Park HW, Han SS, Park JW.
Feasibility of laser trabeculoplasty in angle closure glaucoma: a review of favourable histopathological findings in narrow angles.
English
2017

Selective laser trabeculoplasty (SLT) has been indicated as a safe and efficient treatment for primary open-angle glaucoma; however, recent studies have also shown positive results with the use of SLT in some clinical conditions related to primary angle-closure glaucoma (PACG). Despite the potential benefits of SLT in selected cases of PACG, the mechanisms underlying the modifications in the trabecular meshwork tissue of patients with PACG are poorly understood. This narrative review approached both the current, limited knowledge about the histological changes observed in different forms of PACG and the clinical results of SLT treatment for PACG. Favourable outcomes of SLT in patients with PACG, specifically in areas of non-occluded angle, need further substantiation through large controlled clinical trials. A deeper understanding of the biomolecular changes of those areas is essential to improve both laser technical details and the clinical efficacy of SLT therapy.

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Source Clin Exp Ophthalmol. 2017 Aug;45(6):632-639. doi: 10.1111/ceo.12938. Epub 2017 Mar 21.
Author(s) Matos AG, Asrani SG, Paula JS.
Results of Selective Laser Trabeculoplasty Treatment for Patients with Open-Angle Glaucoma during a 2-year Period.
English
2017

Purpose: To describe the results of selective laser trabeculoplasty for patients with open-angle glaucoma during a 2-year period. Study design: Descriptive, retrospective, and longitudinal study. Method: A descriptive, retrospective, and longitudinal study was conducted among 40 eyes of 20 patients who underwent selective laser trabeculoplasty from 2012 to 2015 and received topical antiglaucoma medication. The following variables were measured: uncorrected visual acuity, best-corrected visual acuity, and intraocular pressure before treatment and during monitoring controls after 1 day, 7 days, 1 month, 3 months, 6 months, 12 months, and 24 months.

Results: No significant differences were identified between uncorrected visual acuity preoperatively and at 1 year (p=0.091) or between preoperative uncorrected visual acuity preoperatively and at 2 years (p=0.827). Best-corrected visual acuity preoperatively and at 1 year showed no statistical significance (p=0.125); however, best corrected visual acuity preoperatively and at 2 years had statistical significance (p=0.007). Mean standard deviation of preoperative intraocular pressure at 2 years had decreased from 17.285.7 to 13.052.4 mm Hg (statistically significant; p=0.00) and the success rate was 75%. Although the mean standard deviation of preoperative for drug use at 2 years decreased from 1.901.1 to 1.651.3, no significant difference (p=0.058) was identified. No complications were identified.

Conclusions: Selective laser trabeculoplasty is an effective and safe treatment that reduces intraocular pressure as well as the number of drugs required by patients with open-angle glaucoma.

Details Peer-Review
Source Vis. Pan-Am. 2017;16(2):39-42.
Author(s) Villavicencio JCI, Baltodano FQ, Ponte-Dvila MC, et al.
[Status of Selective Laser Trabeculoplasty (SLT)].
German
2017

Purpose: Worldwide, in recent years, selective laser trabeculoplasty (SLT) has developed into a very successful therapy for glaucoma. Material and Methods The article provides a review of the literature from PubMed and clinical experience.

Results: SLT is equally efficacious to argon laser trabeculoplasty (ALT) and to a first-line glaucoma medication. SLT can be used in most common forms of open-angle glaucoma and ocular hypertension. In contrast to ALT, SLT is repeatable and requires much less energy. SLT has been reported to be also successful in some rare forms of ocular hypertension/glaucoma. There is no negative influence of SLT to other forms of glaucoma treatment. Complications are rare and include intraocular pressure spikes, corneal scarring or corneal decompensation due to endothelial cell damage and cystoid macular edema. The potential of SLT as a first-line treatment of glaucoma is now under investigation.

Conclusion: SLT is a low-risk procedure to treat glaucoma in a broad range of indications. Advantages of SLT include the potential to use SLT more and more as a primary treatment procedure. Therefore, SLT is now under intensive investigation worldwide.

Details Peer-Review
Source Klin Monbl Augenheilkd. 2017 Nov;234(11):1362-1371. doi: 10.1055/s-0043-102946. Epub 2017 Jun 28.
Author(s) Schlote T.
Efficacy of SLT in patients with open-angle glaucoma or ocular hypertension, a systematic review and meta analysis.
English
2017

Purpose: To determine the efficacy of selective laser trabeculoplasty (SLT) in lowering intra-ocular pressure (IOP) levels and reducing the number of medications in patients with open angle glaucoma (OAG) or ocular hypertension (OHT).

Methods: A systematic review was conducted by searching various databases including MEDLINE (Ovid), EMBASE (Ovid), CINAHL, Cochrane Library, Web of Science- Core Collections, BIOSIS Previews, and Scopus. Duplicates were removed and articles were screened using EPPI Reviewer 4.0. A meta-analysis was conducted using STATA 13.0. Weighted mean difference (WMD) was computed and the heterogeneity statistic was assessed using the I2. Fixed and random effects models were computed based on heterogeneity.

Results: We identified 31 articles that met our inclusion criteria. We found that Sequential SLT versus pharmacotherapy had an IOP-lowering effect favoring pharmacotherapy: WMD= 5.92% (95% CI [3.06, 8.79]) and WMD= 2.73% (95% CI [0.24, 5.23]) at 6 and 12 months, respectively. Adjunctive SLT had a greater IOP-lowering effect compared to pharmacotherapy, WMD= -8.98% (95% CI [-17.19, -0.77]). A significant reduction in the post-operative medications was observed up to 17 months. No serious complications were reported.

Conclusion: Adjunctive SLT may lead to significant reduction in IOP compared to topical medications. Additional studies need to be conducted on SLT alone, without previous treatment in order to determine its IOP-lowering effect.

Details Thesis
Source Electronic Thesis and Dissertation Repository. 4524. https://ir.lib.uwo.ca/etd/4524.
Author(s) Hassan M.
Comparison of Prostaglandin Analogue and Selective Laser Trabeculoplasty Capability to Maintain Intraocular Pressure Fluctuation on Primary Open Angle Glaucoma.
English
2017

Background: Glaucoma patients often come with intraocular pressure (IOP) that reach target pressure, but still have glaucoma progression due to IOP fluctuation. Water drinking test (WDT) can be used as a method to predict IOP fluctuation.

Purpose: To compare prostaglandin analogue (PGA) and selective laser trabeculoplasty (SLT) capability to maintain IOP fluctuation on primary open angle glaucoma (POAG).

Method: This clinical experimental research was conducted at Dr. Kariadi Hospital. Subjects were POAG patients selected with consecutive sampling. Intraocular pressure was measured before and after WDT. After WDT, IOP was measured every 15 minutes until 1 hour. Peak IOP and IOP fluctuation data were collected then analyzed with t-test.

Results: Forty two eyes from 30 POAG patients were analyzed. Twenty six eyes in PGA group and 16 eyes in SLT group. Most of the subjects were male with mild glaucoma degree. WDT increased IOP significantly on both groups. Mean IOP pre WDT was 14.58 2.580 mmHg and 16.94 2.645 mmHg in PGA and SLT groups. Mean peak IOP post WDT was 22.73 4.114 mmHg and 25.75 5.859 mmHg in PGA and SLT groups. Mean IOP fluctuation was 8.15 4.202 mmHg and 8.81 5.344 mmHg in PGA and SLT groups. Peak IOP and IOP fluctuation result analysis on both groups were not significantly different.

Conclusion: Prostaglandin analogue and SLT had equal capability to maintain IOP fluctuation but still higher than normal fluctuation (>6 mmHg) that affects glaucoma progression.

Details Peer-Review
Source J Biomed Transl Res. 2017 Jul;3(1):13-6.
Author(s) Koentjoro SL, Cahyono M, Rahmi FL.
Effect of SLT in glaucoma patients with high or low central corneal thickness.
English
2017

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 _m with patients having CCT <550 _m. 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.

Details Peer-Review
Source Ins Ophthal. 2017;1:1.
Author(s) De Keyser M, De Belder M, De Belder J, et al.
The effects of selective laser trabeculoplasty and travoprost on circadian intraocular pressure fluctuations: A randomized clinical trial.
English
2017

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 2_hours 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 <3_mm_Hg. 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 (-3.7_mm Hg [P_=_0.002] vs -4.1_mm 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 <3_mm 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 <3_mm 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.

Details Peer-Review
Source Medicine (Baltimore). 2017 Feb;96(6):e6047. doi: 10.1097/MD.0000000000006047.
Author(s) Kiddee W, Atthavuttisilp S.
Microarchitecture of Schlemm Canal Before and After Selective Laser Trabeculoplasty in Enhanced Depth Imaging Optical Coherence Tomography.
English
2017

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, _35 _m) 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, 68.29.2 y). After SLT, the mean IOP was reduced from 19.87.6 to 14.43.8 mm Hg (P=0.003); the mean SC CSA increased by 8%, from 2478550 to 2682598 _m (P=0.029); and the mean SC volume increased from 4,304,592954,777 to 4,658,2501,039,956 _m (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.

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Source J Glaucoma. 2017 Apr;26(4):361-366. doi: 10.1097/IJG.0000000000000624.
Author(s) Skaat A, Rosman MS, Chien JL, et al.
Racial Differences in Selective Laser Trabeculoplasty Efficacy.
English
2017

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 urn 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.

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Source J Curr Glaucoma Pract. 2017 Jan-Apr;11(1):22. Published online 2017 Jan 18. doi: 10.5005/jp-journals-10008-1216.
Author(s) Goosen E, Coleman K, Visser L, et al.
The impact of chronic use of prostaglandin analogues on the biomechanical properties of the cornea in patients with primary open-angle glaucoma.
English
2017

AIMS:
To determine the influence of prostaglandin analogues (PGAs) on corneal biomechanical properties in patients undergoing chronic treatment for primary open-angle 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 (9.01.8 vs 10.31.7_mm_Hg), CRF (10.52.1 vs 11.72.1_mm_Hg), CCT (541.843.2 vs 551.941.9__m) and IOPGAT (15.43.0 vs 18.43.8_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.

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Source Br J Ophthalmol. 2017 Feb;101(2):120-125. doi: 10.1136/bjophthalmol-2016-308432. Epub 2016 May 9.
Author(s) Meda R, Wang Q, Paoloni D, et al.
Selective laser trabeculoplasty as an initial treatment option for open-angle glaucoma.
English
2017

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 lasers effect is known to be transitory, recent data suggest it can be successfully repeated in cases with good response to the first SLT treatment.

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Source Arq Bras Oftalmol. 2016 Nov-Dec;79(6):417-421. doi: 10.5935/0004-2749.20160118.
Author(s) Freitas AL, Ushida M, Almeida I, et al.
[Selective laser trabeculoplasty: Effect of number of preoperative topical glaucoma medications on pressure lowering and success rate].
French
2017

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 19.43.6mmHg preoperatively to 15.73.1mmHg at 12 months, which corresponds to an average decrease of 18.8%. At 1 year, 62.2% (n=66) were responders (IOP reduction3mmHg): 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 20.73.4 to 15.22.9mmHg (26.6%), respectively from 20.82.6 to 15.83.2 (25%) without medications, 20.63.2 to 14.93.7 (27.3%) with one, 20.84.1 to 15.53.3 (25.1%) with two and 20.73.2 to 14.42.4mmHg (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.

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Source J Fr Ophtalmol. 2017 Jan;40(1):22-28. doi: 10.1016/j.jfo.2016.11.003. Epub 2017 Jan 9.
Author(s) Bonnel S, Fenolland JR, Marill AF, et al.
A Review of Selective Laser Trabeculoplasty: Recent Findings and Current Perspectives.
English
2017

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.

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Source Ophthalmol Ther. 2017 Jun;6(1):19-32. doi: 10.1007/s40123-017-0082-x. Epub 2017 Mar 3.
Author(s) Zhou Y, Aref AA.
Mechanism of Action of Selective Laser Trabeculoplasty and Predictors of Response.
English
2017

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 5.1 vs. 19.7 3.0 mm Hg; P = 0.001) and noon (23.4 4.6 vs. 20.0 3.5 mm Hg; P < 0.001). Outflow facility by fluorophotometry was significantly increased from 0.17 0.11 _L/min/mm Hg at baseline to 0.24 0.14 _L/min/mm Hg at 3 months (P = 0.008). Outflow facility by tonography (baseline: 0.16 0.07 _L/min/mm Hg vs. 3 months: 0.22 0.16 _L/min/mm Hg; P = 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.

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Source Invest Ophthalmol Vis Sci. 2017 Mar;58(3):1462. doi: 10.1167/iovs.16-20710.
Author(s) Gulati V, Fan S, Gardner BJ, et al.
24-Hour Intraocular Pressure Rhythm in Patients With Untreated Primary Open Angle Glaucoma and Effects of Selective Laser Trabeculoplasty.
English
2017

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 16.33.7 to 22.18.4 mm Hg (5.8 mm Hg; 95% confidence interval (CI), 2.41-12.71; P=0.009) after the wash-out procedure. After SLT, IOP significantly decreased by 3.4 mm Hg (95% CI, 0.09-7.89; P=0.041) (14.9%) at 1 month and 1.9 mm 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 (01:573:32 AM, 01:223:01 AM, and 03:172:12 AM at inclusion, 1 and 6 mo, 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.

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Source J Glaucoma. 2017 Mar;26(3):272-277. doi: 10.1097/IJG.0000000000000604.
Author(s) Aptel F, Musson C, Zhou T, et al.
Efficacy of Selective Laser Trabeculoplasty in Phakic and Pseudophakic Patients with Open-angle Glaucoma.
English
2017

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 anti-glaucoma 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 19.52.5 and 20.23.2 mmHg preoperatively to 15.63.4 and 15.33.1 mmHg 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 (5.03.06 mmHg, p=0.197). The non-inferiority test indicated that mean IOP reduction in pseudophakic group was non-inferior 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.

Details Peer-Review
Source Siriraj Med J. 2017;69:70-4.
Author(s) Petchyim S, Kitnarong N, Wongsiwaroj C.
Transscleral Selective Laser Trabeculoplasty Without a Gonioscopy Lens.
English
2017

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 20.213.19 mm Hg for the study group (n=14) and 21.142.98 mm Hg for the controls (n=14; P =0.43), dropping to 15.503.77 and 15.004.08 mm Hg (P =0.74) after 6 months and to 16.003.31 and 14.002.45 mm Hg (P =0.22) after 12 months. The average IOP reduction after 6 and 12 months was 23.4% and 20.83% for the study group and 27.1% and 33.77% for the controls (P=0.528). Success (a decrease of 15% at 6 months with no additional medications, laser, or glaucoma surgery) was achieved in 12 (85.7%) study patients and 9 (69.2%) controls (P=0.385). Complications were mild and transient (n=30), although significantly higher in the controls (n=15; P <0.0001).

CONCLUSIONS:
SLT applied directly to the perilimbal sclera may be as efficacious as the conventional procedure for 1 year.

Details Peer-Review
Source J Glaucoma. 2017 Mar;26(3):201-207. doi: 10.1097/IJG.0000000000000464.
Author(s) Geffen N, Ofir S, Belkin A, et al.
Randomized Prospective Study of the Use of Anti-Inflammatory Drops After Selective Laser Trabeculoplasty.
English
2017

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 anti-inflammatory 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 to 32% to 42%, but the amount of patients with redness returned to pretreatment levels after 1 week. An IOP peak of >5 mm 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.

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Source J Glaucoma. 2017 Feb;26(2):e22-e29. doi: 10.1097/IJG.0000000000000522.
Author(s) De Keyser M, De Belder M, De Groot V.
Effect of selective laser trabeculoplasty on ocular haemodynamics in primary open-angle glaucoma.
English
2017

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 _l (17.2%; p = 0.001) and pOBF from 17.11 5.42 to 19.74 6.59 _l/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.

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Source Acta Ophthalmol. 2017 Jun;95(4):374-377. doi: 10.1111/aos.13360. Epub 2017 Jan 31.
Author(s) Pillunat KR, Spoerl E, Terai N, et al.
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).
English
2016

Purpose: One-year outcomes 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: 24 eyes underwent MDLT and 5 eyes had SLT as primary treatment for glaucoma. 19/24 (79%) MDLT eyes and 5/5 (100%) SLT eyes had sustained ?20% IOP reduction (P=0.262, no significant difference) at one 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 one year. Mean reduction of drops are 0.08 in the MDLT group and 0.17 in the SLT group . No complications.

Conclusion: SLT has marginally better IOP control but no significant difference when compared to 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.

Details Abstract
Source RANZCO 2016.
Author(s) Ng A, Mohite A, Lee S, et al.
Polymegathism, Pleomorphism, and Endothelial Cell Count after Selective Laser Trabeculoplasty.
English
2016

The purpose of the study was to investigate the changes in the endothelial cell count and cell 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 h prior to the laser surgery and then 1 h, 1 day, 1 week, and 1 month after SLT. The obtained micrographs were then analyzed in order to study the infl uence 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.

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Source Biol Med (Aligarh) 2016;8:7. doi: 10.4172/0974-8369.1000343.
Author(s) Kurysheva N, Shatalova E.
Selective laser trabeculoplasty for early glaucoma: analysis of success predictors and adjusted laser outcomes based on the untreated fellow eye.
English
2016

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 R 2_=_0.35; p_<_0.001 and R 2_=_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).

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Source BMC Ophthalmol. 2016 Nov 23;16(1):206.
Author(s) Chun M, Gracitelli CPB, Lopes FS, et al.
Adherence to Glaucoma Medications Over 12 Months in Two US Community Pharmacy Chains.
English
2016

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.

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Source J Clin Med. 2016 Sep 7;5(9). pii: E79. doi: 10.3390/jcm5090079.
Author(s) Feehan M, Munger MA, Cooper DK, et al.
Early & delayed effect of using steroid following SLT, randomised controlled trial.
English
2016

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 &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&2 was 7.2 & 6.8 (p = 0.60).

A day after SLT 4 eyes had mild uveitis in group 1 & 6 in group 2, all cleared by 1 week.

More eyes had more sever conjunctiva congestion in group2 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 doesn't have an effect on the final IOP reduction, and reduced post SLT inflammation & discomfort.

Details Peer-Review
Source Acta Ophthalmologica. 94(S256).
Author(s) Ali Aljasim L, Owaidhah O.
[Long-term Results of Selective Laser Trabeculoplasty vs Latanoprost or Dorzolamide/Timolol Fixed Combination].
Korean
2016

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 3 mm Hg 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 2.2 mm Hg in the latanoprost group and, 16.2 2.4 mm Hg in the DTFC group. At the postoperative five-year follow-up, the mean IOP was 15.1 2.5 mm Hg in the latanoprost group and, 14.6 1.7 mm Hg 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.

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Source J Korean Ophthalmol Soc. 2016 Sep;57(9):1415-1421. Published online September 13, 2016. https://doi.org/10.3341/jkos.2016.57.9.1415.
Author(s) Lim JH, Kim DG, Cho SH, et al.
Comparison of Outcomes of Laser Trabeculoplasty Performed by Optometrists vs Ophthalmologists in Oklahoma.
English
2016

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 enrollees 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 enrollees 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 enrollees 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.

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Source JAMA Ophthalmol. 2016 Oct 1;134(10):1095-1101. doi: 10.1001/jamaophthalmol.2016.2495.
Author(s) Stein JD, Zhao PY, Andrews C, et al.
Public Health Policy Lessons From Oklahoma.
English
2016

Laser trabeculoplasty (LTP) was popularized in 1979 in eyes receiving maximal medical therapy. Various prospective clinical trials sponsored by the National Institutes of Health have since better defined its usefulness in early and advanced glaucoma. Today, the American Academy of Ophthalmology Primary Open Angle Glaucoma Preferred Practice Pattern finds that argon LTP and selective LTP have comparable intraocular pressure (IOP) lowering efficacy and safety profiles, but additional LTP (regardless of the laser type) has a decreased rate of success and an increased complication profile, including permanent IOP increase.

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Source JAMA Ophthalmol. 2016;134(10):1102-3. doi:10.1001/jamaophthalmol.2016.2573.
Author(s) Robin AL.
Laser Trabeculoplasty Use Patterns Among Optometrists and Ophthalmologists in Oklahoma.
English
2016

In the article by Stein et al, the authorsstated objective was o compare outcomes of LTPs [laser trabeculoplasties] performed by ophthalmologists with those performed by optometrists to determine whether differences exist in the need for additional LTPs.However, the conclusions seem misleading and not supported by their data.

The authors found that he 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%).They conclude that ealth policy makers should be cautious about approving laser privileges for optometrists practicing in other states until the reasons for these differences are better understood.It is unclear how the authors could have made this conclusion. Using Medicare claims data as their only resource, they did not have access to LTP outcomeshe goal of their studynd hence, only reported procedure utilization rates. It is hard to understand the meaning of their conclusions without knowing whether treatments were performed in more than 1 session with 180 treatments or a single session with 360 treatments. Moreover, there was no information about intraocular pressure reduction, associated complications, or any other measure of the safety or efficacy of the laser treatment. Without the aforementioned information, the number of LTP sessions cannot be a substitute for the quality of the procedure.

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Source JAMA Ophthalmol. 2016;134(10):1101-1102. doi:10.1001/jamaophthalmol.2016.2567.
Author(s) Fingeret M.
Selective Laser Trabeculoplasty Reduces Intraocular Pressure Peak in Response to the Water Drinking Test.
English
2016

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 800 mL 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 7315 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 16.92.4 to 14.22.3 mm Hg (P<0.001), peak IOP from 21.93.7 to 16.93.1 mm 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.

Details Peer-Review
Source J Glaucoma. 2016 Sep;25(9):727-31. doi: 10.1097/IJG.0000000000000512.
Author(s) Kerr NM, Lew HR, Skalicky SE.
Complications of selective laser trabeculoplasty: a review.
English
2016

Selective laser trabeculoplasty is a laser treatment to treat glaucoma. It was initially indicated for open-angle glaucoma but has been proven to be efficacious for various types of glaucoma. This review article summarizes the few rare complications that can be seen with selective laser trabeculoplasty. It also makes recommendations on how to avoid these problems and how to treat patients when these rare complications arise.

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Source Clin Ophthalmol. 2016;10:1373.
Author(s) Song J.
Intraocular Pressure-Lowering Potential of Subthreshold Selective Laser Trabeculoplasty in Patients with Primary Open-Angle Glaucoma.
English
2016

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.

CONCLUSION:
The efficacy of subthreshold SLT group in reducing IOP in POAG patients is comparable to the efficacy of conventional SLT group.

Details Peer-Review
Source J Ophthalmol. 2016;2016:2153723. doi: 10.1155/2016/2153723. Epub 2016 Jul 27.
Author(s) Zhang HY, Qin YJ, Yang YF, et al.
Randomized Controlled Comparison of Titanium-Sapphire Versus Standard Q-Switched Nd: YAG Laser Trabeculoplasty.
English
2016

PURPOSE:
To evaluate the clinical effects of laser trabeculoplasty using a novel 790 nm wavelength titanium-sapphire laser (TLT) compared with a 532 nm 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 20.4 mm Hg in SLT (n=19, P=0.69).At 2 years, the mean IOP was 12.9 mm Hg (35% decrease, P<0.001) in the TLT group and 15.4 mm Hg (25% decrease, P=0.006) in the SLT group. The 2 groups did not differ in glaucoma medication use. Success, defined as IOP<21 mm Hg with >20% 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.

Details Peer-Review
Source J Glaucoma. 2016 Jul;25(7):e663-7. doi: 10.1097/IJG.0000000000000317.
Author(s) Kaplowitz K, Wang S, Bilonick R, et al.
[Effectiveness of unilateral selective laser trabeculoplasty for primary open angle glaucoma].
Chinese
2016

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 (18.92.5) 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 (1.72.9) mmHg, (2.52.5) mmHg, (3.52.8) mmHg, (3.42.5) mmHg and the percentage of IOP reduction were (816) %, (1313) % (1814) %, (1812) % 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 (17.32.4) mmHg. Mean IOP reduction for 1 week, 1month, 3 month, and 6 month after SLT were (1.12.0) mmHg, (1.02.7) mmHg, (2.62.2) mmHg and (2.52.2) 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.

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Source Zhonghua Yan Ke Za Zhi. 2016 Jun 11;52(6):410-5. doi: 10.3760/cma.j.issn.0412-4081.2016.06.004.
Author(s) Di X, Fan X, Zhou JC, et al.
Predictors, Resource Utilization, and Short-term Costs of Laser Trabeculoplasty Versus Medication Management in Open-Angle Glaucoma.
English
2016

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 vs glaucoma medication treatment; and (2) estimate the resource utilization and short-term costs associated with LT vs medication management.

DESIGN:
Retrospective administrative claims analysis.

METHODS:
Medical and pharmacy claims data between 2007 and 2012 were analyzed to identify prostaglandin analogue monotherapy OAG patients with an index date 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 _(2) and Student t tests, logistic regression (predictive), and generalized linear models (cost).

RESULTS:
The study included 4743 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 ($2684 vs $1980; P < .0001), lower pharmacy ($807 vs $1467; P < .0001), and greater overall costs ($3441 vs $3408; 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 glaucoma-specific cost savings.

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Source Am J Ophthalmol. 2016 Aug;168:78-85. doi: 10.1016/j.ajo.2016.05.001. Epub 2016 May 10.
Author(s) Schultz NM, Wong WB, Coleman AL, et al.
Preoperative intraocular pressure as a predictor of selective laser trabeculoplasty efficacy.
English
2016

PURPOSE:
To identify predictors of intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) in patients with high- and low-pressure 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 open-angle 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.

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Source Acta Ophthalmol. 2016 Nov;94(7):692-696. doi: 10.1111/aos.13094. Epub 2016 May 23.
Author(s) Pillunat KR, Spoerl E, Elfes G, et al.
Selective Laser Trabeculoplasty as Primary Treatment for Open-Angle Glaucoma.
English
2016

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.

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Source R I Med J (2013). 2016 Jun 1;99(6):22-5.
Author(s) Kadasi LM, Wagdi S, Miller KV.
Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity.
English
2016

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.

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Source Medicine (Baltimore). 2016 Dec; 95(52): e5745.
Author(s) Guedes RAP, Guedes VMP, De Mello Gomes CE, et al.
Intraocular Pressure Changes After Selective Laser Trabeculoplasty (SLT) in Open-Angle Glaucoma.
English
2016

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

Methods: Design of this research was cohort-prospective study. Twenty-six eyes of 18 patients withOAG were participated in this study. All the patients were treated with 180o SLT to the temporaltrabecular meshwork and followed by 180o SLT to the nasal trabecular meshwork 1 week after the firsttreatment. A frequency-doubled (532 nm) Q-switched Nd:YAG laser with a 400 _m spot size wasused to deliver 0.4-1.0 mJ of energy for 0.3 ns to perform the procedure. Additionally, IOP in thetreated eye was assessed and measured with Goldman applanation before SLT, and 1 hour, 1 week,and 2 weeks following complete SLT. All patientes 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 slightlyincrease. 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. SLTeffectively reduces IOP in open-angle glaucoma. It can be used as a primary or adjunctive therapy inpatient with open-angle glaucoma.

Details Peer-Review
Source Ophthalmol Indonesiana. 2016;42(2).
Author(s) Mayasari A, Cahyono M.
Selective laser trabeculoplasty in patients with pseudoexfoliative glaucoma vs primary open angle glaucoma: a one-year comparative study.
English
2016

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, nonrandomized 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, 12mo 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 (P=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 (P<0.001 and P=0.02), and to 17.9 (4.0) and 21.0 (6.6) mm Hg in the PXFG group (P<0.001 and P=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 (P=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 (P=0.08; log rank test) at 6mo, and 29.1% and 25.0% at 12mo, respectively (P=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.

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Source Int J Ophthalmol. 2016 Mar 18;9(3):406-10. doi: 10.18240/ijo.2016.03.14. eCollection 2016.
Author(s) Miraftabi A, Nilforushan N, Nassiri N, et al.
Intraocular Pressure Changes Post Selective Laser Trabeculoplasty in the Contralateral Untreated Eyes of Nigerian Patients With Primary Open Angle Glaucoma.
English
2015

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.

CONCLUSION:
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.

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Source Nig Q J Hosp Med. 2015 Apr-Jun;25(2):133-8.
Author(s) Onakoya AO, Olowoyeye AO, Onyekwelu OM, et al.
Selective laser trabeculoplasty: current perspectives.
English
2015

Selective laser trabeculoplasty (SLT) has been used in the treatment of glaucoma for just over a decade. Here, we review the current literature in terms of suggested mechanism, efficacy, method of treatment, predictors of success, adverse events, repeatability, and cost of SLT. The exact mechanism by which SLT lowers intraocular pressure (IOP) remains unknown although circumstantial evidence has come in many forms in relation to structural alteration; oxidative stress and inflammatory responses; tight junction integrity; proliferative responses; and microbubble formation. SLT is as effective as argon laser trabeculoplasty and medications in reducing IOP in glaucoma and ocular hypertension. The treatment is not uniformly effective in all eyes, and its IOP-lowering effect decreases over time. High pretreatment IOP is the strongest predictor of success; however, significant pressure reduction has also been shown in normal-tension glaucoma and in patients already taking multiple antiglaucoma drops. Mild, transient adverse effects are common. Transient IOP spikes usually resolve quickly with or without antiglaucoma treatment but may be problematic in pigmented angles. The limited available evidence suggests SLT is repeatable and cost-effective for the treatment of glaucoma and ocular hypertension.

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Source Clin Ophthalmol. 2015; 9: 8331. Published online 2015 May 11. doi: 10.2147/OPTH.S53490.
Author(s) Leahy KE, White AJ.
Intraocular pressure-lowering medications and long-term outcomes of selective laser trabeculoplasty.
English
2015

BACKGROUND:
To investigate the effects of current intraocular pressure-lowering medications on the efficacy of selective laser trabeculoplasty.

DESIGN:
Retrospective chart review of records from an urban glaucoma clinic in Sydney, Australia.

PARTICIPANTS:
Patients who received their first selective laser trabeculoplasty between 2002 and 2005 were studied (grouped from 0 to 3 according to the number of pre-selective laser trabeculoplasty medications, and followed for 5 years). Those with previous argon laser therapy, trabeculectomy or angle-closure were excluded.

METHODS:
Selective laser trabeculoplasty (Ellex) used to deliver 180 or 360 degree of treatment, under the same protocol.

MAIN OUTCOME MEASURES:
Responders were defined by 20% reduction from baseline intraocular pressure. Data were censored when pressure-lowering intervention was required. The mean intraocular pressure, survivor, response rate, number and type of medications were compared.

RESULTS:
There were 206 patients with ocular hypertension, primary, pseudo-exfoliation, or pigmentary glaucoma who used_none (n_=_20), one (n_=_33), two (n_=_61) or three or more (n_=_92) pre-selective laser trabeculoplasty topical anti-glaucoma medications. The mean baseline intraocular pressures for each group was 23.7, 22.2, 20.7 and 20.4_mmHg, respectively (P_=_0.061). Post-treatment mean intraocular pressure was 17.9, 17.7, 15.5, and 15.7_mmHg; percentage reduction was similar between groups (23.6-25.6%, P_=_0.20). Kaplan-Meier survival analysis showed comparable survival rates across groups (P_=_0.445). At 60 months, 11.1, 17.1, 30.5 and 11.5% of responders remained in each group. Higher proportions of patients in groups 2 and 3 required further laser or surgery.

CONCLUSION:
The number of pre-selective laser trabeculoplasty medications did not affect the intraocular pressure-lowering effectiveness of selective laser trabeculoplasty; however, groups on more medications required more pressure-lowering interventions.

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Source Clin Exp Ophthalmol. 2015 May-Jun;43(4):320-7. doi: 10.1111/ceo.12452. Epub 2014 Nov 4.
Author(s) Woo DM, Healey PR, Graham SL, et al.
A Study of Selective Laser Trabeculoplasty as Adjunctive Treatment in Patients Affected by Open Angle Glaucoma for Control of Intraocular Pressure in Indian Eyes.
English
2015

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 58.9618.19 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 &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 24.626.38, IOP was reduced to 14.204.10 mmHg on Day 1 (42.32% reduction), on day 7 it was 15.964.731 mmHg (35.17% reduction), at 1 month it was 17.274.77 mmHg (29.82% reduction), at 3 months it was 19.414.40 mmHg (21.10% reduction), at 6 months it was 16.934.03 mmHg (31.23% reduction) and at 1 year it was 16.474.04 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 atleast 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 atleast 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.

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Source Ophthalmology Research. 2015;5(1):1-11.
Author(s) Sushil O, Pandav SS, Sushmita K, et al.
Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review.
English
2014

PURPOSE:
Systemic review to compare selective laser trabeculoplasty (SLT) to other glaucoma treatment options in terms of their intraocular pressure (IOP)-lowering effect.

METHODS:
Searches of the following databases were performed: PubMed, Cochrane Central Register of Controlled Trials, Ovid, EMBASE, metaRegister of Controlled Trials, and ClinicalTrials.gov. Only randomised controlled trials (RCTs) published in peer-reviewed journals comparing SLT to other glaucoma treatment options were considered. The main outcome measure was the change in IOP from baseline.

RESULTS:
An initial search of PubMed identified 23 RCTs with 17 meeting the inclusion criteria. Nine RCTs compared 180 SLT to 180 argon laser trabeculoplasty (ALT) and one trial compared 360 SLT to 360 ALT, all reporting no difference in terms of IOP reduction from baseline. One RCT reported better outcomes with SLT at 1 year but this effect regressed at 2 years. Three trials compared 360 SLT to medical therapy and found no difference between the two treatment options. One trial found greater IOP reduction with latanoprost vs 90 and 180 SLT, and greater IOP reduction with 180 and 360 SLT versus 90 SLT, however no differences were found between 360 SLT versus latanoprost or 360 vs 180 SLT. Two trials compared 180 SLT to 360 SLT finding no difference in IOP reduction. Two trials compared 180 SLT to 90 SLT, one finding no significant difference and one finding greater IOP reduction with 180 SLT over 90 SLT. One trial compared excimer laser trabeculotomy (ELT) to 180 SLT, finding no differences in IOP reduction up to 3 months follow-up but greater IOP reduction with ELT at time intervals between 9 and 24 months. There were no RCTs identified that compared SLT to surgery.

CONCLUSION:
In terms of the IOP lowering effect, there is no difference between SLT and ALT. Three trials indicate no difference between 360 SLT and medical therapy, with one of the trials indicating greater IOP reduction with latanoprost over 90 and 180 SLT. Three trials indicate no difference between 180 SLT and 360 SLT. It is inconclusive whether 90 is less efficacious than 180 SLT. One trial reports greater IOP reduction with ELT over 180 SLT in the long term.

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Source Eye (Lond). 2014 Mar;28(3):249-58. doi: 10.1038/eye.2013.267. Epub 2013 Dec 6.
Author(s) McAlinden C.
Debate Over SLT Continues.
English
2013

Latina and Wilson discuss benefits of SLT as opposed to ALT

Details Article
Source Ocular Surgery News. Feb 15 2003.
Author(s) Wolkoff L.
The outcome of 270-degree selective laser trabeculoplasty.
English
2012

PURPOSE:
To evaluate the reduction of intraocular pressure (IOP) by a single-session 270 selective laser trabeculoplasty (SLT) in pseudoexfoliation glaucoma (PXFG) and primary open angle glaucoma (POAG) patients.

METHODS:
A successful outcome was defined as an IOP reduction 20% from baseline with no further need for laser or incisional surgery. The preoperative pharmaceuticals were maintained unchanged throughout the course of the study. 70-80 nonoverlapping pulses were distributed around 270 in the trabecular band.

RESULTS:
Sixty-six eyes of 42 patients with PXFG (30 eyes) or POAG (36 eyes) met the inclusion criteria. The mean standard deviation preoperative IOP was 23.7 4.5_mmHg and at the end of the followup was 19.0 4.5_mmHg with a pressure drop of 4.7 3.1_mmHg (20%) (P < 0.001, 95% confidence interval 3.94-5.46). The cumulative probability of success was 39% (26 of 66 eyes) after 6 months of followup. Statistically significant differences in success rates were observed between the PXFG and POAG groups (27% versus 50%; P = 0.025). Postoperative inflammatory reaction was scanty.

CONCLUSIONS:
270-degree SLT is useful in lowering IOP in PXFG and POAG, but the average reduction of IOP seems to be within the same range as reported with 180-degree SLT previously.

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Source J Ophthalmol. 2012;2012:313616. doi: 10.1155/2012/313616. Epub 2012 Dec 5.
Author(s) Pehkonen PT, Vlimki JO.
Selective laser trabeculoplasty versus medical therapy as initial treatment of glaucoma: a prospective, randomized trial.
English
2012

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.

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Source J Glaucoma.
Author(s) Katz LJ, Steinmann WC, Kabir A, et al.
Argon Versus Selective Laser Trabeculoplasty in Younger Patients: 2-Year Results.
English
2012

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. Forty-two young patients (age 29 to 60 y) 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 postlaser. 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).

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

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Source J Glaucoma. 2012 Feb;21(2):112-5. doi: 10.1097/IJG.0b013e318202791c.
Author(s) Liu Y, Birt CM.
Clinical results of selective laser trabeculoplasty in open-angle glaucoma in Japanese eyes: comparison of 180 degree with 360 degree SLT.
English
2012

PURPOSE:
To evaluate the efficacy of selective laser trabeculoplasty (SLT) in the adjunctive treatment of medically diagnosed open-angle glaucoma and to compare the difference in intraocular pressure (IOP) lowering effects between 180-degree and 360-degree SLT.

METHODS:
This study is a retrospective consecutive chart review of open-angle glaucoma patients who had undergone first-time SLT from January of 2005 to July of 2007. All the patients had primary open-angle glaucoma or pseudoexfoliation glaucoma under medical treatment and followed for at least 3 months after the procedure. The IOP reduction and treatment success were compared with the 2 treatment types.

RESULTS:
Twenty-nine patients underwent 180-degree SLT (35 eyes) and 25 patients underwent 360-degree SLT (34 eyes). The average follow-up was 19.5 months (range 3 to 36) for 180-degree group and 17.9 months (range 3 to 36) for 360-degree group. During the follow-up period, the 360-degree SLT group showed significantly lower posttreatment IOP at each follow-up point relative to pretreatment IOP, and its IOP reduction rate stayed statistically higher than the 180-degree group. We found a positive correlation between the pretreatment IOP and the IOP reduction rate for 360-degree SLT. The lower the pretreatment IOP was, the lower IOP reduction rate became. A Kaplan-Meier survival analysis showed higher success rates after 360-degree SLT than after 180-degree SLT.

CONCLUSIONS:
The 360-degree SLT was shown to be more effective than180-degree SLT for intermediateterm reduction in IOP of Japanese patients with open-angle glaucoma as an adjunctive treatment protocol.

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Source J Glaucoma. 2012 Jan;21(1):17-21. doi: 10.1097/IJG.0b013e3181fc8020.
Author(s) Shibata M, Sugiyama T, Ishida O, et al.
Selective laser trabeculoplasty in Egyptian patients with primary open-angle glaucoma.
English
2012

PURPOSE:
To assess the change in intraocular pressure (IOP) in Egyptian patients after selective laser trabeculoplasty (SLT) as a primary or adjunctive treatment for primary open-angle glaucoma (POAG).

MATERIALS AND METHODS:
One hundred and six eyes with POAG were enrolled in this prospective study. Patients were divided into two groups: recently diagnosed cases with no preoperative medications (group 1) and; patients with confirmed glaucoma on medical therapy (group 2). All patients underwent 360 SLT. Patients were evaluated to 18 months postoperatively. Data were analyzed on postoperative changes in IOP, number of medications and complications. A P-value less than 0.05 was statistically significant.

RESULTS:
A statistically significant drop in IOP occurred, from 19.55 4.8 mmHg preoperatively, to 16.03 2.8 mmHg postoperatively (P < 0.001). Each group had a statistically significant drop in IOP (P < 0.001). There was a statistically significant decrease in the number of medications in group 2 from 2.25 0.97 medications preoperatively to 1.0 1.3 medications postoperatively (P = 0.004). No serious complications occurred for the duration of the study.

CONCLUSION:
SLT can be safely and effectively used as primary or adjunctive therapy for the treatment of POAG.

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Source Middle East Afr J Ophthalmol. 2012 Jul-Sep;19(3):299-303. doi: 10.4103/0974-9233.97930.
Author(s) Abdelrahman AM, Eltanamly RM.
Baseline Factors Predictive of SLT Response: A Prospective Study.
English
2012

Purpose. To study the response to Selective Laser Trabeculoplasty (SLT) according to baseline medical treatment, angle pigmentation, age, diagnosis (open-angle glaucoma or ocular hypertension), and baseline intraocular pressure (IOP).

Methods. 74 eyes of 74 patients were enrolled in this study. Baseline characteristics were recorded for each patient. IOP in the treated and fellow eyes was measured at baseline, and 1 month, 6 months, and 12 months following SLT. IOP changes in the different groups were compared using two-way ANOVA and Pearson's correlation.

Results. The mean age of our cohort was 71 10 years. The mean baseline IOP was 21.5 5_mmHg, and the mean change in IOP from baseline in the treated eye at one year was _4.67 3.40_mmHg. Higher baseline IOP was highly correlated with greater absolute IOP decrease. Prostaglandin analogue use at baseline was shown to be associated with a statistically decreased IOP-lowering response following SLT when corrected for baseline IOP. No significant differences in IOP response were found when comparing groups stratified for age, angle pigmentation, phakic status, gender, or diagnosis.

Discussion. The results of this study confirm the finding that higher baseline IOP is a predictor of greater IOP response following SLT, and that pretreatment with prostaglandin analogue therapy is associated with a decreased IOP-lowering response following SLT. The study is limited by the small number of eyes with data available for complete case analysis.

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Source J Ophthalmol. 2012; 2012: 642869. Published online 2012 Jul 31. doi: 10.1155/2012/642869.
Author(s) Bruen R, Lesk MR, Harasymowycz P.
Selective laser trabeculoplasty in the treatment of open-angle glaucoma.
English
2011

PURPOSE:
To determine the effect of selective laser trabeculoplasty (SLT) on different types of open-angle glaucoma (OAG) in terms of intraocular pressure (IOP).

METHODS AND MATERIALS:
In this prospective, nonrandomized, interventional study, patients with OAG, unresponsive to maximum tolerable antiglaucoma medication, were enrolled. One thirty six eyes were studied. Distribution of glaucoma type was 91 primary OAG eyes (POAG, 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 antiglaucoma 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 16.64.3 months. The mean preoperative IOP was 22.03.7 mm Hg, and reduced to 18.33.7 mm Hg at last visit. The overall mean IOP decrease was 3.62.6 mm 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.

CONCLUSIONS:
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.

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Source J Glaucoma. 2012 Jan;21(1):65-70. doi: 10.1097/IJG.0b013e3182027596.
Author(s) Koucheki B, Hashemi H.
Prophylactic selective laser trabeculoplasty in the prevention of intraocular pressure elevation after intravitreal triamcinolone acetonide injection.
English
2011

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.

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Source Am J Ophthalmol. 2011 Dec;152(6):976-981.e2. doi: 10.1016/j.ajo.2011.05.027. Epub 2011 Sep 8.
Author(s) Bozkurt E, Kara N, Yazici AT, et al.
What's new in laser treatment for glaucoma?
English
2011

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 selective laser trabeculoplasty (SLT) as initial therapy for open-angle glaucoma and ocular hypertension and have demonstrated efficacy in other glaucoma subtypes. Novel laser applications (micropulse diode laser trabeculoplasty, titanium sapphire laser trabeculoplasty and excimer laser trabeculotomy) have shown favorable 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 primary angle closure glaucoma is undetermined. Laser goniopuncture is an important adjunct to nonpenetrating 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 nonpenetrating surgery. Additional research is needed to better define their safety and efficacy.

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Source Curr Opin Ophthalmol. 2012 Mar;23(2):111-7. doi: 10.1097/ICU.0b013e32834f1887.
Author(s) Meyer JJ, Lawrence SD.
Long term effects on the lowering of intraocular pressure: selective laser or argon laser trabeculoplasty?
English
2011

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 three ophthalmologists at the University of Ottawa.

METHODS:
We randomized 176 eyes of 152 patients with uncontrolled IOP on 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 pretreatment baseline.

RESULTS:
Comparison of baseline parameters was similar in the two 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 in IOP in either of the two 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.

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

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Source Can J Ophthalmol. 2011 Oct;46(5):408-13. doi: 10.1016/j.jcjo.2011.07.016. Epub 2011 Aug 4.
Author(s) Bovell AM, Damji KF, Hodge WG, et al.
Long-Term Outcomes of Selective Laser Trabeculoplasty (SLT) Treatment.
English
2011

Purpose:
Glaucoma is a progressive optic neuropathy that may lead to blindness. Reducing intraocular pressure (IOP) seems to be the only treatment that slows progression in glaucoma. IOP can be decreased by pharmaceutical treatment, laser treatment or surgery.

The aim of the present study was to assess the long-term efficacy of selective laser trabeculoplasty (SLT) treatment.

Methods:
Retrospective chart review of eyes that underwent SLT between 1 January 2005 and 31 December 2005. The primary outcome measure was time to failure after SLT treatment. Failure after SLT was defined as any one or more of the following: change in the medical treatment, performance of a further SLT treatment, the patient being sent for surgery. All patients were treated over 90 with SLT.

Results:
120 eyes of 120 patients were identified. The average time to failure after SLT was 18 months. The success rate after 12 months was 62%, after 24 months 34%, after 36 months 28% and after 48 months 24%.

Conclusions:
The long-term effects of SLT when eyes were treated over 90 seem to be low. The authors recommend treating patients over 180, as has traditionally been done. We suggest that this will improve the long-term results.

Details Peer-Review
Source Open Ophthalmol J. 2011;5:32.
Author(s) Ayala M, Chen E.
Reconditioning of the trabeculo-descemet's membrane with the 532-nm Nd_:_YAG (SLT) laser after deep sclerectomy.
English
2011

The purpose of this study was to evaluate the intraocular pressure (IOP)-lowering effect of modified goniopuncture with the 532-nm Nd_:_YAG selective laser trabeculoplasty (SLT) laser on eyes after deep sclerectomy with collagen implant (DSCI). 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 71.07.7 (SD) years were treated with SLT-G. The mean time of SLT-G after DSCI procedure was 7.110.9 months. SLT-G decreased IOP from an average of 16.13.4_mm_Hg to 14.22.8_mm_Hg (after 15_min), 13.63.9_mm_Hg (at 1 day), 12.54.1_mm_Hg (at 1 month), and 12.62.5 (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).

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Source Eye (Lond). 2011 Dec;25(12):1655-7. doi: 10.1038/eye.2011.231. Epub 2011 Sep 16.
Author(s) Mansouri K, Mariani A, Ravinet E.
Laser trabeculoplasty: an investigation into factors that might influence outcomes.
English
2011

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

DESIGN:
Retrospective review.

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 = 0.41). When the final IOP was examined by multiple regression analysis, there was a significant effect in favor 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.

CONCLUSIONS:
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.

Details Peer-Review
Source Can J Ophthalmol. 2011 Aug;46(4):305-9. doi: 10.1016/j.jcjo.2011.06.005. Epub 2011 Jul 7.
Author(s) Tzimis V, Tze L, Ganesh J, et al.
Keeping Glaucoma Laser Therapy On Target.
English
2011

Strategies for avoiding and managing the complications involved in three common glaucoma laser procedures.

Details Article
Source Glaucoma Today, Fall 2011. http://glaucomatoday.com/2011/10/keeping-glaucoma-laser-therapy-on-target/
Author(s) Mayer HR.
Laser trabeculoplasty for open-angle glaucoma: a report by the american academy of ophthalmology.
English
2011

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.

Details Peer-Review
Source Ophthalmology. 2011 Nov;118(11):2296-302. doi: 10.1016/j.ophtha.2011.04.037. Epub 2011 Aug 17.
Author(s) Samples JR, Singh K, Lin SC, et al.
Comparison of selective laser trabeculoplasty (SLT) in primary open angle glaucoma and pseudoexfoliation glaucoma.
English
2011

BACKGROUND AND OBJECTIVE:
The aim of the present study was to compare intraocular pressure (IOP) 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:
Sixty patients (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.

Details Peer-Review
Source Clin Ophthalmol. 2011;5:1469-73. doi: 10.2147/OPTH.S25636. Epub 2011 Oct 12.
Author(s) Ayala M, Chen E.
Pattern of intraocular pressure reduction following laser trabeculoplasty in open-angle glaucoma patients: comparison between selective and nonselective treatment.
English
2011

OBJECTIVE:
To compare the pattern of intraocular pressure (IOP) reduction following selective laser trabeculoplasty (SLT) versus argon laser trabeculoplasty (ALT) in open-angle glaucoma (OAG) 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 mmHg; 26.6%) and ALT (4.4 2.8 mmHg; 22.8%) groups at month 6 (P = 0.38). Success rates (IOP 16 mmHg and IOP reduction 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 < 0.001). No significant differences were observed at other time points (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.

Details Peer-Review
Source Clin Ophthalmol. 2011;5:933-6. doi: 10.2147/OPTH.S21759. Epub 2011 Jul 7.
Author(s) Almeida ED Jr, Pinto LM, Fernandes RA, et al.
Predictive factors of success in selective laser trabeculoplasty (SLT) treatment.
English
2011

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 SLT. A multivariate regression analysis was performed to assess correlation between time to failure after SLT and age, gender, IOP before treatment, number of medications used, SLT number, amount of spots, laser energy used, grade of angle, pigmentation and diagnosis.

RESULTS:
120 eyes of 120 patients were identified. The average time to failure after SLT was 18 months. The predictive factors identified were: age, IOP before SLT and dose.

CONCLUSION:
Predictive factors identified in our study were high baseline IOP, age and amount of laser energy used. Our study confirms previous results about baseline IOP as a predictive factor.

Details Peer-Review
Source Clin Ophthalmol. 2011;5:573-6. doi: 10.2147/OPTH.S19873. Epub 2011 May 9.
Author(s) Ayala M, Chen E.
Selective laser trabeculoplasty in uncontrolled pseudoexfoliation glaucoma.
English
2011

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

PATIENTS AND METHODS:
Fifty-seven eyes (57 patients) with uncontrolled PEXG and intra-ocular pressure (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 < .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 5 mm Hg was detected in two eyes (3.5%) and resolved within 24 hours with topical medication.

CONCLUSION:
SLT is safe and effective in patients with PEXG.

Details Peer-Review
Source Ophthalmic Surg Lasers Imaging. 2011 Sep-Oct;42(5):390-3. doi: 10.3928/15428877-20110630-01. Epub 2011 Jul 7.
Author(s) Goldenfeld M, Geyer O, Segev E, et al.
The influence of topical prostaglandin analogues in inflammation after selective laser trabeculoplasty treatment.
English
2011

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 to 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. One hundred and eighteen 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 then 2 h, 1 week, and 1 month after SLT treatment. IOP was also checked at the same time intervals. The SLT treatment was performed over 90. All patients were divided into two groups: those receiving prostaglandins analogues and those treated with nonprostaglandin analogues.

RESULTS:
Inflammation before and after SLT showed no significant difference between the groups at all the time intervals studied (t-test, before: P=0.16; 2 h: P=0.14; 1 week: P=0.12; and 1 month: P=0.36). IOP reduction showed no significant difference between the groups (t-test, P=0.31).

CONCLUSIONS:
SLT treatment effects do not seem to be influenced by the use of prostaglandin analogues.

Details Peer-Review
Source J Ocul Pharmacol Ther. 2012 Apr;28(2):118-22. doi: 10.1089/jop.2011.0084. Epub 2011 Nov 16.
Author(s) Ayala M, Chen E.
Trabecular meshwork gene expression after selective laser trabeculoplasty.
English
2011

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.

Details Peer-Review
Source PLoS One. 2011;6(7):e20110. doi: 10.1371/journal.pone.0020110. Epub 2011 Jul 1.
Author(s) Izzotti A, Longobardi M, Cartiglia C, et al.
Inflammation assessment after selective laser trabeculoplasty (SLT) treatment.
English
2011

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:
Forty 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.

RESULTS:
Inflammation before and after SLT showed no significant difference measured clinically with slit lamp and objectively with the laser flare meter among the groups. No inflammation or IOP reduction was found in the untreated eyes. No IOP spikes after SLT treatment were found.

CONCLUSION:
Selective laser trabeculoplasty treatment seems not to induce inflammation in the anterior chamber when 90 was treated. SLT effectively and safely lowers IOP and might be considered as primary therapy.

Details Peer-Review
Source Acta Ophthalmol. 2011 Jun;89(4):e306-9. doi: 10.1111/j.1755-3768.2010.02029.x. Epub 2011 Mar 22.
Author(s) Ayala M, Landau Hgbeck I, Chen E.
Dose - Response of Selective Laser Trabeculoplasty for Open Angle Glaucoma.
English
2011

Purpose: To evaluate the response to selective laser trabeculoplasty (SLT) across a range of total energy (TE) laser intensities in patients with poorly controlled open angle glaucoma (OAG) while ocular drug therapy was held constant over a 1 year period.

Methods: A retrospective chart review was performed to evaluate the effect of SLT at different levels of laser TE on intraocular pressure (IOP) in consecutively treated patients with OAG while receiving fixed ocular drug therapy. For each patient, single session SLT 3600 was performed by one of two glaucoma specialists to augment IOP control in patients not achieving target IOP despite medical therapy. The first eye receiving SLT was included for analysis. Baseline IOP was defined as the average IOP on 3 visits on fixed ocular drug therapy prior to SLT treatment. A total of 43 eyes met inclusion criteria and were followed for up to 1 year with a minimum of 3 post-treatment IOP measurements. Laser TE of the SLT session was recorded and serial IOP measurements were used to construct a dose-response function.

Results: We studied 43 patients with a mean age of 72.6 years, 32 were phakic and 11 pseudophakic, taking an average of 2.2 glaucoma medications. The average TE utilized for SLT was 116.46 mJ with a range from 63.9 mJ to 207.1 mJ and an average of 97.65 (71-110) shots. The average pre-treatment IOP was 17.8 mmHg, and the average post-treatment IOP was 15.4 mmHg. A two-factor repeated measures analysis of variance was used to assess the effects of TE on post-treatment IOP. The analysis showed that SLT produced a significant decrease in IOP (2.4 mmHg). We found that Provider 1 used significantly higher mean TE than Provider 2 (142.4 vs 80.75 mJ / session). However, there was no significant difference in the degree of IOP change as a function of TE. There was a trend for higher TE in eyes with less trabecular meshwork pigment. Post-op complications included 5 patients (11.63%) who experienced an IOP spike greater than 15% and this group received an average TE of 183.72 mJ. All complications were self limited and none required incisional surgical intervention to achieve target IOP during the study period.

Conclusions: The IOP lowering effect of SLT is independent across the range of TE measured in this study. There is a tendency for IOP spikes to occur when using TE higher than 180 mJ per session. SLT across the range of TE used in this study is a useful adjunctive therapy in patients with OAG who are not achieving target IOP with ocular drug therapy.

Details Abstract
Source Invest Ophthalmol Vis Sci. April 2011;52:2614.
Author(s) Hanson DW, DeMarco PJ, Nussdorf JD.
Corneal edema and haze after selective laser trabeculoplasty.
English
2011

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.

Details Peer-Review
Source J Glaucoma. 2011 Jun-Jul;20(5):327-9. doi: 10.1097/IJG.0b013e3181e6668d.
Author(s) Regina M, Bunya VY, Orlin SE, et al.
The efficacy of low-energy selective laser trabeculoplasty.
English
2010

OBJECTIVE:
To evaluate the efficacy of low-energy selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) following up to one year.

METHODS:
In this prospective clinical study, seventy-four eyes of seventy-four patients with OHT and POAG were enrolled. Thirty-nine patients received low-energy treatment using half of conventional laser energy and 100 spots over 360 of the trabecular meshwork, while thirty-five patients received conventional laser energy as control. Intraocular pressure (IOP) and complications including conjunctival hyperemia and anterior uveitis were followed up at week 2, and month 1, 3, 6, and 12. Effective rate (reduction of IOP 20%) of treatment between the two groups and total rate of complications were analyzed by the chi-squared test.

RESULTS:
In OHT group, the effective rates of treatment were 81.81(9/11), 63.63 (7/11), 63.63 (7/11), 63.63 (7/11), and 45.45% (5/11) in the low-energy group and 50.00 (5/10), 70.0 (7/10), 60.0 (6/10), 40.0 (4/10), and 50.0% (5/10) in the control group, at weeks 2, month 1, 3, 6, and 12 after treatment respectively, while in POAG, the effective rates were 83.33 (15/18), 88.88 (16/18), 72.22 (13/18), 66.66 (12/18), and 44.44% (8/18) in the low-energy group and 84.21 (16/19), 73.68 (14/14), 57.89 (11/19), 57.89 (11/19) and 47.37% (9/19) in the control group at weeks 2, month 1, 3, 6, and 12 after treatment, respectively. There were no statistical difference between the low energy and conventional energy group at all time points in OHT (_(2) = 2.386, 0.096, 1.173, 1.110, 0.043) and POAG (_(2) = 0.005, 1.393, 0.833, 0.302, 0.032) group (P > 0.05). Complications were significantly (_(2) = 4.299, P < 0.05) different between the two groups (eight eyes in the low-energy group on the day of treatment and fifteen eyes in the control group). Transient IOP spike ( 3 mm Hg, 1 mm Hg = 0.133 kPa) occurred in three eyes (in the control group) on the day of treatment and partial peripheral anterior synechiae in one eye (in the control group) one month after treatment.

CONCLUSIONS:
Low-energy SLT is as effective in lowering IOP with less complications compared with conventional laser energy SLT, which can be considered as an option for glaucoma therapy.

Details Peer-Review
Source Ophthalmic Surg Lasers Imaging. 2011 Jan-Feb;42(1):59-63. doi: 10.3928/15428877-20101124-07. Epub 2010 Dec 1.
Author(s) Tang M, Fu Y, Fu MS, et al.
Long-term safety and efficacy of selective laser trabeculoplasty as primary therapy for the treatment of pseudoexfoliation glaucoma compared with primary open-angle glaucoma.
English
2010

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.

Details Peer-Review
Source Clin Ophthalmol. 2010 Dec 16;5:5-10. doi: 10.2147/OPTH.S15952.
Author(s) Shazly AT, Smith J, Latina MA.
Selective laser trabeculoplasty reduces mean IOP and IOP variation in normal tension glaucoma patients.
English
2010

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 intervisit 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.

Details Peer-Review
Source Clin Ophthalmol. 2010 Aug 9;4:889-93.
Author(s) El Mallah MK, Walsh MM, Stinnett SS, et al.
Similar effects of selective laser trabeculoplasty and prostaglandin analogs on the permeability of cultured Schlemm canal cells.
English
2010

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.

Details Peer-Review
Source Am J Ophthalmol. 2010 Aug;150(2):254-64. doi: 10.1016/j.ajo.2010.03.012. Epub 2010 Jun 8.
Author(s) Alvarado JA, Iguchi R, Martinez J, et al.
Is There A Role For SLT in Managing Steroid-Related OHT?
English
2010

This procedure may offer a temporary solution to what is often a temporary problem.

Details Article
Source Glaucoma Today, Spring 2010. http://glaucomatoday.com/2010/04/is-there-a-role-for-slt-in-managing-steroid-related-oht/
Author(s) Realini T.
Observational Study of Aqueous Dynamic Effects of Selective Laser Trabeculoplasty (SLT) And Topical Latanoprost.
English
2010

Purpose:
SLT is thought to increase trabecular outflow and prostaglandinsare beleived to increase uveoscleral outflow. We compared theaqueous dynamics changes following SLT and latanoprost treatmentin a group of previously untreated patients.

Methods:
Retrospective observational report. Since June 2007, all untreatedprimary 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 electronicSchiotz and fluorophotometry for aqueous flow. Patients werefree to chose between primary 360 degree SLT or medical treatment.

Results:
60 patients were identified from our database with baselineand 3 month data. 16 patients were excluded as they were treatedwith either timolol or bimatoprost. 20 had SLT and 24 had latanoprost,of which 5 SLT and 10 latanoprost patients were excluded dueto poor measurements. 16 eyes of 15 SLT treated patients and17 eyes of 14 latanoprost treated patients were included inthis report (Table 1). Mean IOP was reduced in each treatmentgroup: 24.2mmHg pre and 18.9mmHg post SLT (p<0.001), 24.5mmHgpre and 19.8mmHg post latanoprost (p<0.001) (Table 2). Tonographicoutflow facility improved from 0.095 to 0.156 in SLT (P=0.003),but did not change significantly in latanoprost (0.166 pre to0.160 post). Both treatments did not have significant effecton aqueous flow rate.

Conclusions:
SLT and latanoprost have slightly different effects on aqueousdynamics in that only SLT appeared to enchance tonographic outflowfacility significantly.

Details Abstract
Source Invest Ophthalmol Vis Sci. 2010 Apr;51:144.
Author(s) Jones EC, Alaghband P, Beltran-Agullo L, et al.
Selective Laser Trabeculoplasty as Primary and Secondary Therapy in Patients With Glaucoma: 8 Year Experience.
English
2010

Abstract
Purpose: To evaluate Selective Laser Trabeculoplasty (SLT) as primary and secondary therapy, to decrease intraocular pressure (IOP) and glaucoma medication (meds) usage.

Methods: Retrospective chart review was performed on 1363 and 945, respectively, of 3013 eyes treated with SLT over 8 years. Two-tailed paired t-test was used to compare maximum pre- and post-procedure IOP and number of meds.

Results: Mean follow-up was 750 and 515 days, respectively. For primary therapy, IOP decreased 31% from mean of 18.8mm Hg to 13.0mm Hg. For IOP control, 87 eyes (6%) required one repeat SLT (15 eyes required multi repeat). After one SLT, 16 eyes (1%) were on meds to control IOP. For SLT as primary (initial) treatment of glaucoma, cumulative probability of success over 7 years was 92%. For secondary therapy, IOP decreased by 22% from mean of 19.8mm Hg to 15.4mm Hg; meds decreased by 60% from a mean of 2.3 to 0.9 meds. For IOP control, reduction in meds' side effects, improvement in compliance, and / or decrease in need for meds, 367 eyes (38%) required one repeat SLT (59 eyes required multi repeat). After one SLT, 540 eyes (57%) were on no meds; 171 eyes (18%) were on less meds (but not zero); 207 eyes (22%) were on the same number of meds; and 27 eyes (3%) were on more meds to control IOP. For SLT as secondary (adjunct) treatment of glaucoma, cumulative probability of success over 7 years was 64%. Results were significant with p<0.01.

Conclusions: In this large long-term series, SLT significantly lowered IOP and decreased number of meds as, primary and secondary therapy, in patients with glaucoma.

Details Abstract
Source Invest Ophthalmol Vis Sci. 2010 Apr;51:4428.
Author(s) Jindra LF, Donnelly JA, Gupta A, et al.
[Use of selective laser trabeculoplasty in primary closed angle glaucoma].
Spanish
2010

OBJECTIVES:
To determine the efficiency and safety of selective laser trabeculoplasty in patients who suffered primary close angle glaucoma and were operated from cataract and/or glaucoma, and to identify the frequency of the main adverse effects.
METHODS:
Prospective descriptive and observational research study of 35 patients (50 eyes) carrying primary close angle glaucoma, who were operated on from cataract and/or glaucoma at 'Ramn Pando Ferrer' Cuban Institute of Ophthalmology from May to November 2007. The equipment called Tango LT 5106T from Laserex was used.
RESULTS:
Female patients, people over 60 years-old, Caucausians, hypermetropics, high frequency of non-communicable chronic diseases prevailed. After six months, the reduction of intraocular pressure amounted to 41,2%. In those patients with a history of previous filtering surgery, the use of this technique showed results very similar to those of the non-operated patients. The therapy proved to be effective in 88% of eyes and the medical hypotensive treatment was reduced. Some adverse events were blood pressure peaks, corneal epitheliopathy and pigment dispersion.
CONCLUSIONS:
Laser technique was effective to control blood pressure and/or reduction of ocular anti-hypertensive medical therapy in this type of patients.

Details Peer-Review
Source Revista Cubana de Oftalmologa. 2010; 23(1)27-37.
Author(s) Fernndez AG, Daz IP, Rodrguez MM.
Monocyte modulation of aqueous outflow and recruitment to the trabecular meshwork following selective laser trabeculoplasty.
English
2010

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.

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Source Arch Ophthalmol. 2010 Jun;128(6):731-7. doi: 10.1001/archophthalmol.2010.85.
Author(s) Alvarado JA, Katz LJ, Trivedi S, et al.
Influence of selective laser trabeculoplasty on 24-hour diurnal intraocular pressure fluctuation in primary open-angle glaucoma: a pilot study.
English
2010

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.

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Source Ophthalmic Surg Lasers Imaging. 2010 May-Jun;41(3):342-7. doi: 10.3928/15428877-20100430-08.
Author(s) Kthy P, Tth M, Holl G.
SLT and adjunctive medical therapy: a prediction rule analysis.
English
2010

PURPOSE:
To investigate if specific classes of antiglaucoma 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 antiglaucoma drops. The area under receiver operator characteristic curve was 0.777.

CONCLUSIONS:
Topical medications do not adversely, nor favorably, 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 antiglaucoma medications, diabetes, sex, corneal thickness, pseudophakia, diagnosis, washout of eye drops, and previous argon laser trabeculoplasty treatment are not associated with SLT treatment efficacy.

Details Peer-Review
Source J Glaucoma. 2011 Apr-May;20(4):266-70. doi: 10.1097/IJG.0b013e3181e3d2c1.
Author(s) Martow E, Hutnik CM, Mao A.
Effect of primary selective laser trabeculoplasty on tonographic outflow facility: a randomised clinical trial.
English
2010

PURPOSE:
To investigate the effect of 180 versus 360 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 or 360 SLT after baseline tonographic outflow facility (electronic Schitz tonography) and IOP measurements were repeated after 1 month. One eye from each patient was randomly selected for analysis. Eight untreated eyes were included as a control group.

MAIN OUTCOME MEASURES:
Tonographic outflow facility and IOP difference. Responders were defined as having at least a 20% reduction in IOP.

RESULTS:
Three patients were excluded due to poor tonography. There were 18 eyes in the 180 group and 19 eyes in the 360 group. Tonographic outflow facility increased significantly (180 p = 0.003, 360 p = 0.005) and IOP decreased significantly (180 and 360 p < 0.001) from baseline. There were no significant differences between the two groups as regards the increase in tonographic outflow facility (180 group 37.5%, 360 group 41%, p = 0.23) and decrease in IOP (180 group 24%, 360 group 35%, p = 0.35). There were similar number of responders in 180 group (72%) as compared to 360 group (89.5%, p = 0.23). Tonographic outflow facility and IOP did not change significantly from baseline in the control group (tonographic outflow facility: 8% increase p = 0.48, IOP: 4% decrease p = 0.33).

CONCLUSIONS:
Primary SLT significantly increased the tonographic outflow facility and decreased IOP in patients with primary open angle glaucoma and ocular hypertension but no statistically significant differences were found between the 360 and 180 groups. The level of IOP reduction due to primary SLT treatment could not be explained by the increase in tonographic outflow facility alone. Clinical trial registration ISRCTN66330584, Current Controlled Trials. 1/11/2006.

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Source Br J Ophthalmol. 2010 Nov;94(11):1443-7. doi: 10.1136/bjo.2009.176024. Epub 2010 May 14.
Author(s) Goyal S, Beltran-Agullo L, Rashid S, et al.
Rapid and delayed death of cultured trabecular meshwork cells after selective laser trabeculoplasty.
English
2010

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.

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Source Lasers Surg Med. 2010 Apr;42(4):326-37. doi: 10.1002/lsm.20907.
Author(s) Wood JP, Plunkett M, Previn V, et al.
The Present Glaucoma Treatment Paradigm should be Re-evaluated.
English
2010

Inspite of the despite current developments in the management, both diagnosis and treatment of glaucoma, there is noevidence of improvement in the success rate of ophthalmologists in reducing blindness and visual impairment. On the contrary, thereis evidence that, even in well-served communities, the incidence of glaucoma blindness is not declining. This implies that the currentmanagement protocol has failed to reduce the burden of glaucoma blindness or visual incapacitation, despite concerted efforts in thisdirection. The following article analyzes the available data, the apparent causes of the situation and suggests a pragmatic rethinking ofthe traditional paradigm of open angle glaucoma treatment in order to improve the visual outcomes in patients suffering from this disease.

Details Article
Source J Curr Glaucoma Pract. Jan-Apr 2010;4(1):5-12. doi: 10.5005/jp-journals-10008-1065.
Author(s) Belkin M.
Selective laser trabeculoplasty for elevated intraocular pressure following subtenon injection of triamcinolone acetonide.
English
2010

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.

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Source Clin Ophthalmol. 2010; 4: 247.
Author(s) Yuki K, Inoue M, Shiba D, et al.
Selective Laser Trabeculoplasty in Pseudophakic Glaucoma.
English
2010

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.

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Source Ophthalmic Surg Lasers Imaging. 2010 Mar 9:1-2. doi: 10.3928/15428877-20100215-15.
Author(s) Nagar M, Shah N, Kapoor B.
One year results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma.
English
2010

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.

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Source J Med Assoc Thai. 2010 Feb;93(2):211-4.
Author(s) Thatsnarong D, Ngamchittiampai C, Phoksunthorn T.
The impact of anti-inflammatory therapy on intraocular pressure reduction following selective laser trabeculoplasty.
English
2010

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.

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Source Ophthalmic Surg Lasers Imaging. 2010 Jan-Feb;41(1):100-3. doi: 10.3928/15428877-20091230-18.
Author(s) Realini T, Charlton J, Hettlinger M.
[Available laser systems and mechanism of action in laser trabeculoplasty].
German
2010

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.

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Source Ophthalmologe. 2010 Jan;107(1):8-12. doi: 10.1007/s00347-009-2051-9.
Author(s) Kuerzinger GR, Eckert S.
[Effectiveness and relevance of laser trabeculoplasty: treatment of open-angle glaucoma].
German
2010

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.

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Source Ophthalmologe. 2010 Jan;107(1):18-21. doi: 10.1007/s00347-009-2053-7.
Author(s) Eckert S.
Selective laser trabeculoplasty in the treatment of pseudoexfoliation glaucoma in patients allergic to all anti-glaucoma drops.
English
2010

Secondary chronic open-angle glaucoma associated with pseudoexfoliation (PEX) syndrome accounts for approximately 25% of all glaucomas and represents the most common identifiable cause of glaucoma overall. Selective laser trabeculoplasty (SLT) is effective in reducing intraocular pressure (IOP) in glaucomatous patients and has the advantage of preserving surrounding structures. We report here SLT treatment of a 82 year old female with a secondary developed open-angle pseudoexfoliation glaucoma allergic to all anti glaucoma eye drops especially those which contain bensalconium chloridum as preservative. Since patient was allergic also to methyl-cellulose, we performed SLT with water as a mediator. Patient had PEX syndrome for 10 years, immature cataracts on both eyes, and best corrected visual acuity (BCVA) 0.7 on the right and 0.2 on the left eye. We have monitored intraocular pressure (IOP), the changes in the visual field and optic nerve. Preoperative IOP was 28 mmHg on the right and 30 mmHg on the left eye. The follow up period was 24 months with time points for measured parameters every 3 months. After 18 months IOP remained in the normal values (average 17 mmHg) on the right eye, but on the left eye it increased up to 28 mmHg. SLT re-treatment was carried out on the left eye and the IOP stabilized again on the values between 16-18mmHg. There were no significant change in the visual field and optic nerve configuration before and after SLT (C/D value for right eye: 0.3-0.4; C/D left eye: 0.5). Based on this case report, SLT seems to be very effective treatment for maintaining regular IOP in patient with PEX who is allergic to all types of medications.

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Source Coll Antropol. 2010 Apr;34 Suppl 2:275-7.
Author(s) Gavrić M, Gabrić N, Dekaris I, et al.
Effect of Selective Laser Trabeculoplasty on Trabecular Outflow Facility and Intraocular Pressure.
English
2009

Purpose: To investigate the effect of 180 & 360 Selective Laser Trabeculoplasy (SLT) treatment on intraocular pressure (IOP) & trabecular outflow facility (TOF).

Methods: One eye of untreated POAG (n=27) or OHT (n=10) patients (IOP 22-35 mmHg) was randomized to receive 180 (n=18) or 360 (n=19) SLT treatment. Fellow eyes of patients which did not require treatment were used as controls (n=8). TOF (electronic Schiotz tonography, C, l/min/mm) and IOP (mmHg) were measured at pre & 1 month post SLT.

Results: No significant changes in IOP & TOF were seen in the controlled eyes between baseline and one month. In 180 SLT group: IOP were reduced from 24.4 4.1 (Mean SD) at baseline to 19.0 5.2 at 1 month (p<0.001); while TOF were increase from 0.08 0.04 to 0.11 0.04 at 1 month (p=0.003). In the 360 group: IOP were reduced from 24.4 4.1 (Mean SD) at baseline to 19.0 5.2 at 1 month (p<0.001); while TOF were increase from 0.08 0.04 to 0.11 0.04 at 1 month (p=0.005). However, the differences in IOP and TOF between the 180 and 360 groups were not statistically significant (p=0.35 & p=0.23 respectively). The SLT treatment caused overall reduction of 29% in IOP and 38% increased in TOF.

Conclusions: Both 180 and 360 SLT treatment had greater effect on IOP and TOF. The overall reduction in IOP following SLT can not be explained by the increase in TOF alone.

Details Abstract
Source Invest Ophthalmol Vis Sci. April 2009;50:154.
Author(s) Lim K, Goyal S, Rashid S, et al.
Excimer laser trabeculotomy vs 180 degrees selective laser trabeculoplasty in primary open-angle glaucoma. A 2-year randomized, controlled trial.
English
2009

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.

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

Details Peer-Review
Source Eye (Lond). 2010 Apr;24(4):632-8. doi: 10.1038/eye.2009.172. Epub 2009 Jul 10.
Author(s) Babighian S, Caretti L, Tavolato M, et al.
From the bedside to the bench and back again: predicting and improving the outcomes of SLT glaucoma therapy.
English
2009

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.

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Source Trans Am Ophthalmol Soc. 2009 Dec;107:167-81.
Author(s) Alvarado JA, Iguchi R, Juster R, et al.
[Selective trabeculoplasty in combination with vasoactive agents in the complex treatment of primary open-angle glaucoma].
Russian
2009

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.

Details Peer-Review
Source Vestn Oftalmol. 2009 Sep-Oct;125(5):28-31.
Author(s) Shaimova VA, Shaimov RB, Goloshchapov KP.
Selective laser trabeculoplasty for primary angle closure with persistently elevated intraocular pressure after iridotomy.
English
2009

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.

CONCLUSIONS:
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.

Details Peer-Review
Source J Glaucoma. 2009 Sep;18(7):563-6. doi: 10.1097/IJG.0b013e318193c2d1.
Author(s) Ho CL, Lai JS, Aquino MV, et al.
Selective Laser Trabeculoplasty - Efficacy of 270 treatment in primary open-angle glaucoma.
English
2009

Purpose: To determine the efficacy of 270 selective laser trabeculoplasty (SLT) in primary open-angle glaucoma (POAG).
Method: The SLT spots are burn in the extent of 270 of trabecular meshwork (1 mJ, 80 spots, 400 um).
Results: In 569 eyes with POAG followed up retrospectively at 12 months after SLT, it was in 357 eyes possible due to decrease of intraocular pressure (IOP), to decrease the medication, or to decrease the frequency of its application. In the other 197 eyes, the IOP was stabilized with no change of therapy, in 15 eyes trabeculectomy was necessary. In the second group of POAG patients (133 eyes) followed-up prospectively in the period 1, 3, 6 and 12 months after SLT, the decrease of IOP from 21.1 mmHg (SD 4.5) to 17.8 mmHg (SD 3.2) after 1 month (P < 0,0001), to 18.6 mmHg (SD 3.6) after 3 months, to 17.8 (SD 3.1) after 6 months, to 17.7 (SD 2.8) after 12 months was established.
Conclusion: 270 SLT was found to be an efficacious method in the treatment of POAG.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract GS23: 344. Boston.
Author(s) Vyborny P, Sickov S.
One Year After Treatment By Selective Laser Trabeculoplasty.
English
2009

Purpose:
To evaluate efficacy of selective laser trabeculoplasty (SLT) in glaucoma patients.

Design: Retrospective study.
Participants: In this study 110 eyes of 58 patients have been evaluated, 24 men and 34 women. The age ranged between 24 years and 80 years (mean, 63,8 10,5 y). 98 eyes of them were with primary open-angle glaucoma, 10 eyes with pseudoexfoliative glaucoma, 2 eyes with pigmentary glaucoma.

Intervention: The SLT spots were burnt in the extent of 180 circumferentially in the anterior chamber angle (1,1 mJ, 90 spots, 400 _m). Existing glaucoma medication has not been changed in any patient. The reason for SLT were: 1. a deficient decrease of intraocular pressure (IOP) with current glaucoma medication and 2. an intolerance of glaucoma medication.

Results: Our patients were followed-up 1 day, 1 week, 1, 3, 6 and 12 months after the treatment. The mean IOP before SLT was 16,6 3,1 mmHg. After one day IOP decreased about 3,4 2,9 mmHg, respectively about 19,0 14,2%. After one week IOP diminished about 1,6 2,5 mmHg, respectively about 8,8 13,9%. After one month IOP decreased about 2,3 2,6 mmHg, respectively about 12,6 13,5%. After three months IOP lowered about 2,4 2,9 mmHg, respectively about 13,0 15,0%. After six months IOP diminished about 2,5 2,8 mmHg, respectively about 13,7 15,0%. After 12 months IOP decreased about 2,2 2,6 mmHg, respective about 12,1 14,6%. In one eye with high myopia considerable elevation of IOP was found and trabeculectomy was necessary.

Conclusion: SLT is a safe and effective method that reduced the IOP in glaucoma patients. A good effect on the decrease of IOP (12,1 14,6%) lasts one year after SLT in our group. Only in high-myopia eyes we did not have good experiences with SLT. The target pressure hae been achieved in 57,27% patients one year after SLT.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P429: 262-3. Boston.
Author(s) Eliasova M, Kotenova V, Mlynarova K.
Higher Energy May Improve Success With Selective Laser Trabeculoplasty (Slt) in Patients With Previous Failure in the First Eye.
English
2009

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 hypercholes-terolemia, 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 mmHg 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: Three hundred thirty SLT procedures were identified. Forty-one patients had SLT in both eyes; 25 met entry criteria. Out of 25 patients who had 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 0.24 mJ in the group of SLT failure in both eyes and 1.19 0.34 mJ in the group of SLT failure in the first eye-success in the second eye.
Conclusions: If there is a poor response to SLT in one eye, the chance of success in the contralateral eye is low. Based on our results, higher energy may be helpful to obtain better outcomes when applying a SLT to the contralateral eye.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P434: 264-5. Boston.
Author(s) Jea SY, Pasquale L, Rhee D.
Comparison of SLT (Selective Laser Trabeculoplasty) Efficacy in Patients With Open Angle And Angle Closure Glaucoma.
English
2009

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 weeks and 12 weeks 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 AOG and 20 ACG patients enrolled into the study. Mean (SD) age of OAG and ACG 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 four 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 OAG and ACG groups at 12 weeks after laser (p < 0.01). The efficacy of SLT in IOP reduction was not different between OAG and ACG groups at both 4 weeks and 12 weeks after laser treatment (p > 0.05). The number of glaucoma medications used between baseline and 12-week post laser in both groups were not different.
Conclusions: 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.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P435: 265. Boston.
Author(s) Tantisevi V, Suramethakul P, Anuttarakulvanich S, et al.
Selective Laser Trabeculoplasty As Adjunctive Treatment For Open-Angle Glaucoma in Indian Eyes
English
2009

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.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P436: 265-6. Boston.
Author(s) Gupta A, Kapoor R.
Laser Trabeculoplasty Induces Changes in the Trabecular Meshwork Glycoproteome: A Pilot Study.
English
2009

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.

Details Peer-Review
Source J Proteome Res. 2009 Jul; 8(7): 3727736. doi: 10.1021/pr900294g
Author(s) Amelinckx A, Castello M, Arrieta-Quintero E, et al.
Five Year Experience of Effect of Race On Selective Laser Trabeculoplasty As Therapy in Patients With Glaucoma.
English
2009

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).

Conclusions: 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).

Details Abstract
Source Invest Ophthalmol Vis Sci. 2009 Apr;50(13):157.
Author(s) Donnelly JA, Moses EB, Miglino EM, et al.
Efficacy of Selective Laser Trabeculoplasty (SLT) in Patients With Insufficient Control of Intraocular Pressure (IOP).
English
2009

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 of the trabecular meshwork (TM) applying 100 non-overlapping laser spots. Energy was chosen depending on the grade of TM pigmentation. No anti-inflammatory drugs were applied postoperatively. A control of IOP was obligatory 2 hours after laser treatment.Postoperative examinations were done on day 1, 30, 90 and 180 including VA, GAT, slit lamp examination, non-dilated funduscopy, and gonioscopy. Preoperative medication was continued unchanged until 90 days and then reduced if possible.

Results: 30 eyes of 30 patients were included. Mean follow up was 174 days (57.9, 33-249). Mean IOP decreased from 19.6 mmHg 4.69 preoperatively to 15.2 mmHg3.2 (-22.8%, p < 0.001) at 30 days, 15.83.5 mmHg (- 19.2%, p= 0.001) at 90 days, and 17.42.8 mmHg (- 11.4%, p= 0.09) at 180 days. There was no significant change in visual acuity over the complete period of follow up. Mean number of IOP lowering substances decreased from 2.4 preoperatively to 1.9 after 180 days (not significant). No serious complications occurred during or after SLT treatment. In 12 cases a mild anterior chamber (AC) inflammation was diagnosed at day 1, which resolved completely without additional therapy. 3 patients developed a paradox rise of IOP 2 hours after SLT and were treated additionally with 250 mg acetazolamid. No synechia formation in the AC angle was observed.

Conclusions: SLT is a non-thermal laser treatment without coagulative tissue damage. It can reduce IOP up to 22 % without severe side effects or complications.

Details Abstract
Source Invest Ophthalmol Vis Sci. 2009 Apr;50(13):158.
Author(s) Hirn C, Zweifel SA, Hediger A, et al.
Long-Term Outcomes of Selective Laser Trabeculoplasty in Patients With Uveitis.
English
2009

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.

Details Abstract
Source Invest Ophthalmol Vis Sci. 2009;50(13):159.
Author(s) Zakka F, Pujari S, Shaikh M, et al.
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.
English
2009

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 exact p= 0.01). Patient age, race, sex, C/D ratio, total laser energy, type of glaucoma, and comorbidities of diabetes and hypertension were similar between the two groups. However, a significant difference was noted between the two groups with regards to the number of glaucoma medications used as medical therapy prior to ALT or SLT procedure. The chronic use group used an average of 1.4 (SD 0.8) more glaucoma medications than non-chronic users (p<0.0001).

Details Abstract
Source Invest Ophthalmol Vis Sci. 2009;50(13):160.
Author(s) Simpson CD, Hughes BA, Juzych MS, et al.
Repeat selective laser trabeculoplasty.
English
2009

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 posttreatment 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.

CONCLUSIONS:
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.

Details Peer-Review
Source J Glaucoma. 2009 Mar;18(3):180-3. doi: 10.1097/IJG.0b013e31817eee0b.
Author(s) Hong BK, Winer JC, Martone JF, et al.
Intraocular pressure measurements throughout the 24 h.
English
2009

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.

Details Peer-Review
Source Curr Opin Ophthalmol. 2009 Mar;20(2):79-83. doi: 10.1097/ICU.0b013e32831eef4f.
Author(s) Bagga H, Liu JH, Weinreb RN.
Selective Laser Trabeculoplasty: NSAIDs vs Steroids in Post-Operative Management.
English
2009

Purpose: To compare the effectiveness of a topical non-steroidal anti-inflamatory eye drop, diclofenac sodium 0.1% ophthalmic solution to a topical steroid, prednisolone acetate 1%, in patients who have undergone selective laser trabecu-loplasty (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 one hour, seven days, one month, three months and six months. The primary outcomes of the study are intraocular pressure (IOP) and inflammation control in the NSAID compared to the steroid group at six 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 six 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 postoperative means for the steroid group were significantly different at 24.23 mmHg and 17.50 mmHg (p < 0.001). There was no significant difference in IOP pre-operatively (p = 0.770) or post-operatively (p = 0.238) between groups. There was no significant difference between groups regarding post-operative inflammation (all p values > 0.080), with the exception of increased anterior chamber flare at one 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.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P408: 252. Boston.
Author(s) Calafati J, Ahmed I.
Selective Laser Trabeculoplasty As Initial And Adjunctive Treatment in Open Angle Glaucoma.
English
2009

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 5.2 mmHg. The mean IOP values at 1, 3, 6, 9 and 12 months were 17.5 4.2, 16.7 4.0, 16.4 3.8 m, 16.5 3.4 and 17.2 3.4 mmHg in order. IOP decreased by 21.4%, 24.2%, 25.5%, 26.1% and
23.9% from baseline during the same examination periods. The percentage of eyes with at least 3 mmHg IOP reduction was 74%, 82% , 83%, 88% and 86%. and the percentage of at least 20% IOP reduction was 52%, 61%, 70%, 67% and 64% at 1, 3, 6 , 9 and 12 months, respectively. Basal IOP correlated with reduction of IOP (p = 0.000 and r = 0.451). Previous argon laser trabeculoplasty; prostoglandin analogue use and pseudophakia did not determine the rate of IOP reduction. Success was mainly determined by basal IOP as shown by logistic regression analysis. No permanent adverse effects were encountered and postlaser IOP spikes were transient
CONCLUSIONS:
SLT over a circumference of 360 degrees is efficient and safe in the treatment of glaucoma as initial or adjunctive treatment.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P424: 260. Boston.
Author(s) Baser E.
Selective Laser Trabeculoplasty For the Treatment of Pseudoexfoliative Glaucoma.
English
2009

Purpose: To evaluate the efficacy and safety of selective laser trabeculoplasty (SLT) for the treatment of pseudoexfoliative glaucoma. Design: Prospective clinical study. Participants: Twenty 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 nonsteroidal antiinflammatory 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 22.76.4 mmHg. The mean IOP values at 1, 3, 6, 9 and 12 months were 17.7 5.9, 17.3 5.6, 16.5 5.8, 16.1 3.6 and 17.8 3.8 mmHg in order. IOP decreased by 21.6%, 23.4%; 27.3 %, 25.4 % and 22.7% from baseline during the same examination periods. The percentage of eyes with at least 3 mmHg IOP reduction was 75%, 85% , 85%, 50% and 40% and the percentage of at least 20% IOP reduction was 45%, 60%, 65%, 35% and 30% at 1, 3, 6 , 9 and 12 months, respectively. Postlaser IOP spikes were controllable and transient. Permanent adverse effects were not encountered.

Conclusions: 360-degrees SLT is efficient and safe in the treatment of pseudoexfoliative glaucoma as initial or adjunctive treatment. The efficacy seems to wane slowly after 6 months.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P425: 260-1. Boston.
Author(s) Baser E.
Selective Laser Trabeculoplasty: Alternative Approach To Glaucoma.
English
2009

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: We have had 21 eyes under our supervision. Average age of the patients was 56.0 years. Average initial IOP reached 23.43 mmHg. 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 to 15), scotomas in Bjerrum area and enlargement of the blind spot. Optic nerve head excavation ranged from 5/10-9/10. Medicinal therapy (for all patients) included beta-blockers, carboanhidrase inhibitors and prostaglandins. In 9.52% of cases filtrational surgery was performed followed by medicinal treatment. Eyes with diabetic angiopathy comprised 9.52%. Intervention or methods or testing: Selective laser trabeculoplasty was performed with diode laser 532 nm, on 90 trabecular areas of the corner of the anterior chamber. We observed the patients during 14 months. Main outcome measure: The SLT success was defined by the following criteria: 1) IOP decrease from the initial level, 2) full cancellation of instillations, 3) condition of optic nerve head, the field of vision and visual functions accordingly.

Results: IOP has decreased by 22.3 % from the base level, average value came down to 18.2 mmHg. In all cases we managed to achieve full cancellation of instillation. No single case of negative dynamics in optic nerve head condition, field of vision and visual functions was observed during the supervision. In 33.33 % of cases reduction of optic nerve excavation was noted.

Conclusions: The results received allow us to conclude that SLT is an effective and suitable alternative method of glaucoma and eye hypertensia treatment. When applied on a limited area (on 90) the procedure enables its repeated use in case if necessity. The SLT appeared to be also effective on eyes after surgical intervention.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P427: 261-2. Boston.
Author(s) Buniatyan I, Malayan AI, Voskanyan L.
SLT For Exfoliative Glaucomas And Primary Open Angle Glaucomas Eight -Year Follow Up.
English
2009

Purpose: Selective laser trabeculoplasty (SLT) is a technique developed for treatment of the trabecular meshwork in patients with glaucoma. The purpose of this study is to establish the efficacy of SLT for exfoliative 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 nm. The eyes were divided into groups. Group 1: 20 eyes with EG, group 2: 22 eyes with POAG. Approximately 105 laser spots were applied over 360 degrees of the the trabecular mesh-work.

Results: The mean preoperative intraocular pressure (IOP) in group 1 was 25,3 1,1 mmHg and in group 2 25,5 1,2 mmHg. A stastically significant decrease of IOP (p < 0,05) was observed after SLT by an average in group 1 of -5,5 mmHg and in group 2 -5,7 mmHg. Mean percentage reduction was EG-22,1% and POAG-22,4 %.

Conclusion: Our results show SLT is an effective method for EG and POAG treatment in reducting IPO treated eyes. SLT decreases IOP somewhat for at least 8 years without increase in topical glaucoma treatment.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P430: 263. Boston.
Author(s) Koev K.
Selective Laser Trabeculoplasty in Pseudoexfoliation Glaucoma.
English
2009

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.

Details Abstract
Source World Glaucoma Congress. 2009 Jul 8-11. Abstract Book, Abstract P432: 264. Boston.
Author(s) Kurysheva NI, Topolnic EV, Zaregorodceva MA.
The Effect of Selective Laser Trabeculoplasty (SLT) With Heavy Versus Light Pigmentation of the Trabecular Meshwork.
English
2009

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 were followed for an average of 5.3 4.1 months. Demographic data were evaluated using chi-square and ANOVA tests. Mean IOP reduction was evaluated in each group using paired sample t-test. IOP reduction between the three groups was compared using the ANOVA test.

Results: Of the 83 eyes, 28 eyes were in Group I, 39 eyes in Group II and 16 eyes in Group III. Demographics for all 3 groups were comparable with respect to age, race, and sex (p > 0.1). The mean pre-SLT IOP was 22.1 ( 4.3) mm Hg in Group I, 22.2 ( 4.5) mm Hg in Group II, and 22.8 ( 4.4) mm Hg in Group III. Baseline pre-SLT IOP among all 3 groups showed no statistical difference (p = 0.9). The mean post-SLT IOP reduction was 4.0 ( 3.9) mm Hg in Group I, 5.1 ( 5.7) mm Hg in Group II, and 4.1 ( 4.2) mm Hg in Group III. There was a significant IOP reduction in all 3 groups (p < 0.005) but there was no difference in magnitude between the three groups (p = 0.65).

Details Abstract
Source Invest Ophthalmol Vis Sci. 2009;50(13):161.
Author(s) Haque M, Hughes BA, Juzych MS, et al.
Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with uncontrolled open-angle glaucoma.
English
2009

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 <18 mmHg. Group B included patients with IOP >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.

Details Peer-Review
Source Eur J Ophthalmol. 2009 May-Jun;19(3):429-34.
Author(s) Russo V, Barone A, Cosma A, et al.
Selective laser trabeculoplasty for glaucoma after penetrating keratoplasty.
English
2009

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.

Details Peer-Review
Source Optom Vis Sci. 2009 Apr;86(4):e404-6. doi: 10.1097/OPX.0b013e318199d226.
Author(s) Nakakura S, Imamura H, Nakamura T.
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.
English
2009

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

Details Peer-Review
Source J Glaucoma. 2009 Feb;18(2):157-60. doi: 10.1097/IJG.0b013e3181752c97.
Author(s) Prasad N, Murthy S, Dagianis JJ, et al.
Intraocular pressure reduction in the untreated fellow eye after selective laser trabeculoplasty.
English
2009

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.

CONCLUSIONS:
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.

Details Peer-Review
Source Curr Med Res Opin. 2009 Mar;25(3):787-96. doi: 10.1185/03007990902728316.
Author(s) Rhodes KM, Weinstein R, Saltzmann RM, et al.
The Effect of Laser Peripheral Iridotomy in Vietnamese Patients With Primary Angle-Closure.
English
2009

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 4.3 years were included in this study. The proportions of eyes which required additional treatments (medical, laser, or surgical) to control IOP were 15/197 (7.6%), 67/126 (53.2%), and 45/49 (91.8%) eyes in the PACS, PAC, and PACG groups, respectively. No eyes in the PACS group needed further laser or surgery. However, 8/126 (6.3%) and 17/49 (34.7%) of eyes in the PAC and PACG groups, respectively, had undergone filtration surgery. Four PACS (1.1%) eyes progressed to PAC; four PACS (1.1%) eyes progressed to PACG; and eight PAC (2.2%) eyes progressed to PACG. No significant difference in anterior chamber depth, lens thickness, axial length, lens/axial length factor, and relative lens position was found between eyes with and without progression.

Conclusions: Further medications, laser, or surgery are required to control IOP after LPI for eyes with primary angle-closure, especially for eyes with PACG. Close follow up and appropriate therapies for these patients is warranted to prevent progression of disease.

Details Abstract
Source Invest Ophthalmol Vis Sci. 2009;50(13):162.
Author(s) Peng PH, Nguyen N, Nguyen H, et al.
[Selective laser trabeculoplasty-new possibilities in glaucoma treatment].
Czech
2009

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 moths, and to 17.7 +/- 2.8 mm Hg after 12 moths 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.

Details Peer-Review
Source Cesk Slov Oftalmol. 2009 Jan;65(1):8-11.
Author(s) V_born_ P, Sickov S.
Topical prostaglandin analogues do not affect selective laser trabeculoplasty outcomes.
English
2009

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 > or =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 vs 4.6+/-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.

Details Peer-Review
Source Eye (Lond). 2009 Dec;23(12):2194-9. doi: 10.1038/eye.2009.1.
Author(s) Singh D, Coote MA, O'Hare F, et al.
Intraocular pressure control and fluctuation: the effect of treatment with selective laser trabeculoplasty.
English
2008

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 pretreatment 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).

CONCLUSIONS:
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.

Details Peer-Review
Source Br J Ophthalmol. 2009 Apr;93(4):497-501. doi: 10.1136/bjo.2008.148510. Epub 2008 Dec 23.
Author(s) Nagar M, Luhishi E, Shah N.
Argon laser trabeculoplasty versus selective laser trabeculoplasty.
English
2008

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.

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Source Surv Ophthalmol. 2008 Nov-Dec;53(6):641-6. doi: 10.1016/j.survophthal.2008.08.020.
Author(s) Pham H, Mansberger S, Brandt JD, et al.
[Two-year outcomes of selective laser trabeculoplasty in open-angle glaucoma and ocular hypertension].
French
2008

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 noncomparative 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.

Details Peer-Review
Source J Fr Ophtalmol. 2008 Dec;31(10):981-6.
Author(s) Zaninetti M, Ravinet E.
Selective laser trabeculoplasty: a better alternative.
English
2008

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.

Details Peer-Review
Source Surv Ophthalmol. 2008;53(6):646-651.
Author(s) Damji KF.
Matrix metalloproteinases and their tissue inhibitors after selective laser trabeculoplasty in pseudoexfoliative secondary glaucoma.
English
2008

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 pretreatment 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.

Details Peer-Review
Source BMC Ophthalmol. 2008 Oct 21;8:20. doi: 10.1186/1471-2415-8-20.
Author(s) Cellini M, Leonetti P, Strobbe E, et al.
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.
English
2008

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.

CONCLUSIONS:
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.

Details Peer-Review
Source J Glaucoma. 2008 Sep;17(6):449-54. doi: 10.1097/IJG.0b013e31815f52cb.
Author(s) Mao AJ, Pan XJ, McIlraith I, et al.
Selective Laser Trabeculoplasty: A Review.
English
2008

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.

Details Peer-Review
Source J Glaucoma. 2008 Sep;17(6):497-502. doi: 10.1097/IJG.0b013e31817d2386.
Author(s) Realini T.
The effect of selective laser trabeculoplasty on intraocular pressure in patients with intravitreal steroid-induced elevated intraocular pressure.
English
2008

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 preexisting open angle glaucoma; 2 patients had preexisting ocular hypertension. Time between intraocular corticosteroid injection and subsequent increased IOP ranged from 5 to 29 weeks. After unsuccessful maximum tolerated medical therapy, patients underwent unilateral SLT between April 2003 and June 2005. IOP was measured 4 weeks prelaser; on the day of laser; within 3 weeks, and at 1, 3, and 6 months postlaser. Two-sample t test was used for analysis.

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 (P<0.001). Four patients underwent a second SLT procedure. Two patients failed after the 3-month visit. IOP in fellow eyes of all patients was unchanged (P>0.080).

CONCLUSIONS:
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.

Details Peer-Review
Source J Glaucoma. 2008 Jun-Jul;17(4):287-92. doi: 10.1097/IJG.0b013e318031676c.
Author(s) Rubin B, Taglienti A, Rothman RF, et al.
Economic evaluation of medication, laser trabeculoplasty and filtering surgeries in treating patients with glaucoma in the US.
English
2008

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' intra-ocular pressure in each year. The distribution of treatment states and the transition probabilities between these states were derived from published literature, adjusted or supplemented by the authors' own treatment experiences. Costs assessed in the model included treatment, complications associated with each treatment, and physician office visits obtained from published literature and standardized fees and schedules.

RESULTS:
The 5-year cumulative costs were approximately $6571, $4838 and $6363 for patients in the medication, laser trabeculoplasty, and filtering surgery arms, respectively. Costs of third-line medication, first-line medication following laser trabeculoplasty, and post-surgery complications had the greatest impact on the model results in the medication, laser trabeculoplasty, and filtering surgery arms, respectively. Probabilistic sensitivity suggested the results were statistically significant (p < 0.001), favoring the use of laser trabeculoplasty.

CONCLUSIONS:
Over 5 years laser trabeculoplasty was associated with the lowest total costs compared to treatment by medication alone or by filtering surgery for patients who were not adequately controlled by two medications. Future development of glaucoma treatment should focus on reducing the need for post-procedure medical therapy as well as lowering the rate of post-procedure complications. Limited by the availability of the transition probabilities in published literature, the model results need to be validated by prospective or retrospective observational studies.

Details Peer-Review
Source Curr Med Res Opin. 2008 Oct;24(10):2905-18. doi: 10.1185/03007990802379996 . Epub 2008 Sep 2.
Author(s) Cantor LB, Katz LJ, Cheng JW, et al.
Evaluation of a modified protocol for selective laser trabeculoplasty.
English
2008

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 nonoverlapping 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 nonoverlapping 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 nonoverlapping SLT (P=0.0019) at all follow-up times. There were no statistically significant predictive factors for IOP reduction in the overlapping SLT group.

CONCLUSIONS:
Overlapping application of SLT results in a poorer IOP response compared with ALT and nonoverlapping SLT.

Details Peer-Review
Source J Glaucoma. 2008 Apr-May;17(3):197-202. doi: 10.1097/IJG.0b013e3181567890.
Author(s) George MK, Emerson JW, Cheema SA, et al.
SLT a new option for pseudoexfoliative glaucoma.
English
2008

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

Details Article
Source Ophthalmology Times Europe, Jan/Feb 2008
Author(s) Nagar M.
[Comparison of Clinical Outcomes of Argon Laser Versus Selective Laser Trabeculoplasty in POAG].
Korean
2008

Purpose
To compare the clinical outcomes between patients undergoing argon laser trabeculoplasty (ALT) and those undergoing selective laser trabeculoplasty (SLT).

Methods
Sixty-one eyes of 61 patients with primary open-angle glaucoma who were treated with more than 1 kind of antiglaucoma medication eye drop were enrolled in this study. Thirty-five eyes of 35 patients were treated with argon laser trabeculoplasty (ALT). Twenty-six eyes of 26 patients were treated with selective laser trabeculoplasty (SLT). The mean IOP at 1, 3, 6, and 12 months and the success rate of treatment at the 12-month follow-up period were evaluated in all patients.

Results
At 12 months postoperative, the ALT group had a mean IOP of 16.532.58 mmHg with a mean IOP reduction of 35.27%, while the SLT group had a mean IOP of 18.405.61 mmHg with a mean IOP reduction of 17.37%. The success rates of treatment defined as definition 1 were 62.85% in ALT and 62.50% in SLT, and the success rates defined as definition 2 were 51.42% in ALT and 46.15% in SLT.

Conclusions
There were no significant differences in the IOP lowering effect or success rates between the ALT and SLT patients at 12 months postoperatively.

Details Peer-Review
Source J Korean Ophthalmol Soc. 2008 Sep;49(9):1491-1500. Korean. Published online September 20, 2008. https://doi.org/10.3341/jkos.2008.49.9.1491
Author(s) Park JJ, Lee JW, Lee KW.
[Clinical results of selective laser trabeculoplasty as adjunctive treatment for primary open-angle glaucoma patients].
Japanese
2007

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.

CONCLUSIONS:
Although SLT significantly decreas ed 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.

Details Peer-Review
Source Nippon Ganka Gakkai Zasshi. 2007 Dec;111(12):953-8
Author(s) Saito Y, Higashide T, Sugiyama K.
[Predictive factors of successful selective laser trabeculoplasty in open-angle glaucoma].
German
2007

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.

Details Peer-Review
Source Klin Monbl Augenheilkd. 2007 Dec;224(12):922-6. doi: 10.1055/s-2007-963744.
Author(s) Gracner T, Naji M, Hudovernik M, et al.
Selective laser trabeculoplasty retreatment after prior argon laser trabeculoplasty: 1-year results.
English
2007

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 < 0.001), but there were no differences among the groups in this respect (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.

Details Peer-Review
Source Can J Ophthalmol. 2007 Oct;42(5):715-9
Author(s) Birt CM.
Selective vs Argon laser trabeculoplasty: controversy in evolution.
English
2007

It is often a difficult task to decide when to incorporate new technologies, such as selective laser trabeculoplasty (SLT), into our clinical regimen. Open-angle glaucoma is a chronic, slowly progressing disease in which the effects of treatment on the quality of life are realized only after several years or even decades. Thus, determining the relative effectiveness of new treatments requires patient observation of the evolving literature, self-critical assessment of our clinical experience, and well-designed long-term randomized comparative trials to justify widespread modification of our therapeutic paradigms.

Details Peer-Review
Source Am J Ophthalmol. 2007 Jul;144(1):120-1.
Author(s) Girkin CA.
Effect of topical prostaglandin analog use on outcome following selective laser trabeculoplasty.
English
2007

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 nonusers (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%).

CONCLUSIONS:
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.

Details Peer-Review
Source J Ocul Pharmacol Ther. 2007 Oct;23(5):503-12.
Author(s) Scherer WJ.
Selective Laser Trabeculoplasty (SLT) As A Primary And Adjunctive Treatment For Secondary Glaucoma Patients.
English
2007

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.

Details Paper Presentation
Source IGS. 2007 Mar 28-31, Athens.
Author(s) Vukosavljevic M, Aleksic P, Milivojevic M, et al.
Selective laser trabeculoplasty as adjunctive treatment for open angle glaucoma.
English
2007

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

Details Paper Presentation
Source VIth International Glaucoma Symposium-IGS 2007 Mar 28-31, Athens. Abstract Book:19.
Author(s) ztrk F, _nan , Ermi_ SS.
[Selective Laser Trabeculoplasty in Fertile Women With Open Angle Glaucoma Or Ocular Hypertension].
Korean
2007

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

Details Peer-Review
Source J Korean Ophthalmol Soc. 2007 Nov;48(11):1494-1499. Korean. Published online November 30, 2007. https://doi.org/10.3341/jkos.2007.48.11.1494.
Author(s) Park MH, Moon J.
Selective laser trabeculoplasty in phakic and pseudophakic eyes.
English
2007

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 < .005) and mean glaucoma medication use decreased from 2.2 to 1.6 medications. Success rates ranged from 54% to 67% in the phakic group and 52% to 65% in the pseudophakic group. No statistically significant difference between phakic and pseudophakic eyes in decreased IOP or success rates was seen at any time point (P > .05). No significant complications occurred in either group.

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

Details Peer-Review
Source Ophthalmic Surg Lasers Imaging. 2007 May-Jun;38(3):182-8.
Author(s) Werner M, Smith MF, Doyle JW.
[What should we think? Is selective trabeculoplasty more effective than conventional argon laser trabeculoplasty?].
French
2007

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.

Details Peer-Review
Source J Fr Ophtalmol. 2007 May;30(5 Pt 2):3S74-8.
Author(s) Lefranois A.
[Selective laser trabeculoplasty in the treatment of primary open-angle glaucoma].
Chinese
2007

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 nonoverlapping 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 - 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.

Details Peer-Review
Source Zhonghua Yi Xue Za Zhi. 2007 Jan 9;87(2):118-20.
Author(s) Qian SH, Sun XH.
Selective Laser Trabeculoplasty Versus Argon Laser Trabeculoplasty: Results From A 1-Year Randomised Clinical Trial.
English
2006

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.

Details Peer-Review
Source Br J Ophthalmol. 2006 Dec;90(12):1490-4. Epub 2006 Aug 9.
Author(s) Damji KF, Bovell AM, Hodge WG, et al.
[Long-term follow-up of selective laser trabeculoplasty in primary open-angle glaucoma].
German
2006

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.

Details Peer-Review
Source Klin Monatsbl Augenheilkd. 2006 Sep;223(9):743-7.
Author(s) Gracner T, Falez M, Gracner B, et al.
Argon laser trabeculoplasty and reduction of ocular hypotensive medication used by glaucoma patients.
English
2006

BACKGROUND:
We studied the effect of argon laser trabeculoplasty (ALT) on medically controlled, pressure-stable glaucoma patients to verify whether it is possible to reduce ocular hypotensive medication after ALT while keeping intraocular pressure levels similar to those observed before the procedure.

METHODS:
Seventy-one consecutive chronic glaucoma patients, all of whom were taking ocular hypotensive medication and had intraocular pressure at adequate levels, underwent ALT. After the laser procedure, each patient discontinued one hypotensive drug. Mean follow-up was 16.39 +/- 5.39 months. We performed diurnal pressure curves on each patient before and after trabeculoplasty to determine the effect on intraocular pressure.

RESULTS:
In 39 (54.9%) patients, it was possible to reduce ocular hypotensive medication and still maintain intraocular pressure levels similar to those achieved before ALT.

INTERPRETATION:
For some medically controlled, chronic glaucoma patients, ALT can reduce the amount of ocular hypotensive medication without significantly altering intraocular pressure.

Details Peer-Review
Source Can J Ophthalmol. 2006 Feb;41(1):44-50.
Author(s) Vaidergorn PG, Susanna R Jr.
Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma.
English
2006

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.

CONCLUSIONS:
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. Nonsteroidal antiinflammatory 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.

Details Peer-Review
Source J Glaucoma. 2006 Apr;15(2):124-30.
Author(s) McIlraith I, Strasfeld M, Colev G, et al.
Selective Laser Trabeculoplasty: Effect of Enhancement And Repeatability On IOP.
English
2006

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: Twenty-seven eyes had enhancement of SLT and 15 eyes had repeat SLT. Average SLT life after enhancement was 18.26 months; and after repeat treatment, 17.47 months. SLT enhancement success rate was 70.37% after one year, 55.55% after two years, and 25.93% after three years. With repeat treatment, success rate was 70.37% at one year and 53.33% after two years.
Conclusion: Enhancement and re-treatment with SLT is effective in reducing IOP.

Details Poster Presentation
Source American Academy of Ophthalmology, 2006 Nov 11-14, Las Vegas. PO120.
Author(s) Nagar M.
Argon versus selective laser trabeculoplasty.
English
2006

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.

CONCLUSIONS:
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.

Details Peer-Review
Source Bull Soc Belge Ophtalmol. 2006;(299):5-10.
Author(s) Van de Veire S, Zeyen T, Stalmans I.
[Argon laser trabeculoplasty or selective laser trabeculoplasty in the treatment of open-angle glaucoma].
Croatian
2006

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.

Details Peer-Review
Source Acta Med Croatica. 2006;60(2):97-9.
Author(s) Bojic L, Ivanisevic M, Mandic Z.
Effect of Selective Laser Trabeculoplasty And Prostaglandins On Diurnal IOP Fluctuations: Randomized Clinical Trial.
English
2006

Purpose: To evaluate the effect of selective laser trabeculoplasty (SLT) and latanoprost on daytime tension curve or diurnal IOP fluctuations. Study Design: Randomized masked clinical trial.
Methods: Open-angle glaucoma (OAG) and patients with ocular hypertension (OHT) were recruited into two groups: laser / latanoprost. Pre- and post-treatment daytime tension curve was plotted.
Results: Following treatment, IOP fluctuation was reduced from 6.90 2.73 mm Hg to 3.20 1.32 mm Hg and from 6.40 1.26 mm Hg to 1.70 0.95 mm Hg in the SLT and latanoprost group respectively.
Conclusion: SLT and latanoprost significantly reduced IOP and IOP fluctuations.

Details Poster Presentation
Source American Academy of Ophthalmology, 2006 Nov 11-14, Las Vegas. PO121.
Author(s) Nagar M.
Projected cost comparison of selective laser trabeculoplasty versus glaucoma medication in the Ontario Health Insurance Plan.
English
2006

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.

Details Peer-Review
Source Can J Ophthalmol. 2006 Aug;41(4):449-56.
Author(s) Lee R, Hutnik CM.
Long Term (Intervisit) IOP fluctuation following Selective Laser Trabeculoplasty (SLT) as Primary Therapy in Open Angle Glaucoma.
English
2006

Purpose:
Intraocular pressure (IOP) fluctuation has been shown to be an important risk factor for visual field progression in glaucoma. This study evaluated the degree of intervisit IOP fluctuation in patients treated with SLT as primary therapy for open angle glaucoma and compared efficacy of 180 vs 360 degree treatment on postaser IOP fluctuation.

Methods:
This is a retrospective study of 73 eyes of 45 patients, with POAG or OHT, who underwent SLT treatment either 180 degrees (36 eyes) or 360 degrees (37 eyes) with 1 year followp without any additional medical or surgical therapy. IOP was measured at 2 weeks, 2, 6, 9, and 12 months postp. The standard deviation (SD) of the mean postreatment IOP was used as a surrogate for IOP fluctuation. Mean postreatment IOP for each treated eye was determined for the entire followp period, and for month 6 to month 12 followp period (to account for early postreatment IOP response). Postreatment IOP fluctuation for 360 vs 180 degree treatments were also compared. The number of eyes with IOP fluctuation 0.5 SD and greater than 1.5 SD were determined.

Results:
Mean preaser IOP for all eyes was 24.7 2.9 mm Hg, and mean postaser IOP at 1 year was 17.1 2.3 or 30.7% reduction. SD ranged from 0 to 3.5 for the entire follow up period, and 0 to 3.7 for followp month 6 to month 12. A comparison of the number of eyes (%) with SD postreatment 1.5 mm Hg for 180 vs. 360 degrees treatment, and the entire F/U period vs. month 6 to month 12 F/U period, is shown in the table below.

Conclusions:
A majority of patients treated with SLT as primary therapy with 1 year F/U show IOP fluctuations of 1.5 mm Hg SD. The percentage of patients with IOP fluctuations of 1.5 mm Hg SD were greater with 360 degrees treatment and a F/U period beyond 6 months. This indicates IOP fluctuation was greater in the early postp period and lessened at longer followp periods. The data also suggests that a 360 degree treatment is associated with a greater proportion of eyes with smaller longerm IOP fluctuation (SD 1.5 ), compared to 180 degrees of treatment (p=.04).

Details Abstract
Source Invest Ophthalmol Vis Sci. May 2006;47:5462.
Author(s) Prasad N, Latina M, Dagianis J.
Long-term clinical results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma.
English
2006

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.

Details Peer-Review
Source Eur J Ophthalmol. 2006 Jan-Feb;16(1):100-4.
Author(s) Weinand FS, Althen F.
Associations between elevated intraocular pressure and glaucoma, use of glaucoma medications, and 5-year incident cataract: the Blue Mountains Eye Study.
English
2006

PURPOSE:
To examine incident relationships between elevated intraocular pressure (IOP), open-angle glaucoma (OAG), and use of glaucoma medications with 5-year incident cataract.

DESIGN:
Population-based cohort study.

PARTICIPANTS:
The Australian Blue Mountains Eye Study examined 3654 participants > or =50 years old at baseline (82.4% response; 1992-1994); 2335 eligible participants were reexamined after 5 years (75.1% response; 1997-1999).

METHODS:
A detailed medical and ocular history, including current medications, was taken, and a comprehensive eye examination, including applanation tonometry, automated perimetry, and lens photography, was performed at each examination. The Wisconsin system was used to grade lens photographs in assessing incident nuclear, cortical, and posterior subcapsular cataract (PSC). Data from both eyes were assessed using generalized estimating equation analyses.

MAIN OUTCOME MEASURES:
Elevated IOP was defined as > or =21 mmHg. Open-angle glaucoma was diagnosed from typical glaucomatous field loss with matching optic disc cupping, without reference to IOP. Subjects without OAG or secondary or angle-closure glaucoma with IOP > 21 mmHg in either eye were classified as having ocular hypertension (OH), as were non-OAG subjects with IOP < 22 mmHg using glaucoma medications. Wisconsin levels 4 to 5 were graded as nuclear cataract, at least 5% lens involvement was graded as cortical cataract, and any PSC defined its presence.

RESULTS:
The 5-year incidence of nuclear cataract was 23.4% (592/2532), or 23.1% (574/2486) after excluding subjects using glaucoma medication. A marginally significant association was found for elevated IOP or OH at baseline and incident nuclear cataract (odds ratio [OR], 1.93 [95% confidence interval (CI), 0.97-3.89], and OR, 1.83 [95% CI, 0.96-3.48], respectively) in subjects not using glaucoma medications, after multivariate adjustment. Age- and gender-adjusted analyses showed similar but statistically significant associations. The association between elevated IOP or OH and nuclear cataract was significant in multivariate analyses (OR, 2.07 [95% CI, 1.04-3.12], and OR, 1.78 [95% CI, 1.05-3.01], respectively). Use of glaucoma medications was associated with nonsignificantly increased adjusted odds for incident nuclear cataract (OR, 1.90 [95% CI, 0.92-3.92]). No associations, however, were found with incident cortical cataract or PSC.

CONCLUSIONS:
Elevated IOP may increase the risk of nuclear cataract, but not that of other types. The use of glaucoma medications could magnify this risk.

Details Peer-Review
Source Ophthalmology. 2006 Mar;113(3):417-24. Epub 2006 Feb 3.
Author(s) Chandrasekara S, Cumming RG, Rochtchina E, et al.
Selective laser trabeculoplasty: predictive value of early intraocular pressure measurements for success at 3 months.
English
2006

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).

CONCLUSIONS:
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.

Details Peer-Review
Source Br J Ophthalmol. 2006 Jun;90(6):741-3. Epub 2006 Feb 7.
Author(s) Johnson PB, Katz LJ, Rhee DJ.
Selective laser trabeculoplasty for intraocular pressure elevation after intravitreal triamcinolone acetonide injection.
English
2006

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.

Details Peer-Review
Source Optom Vis Sci. 2006 Jul;83(7):421-5.
Author(s) Pizzimenti JJ, Nickerson MM, Pizzimenti CE, et al.
Laser trabeculoplasty trends with the introduction of new medical treatments and selective laser trabeculoplasty.
English
2006

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.

Details Peer-Review
Source J Glaucoma. 2006 Aug;15(4):306-9
Author(s) Rachmiel R, Trope GE, Chipman ML, et al.
[Selective laser trabeculoplasty treatment for medication-refractory open angle glaucoma].
Hebrew
2005

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.

Details Peer-Review
Source Harefuah. 2005 Nov;144(11):790-3, 822, 821.
Author(s) Geyer O, Wolf A, Levinger E, et al.
How SLT Works.
English
2005

Details Article
Source Glaucoma Today. Mar/Apr 2005:30-1.
Author(s) Noecker RJ.
Selective Laser Trabeculoplasty Effective in Lowering, Maintaining IOP
English
2005

Details Article
Source Ocular Surgery News. 2005 Oct 1.
Author(s) Kronemyer B.
Baseline IOP predicts selective laser trabeculoplasty success at 1 year post-treatment: results from a randomised clinical trial.
English
2005

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.

Details Peer-Review
Source Br J Ophthalmol. 2005 Sep;89(9):1157-60.
Author(s) Hodge WG, Damji KF, Rock W, et al.
Selective laser trabeculoplasty as a replacement for medical therapy in open-angle glaucoma.
English
2005

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.

Details Peer-Review
Source Am J Ophthalmol. 2005 Sep;140(3):524-5.
Author(s) Francis BA, Ianchulev T, Schofield JK, et al.
Selective laser trabeculoplasty.
English
2005

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.

Details Peer-Review
Source Ophthalmol Clin North Am. 2005 Sep;18(3):409-19, vi.
Author(s) Latina MA, de Leon JM.
A new insight into the cellular regulation of aqueous outflow: how trabecular meshwork endothelial cells drive a mechanism that regulates the permeability of Schlemm's canal endothelial cells.
English
2005

AIM:
To test the hypothesis that trabecular meshwork endothelial cells (TMEs) increase the permeability of Schlemm's canal endothelial cells (SCEs) by actively releasing ligands that modulate the barrier properties of SCEs.

METHODS:
The TMEs were first irradiated with a laser light and allowed to condition the medium, which is then added to SCEs. The treatment response is determined by both measuring SCE permeability (flow meters) and the differential expression of genes (Affymetrix chips and quantitative polymerase chain reaction (PCR)). The cytokines secreted by the treated cells were identified using ELISA and the ability of these cytokines to increase permeability is tested directly after their addition to SCEs in perfusion experiments.

RESULTS:
SCEs exposed to medium conditioned by the light activated TMEs (TME-cm) respond by undergoing a differential expression (DE) of 1,120 genes relative to controls. This response is intense relative to a DE of only 12 genes in lasered SCEs. The TME-cm treatment of SCEs increased the SCE permeability fourfold. The role of cytokines in these responses is supported by two findings: adding specific cytokines established to be secreted by lasered TMEs to SCEs increases permeability; and inactivating the TME-cm by boiling or diluting, abrogates these conditioned media permeability effects.

CONCLUSION:
These experiments show that TMEs can regulate SCE permeability and that it is likely that TMEs have a major role in the regulation of aqueous outflow. This novel TME driven cellular mechanism has important implications for the pathogenesis of glaucoma and the mechanism of action of laser trabeculoplasty. Ligands identified as regulating SCE permeability have potential use for glaucoma therapy.

Details Peer-Review
Source Br J Ophthalmol. 2005 Nov;89(11):1500-5.
Author(s) Alvarado JA, Alvarado RG, Yeh RF, et al.
Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks.
English
2005

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.

Details Peer-Review
Source Am J Ophthalmol. 2005 Jun;139(6):1110-3.
Author(s) Harasymowycz PJ, Papamatheakis DG, Latina M, et al.
[Long-term results after selective laser trabeculoplasty -- a clinical study on 269 eyes].
German
2005

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.

Details Peer-Review
Source Klin Monatsbl Augenheilkd. 2005 Apr;222(4):326-31.
Author(s) Best UP, Domack H, Schmidt V.
Glaucoma lasers: a review of the newer techniques.
English
2005

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.

Details Peer-Review
Source Curr Opin Ophthalmol. 2005 Apr;16(2):89-93.
Author(s) Holz HA, Lim MC.
SLT fares best as early intervention in glaucoma.
English
2005

Details Article
Source Ophthalmology Times, April 15, 2005.
Author(s) Iwach A.
Trials find SLT safe, effective in different populations.
English
2005

Details Article
Source Ocular Surgery News. 29 March 2005.
Author(s) N/A
The Effect of Topical Glaucoma Medication On the Efficacy of SLT.
English
2004

The type of medication affects additional IOP lowering with SLT. SLT is more effective if eyes concomitantly receive aqueous suppressants vs. Prostaglandins SLT.

Details Article
Source Glaucoma Today Nov-Dec 2004; 31-33.
Author(s) Latina MA, De Leon JMS.
Comparison of long-term outcomes of selective laser trabeculoplasty versus argon laser trabeculoplasty in open-angle glaucoma.
English
2004

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 nonoverlapping 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, nonoverlapping 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).

CONCLUSIONS:
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.

Details Peer-Review
Source Ophthalmology. 2004 Oct;111(10):1853-9.
Author(s) Juzych MS, Chopra V, Banitt MR, et al.
SLT compared to drugs as first-line glaucoma therapy.
English
2004

Introduction to randomized trial comparing SLT to medical therapy as initial therapy for OAG.

Details Article
Source Ocular Surgery News. 26 October 2004.
Author(s) N/A