The Effect of Selective Laser Trabeculoplasty on Aqueous Humor Dynamics in Patients With Ocular Hypertension and Primary Open-angle Glaucoma

Beltran‐Agullo, Laura; Alaghband, Pouya; Obi, Adanna; Husain, Rahat; Lim, Kin-Sheng

doi:10.1097/ijg.0b013e31825af0eb

Cited by 25 publications

(22 citation statements)

References 13 publications

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“…The follow-up measurement was done at a consistent time after the laser, allowing 3 months for laser effects to be established before making repeat measurements. Given the fairly low baseline outflow facility in the two prior reports (0.08 μL/min/mm Hg and 0.09 μL/min/mm Hg), 14,15 our study perhaps represents a more moderate degree of trabecular pathology, more representative and generalizable to what is likely to be encountered in clinics.…”

Section: Discussionmentioning

confidence: 69%

“…Using Schiotz tonometry–based tonographic assessment, other authors 14,15 have reported an increase in outflow facility after SLT. This study has an expanded design as compared with any prior similar study.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have shown an increase in conventional outflow facility at 1 and 3 months and no effect on aqueous humor inflow rate at 3 months after SLT. 14,15 These are two important parameters of aqueous humor dynamics (AHD), changes in which alter IOP. Other parameters important in regulating IOP but with unknown roles in the IOP responses to SLT treatment are episcleral venous pressure (EVP) and uveoscleral outflow.…”

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confidence: 99%

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Mechanism of Action of Selective Laser Trabeculoplasty and Predictors of Response

Gulati

Fan

Gardner

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PurposeThis 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.MethodsThirty-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.ResultsCompared 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 μL/min/mm Hg at baseline to 0.24 ± 0.14 μL/min/mm Hg at 3 months (P = 0.008). Outflow facility by tonography (baseline: 0.16 ± 0.07 μL/min/mm Hg vs. 3 months: 0.22 ± 0.16 μL/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.ConclusionsThe 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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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Mechanism of Action of Selective Laser Trabeculoplasty and Predictors of Response

Gulati

Fan

Gardner

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…In previously untreated OHTN, 360°treatment with SLT caused a 55.5% increase in outflow facility and 21% reduction in IOP [63]. A study by the same group compared the effect of 180°vs.…”

Section: Aqueous Dynamics Of Laser Trabeculoplastymentioning

confidence: 99%

Laser Trabeculoplasty and Aqueous Dynamics

Lee¹,

Rahmatnejad²,

Waisbourd³

et al. 2016

Glaucoma - Intraocular Pressure and Aqueous Dynamics

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For the past four decades, laser trabeculoplasty has been a staple in the treatment armamentarium against glaucoma. Although the exact mechanism of laser trabeculoplasty has not been fully elucidated, its clinical utility in lowering intraocular pressure has been well established. Aqueous dynamic studies uniformly reveal an increase in aqueous outflow facility at the trabecular meshwork. Accumulating evidence suggests that the mechanism is the result of complex cellular and biochemical processes. Histopathological studies of the trabecular meshwork tissue after argon laser suggest an additional mechanical role. The traditional treatment algorithm for glaucoma placed laser trabeculoplasty as an intermediary between medical therapy and incisional surgery. However, because of the safety profile of selective laser trabeculoplasty, recent studies have challenged this treatment paradigm. One such study was a multicenter trial headed by our department that compared laser trabeculoplasty and medical therapy as initial treatment for glaucoma. We showed a similar efficacy between the two modalities, reinforcing the possibility of using laser as the initial treatment in the right clinical setting.

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“…Sua eficácia é mais limitada, em termos de redução da PIO, assim como a duração de seu efeito 42,43 .…”

Section: Tratamento Clínico E Cirúrgicounclassified

Estudo da eficácia do agulhamento transconjuntival com 5-fluoracil em olhos com pressão intraocular elevada e bolha encapsulada pós trabeculectomia

Suzuki¹

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The Effect of Selective Laser Trabeculoplasty on Aqueous Humor Dynamics in Patients With Ocular Hypertension and Primary Open-angle Glaucoma

Abstract: Our results show that SLT lowers the IOP by increasing the outflow through the trabecular meshwork, but it has no significant effect on the aqueous flow rate.

Cited by 25 publications

References 13 publications

Mechanism of Action of Selective Laser Trabeculoplasty and Predictors of Response

Mechanism of Action of Selective Laser Trabeculoplasty and Predictors of Response

Laser Trabeculoplasty and Aqueous Dynamics

Estudo da eficácia do agulhamento transconjuntival com 5-fluoracil em olhos com pressão intraocular elevada e bolha encapsulada pós trabeculectomia

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