Repeatability of primary selective laser trabeculoplasty in patients with primary open-angle glaucoma

Abstract

To determine if primary selective laser trabeculoplasty (SLT) can be repeated with clinical benefit in patients with primary open-angle glaucoma (POAG). Forty-two eyes of 42 patients with POAG were studied. All patients underwent primary SLT treatment of 40-50 shots to the trabecular meshwork over 360°. The treatment response at the initial post-SLT visit (4 weeks), and second post-SLT visit (mean 4 months), clinical success and duration of clinical success were measured. SLT was repeated in all patients after failure to maintain target intraocular pressure (IOP). The same parameters were measured after repeat SLT. The main outcome measures were success of treatment (as defined by reduction of IOP by at least 20 % and below an individually determined target pressure), duration of treatment success and reduction in IOP. No significant difference between initial and repeat treatments was found for mean reduction in IOP or success rate, or duration of success. Survival analysis found significantly longer benefit for repeat treatment compared to initial treatment (P < 0.01). Repeat SLT treatment in eyes with POAG has similar efficacy to primary SLT treatment with respect to reduction in IOP and success rates, produces a longer duration of treatment success.

Significant peripheral anterior synechiae after repeat selectıve laser trabeculoplasty

“…1 To date, only 2 studies reported the results of repeat SLT after failed SLT; none of these studies reported PAS. 7,8 To our knowledge, this is the first report to demonstrate PAS as a late complication of repeat SLT. Both of our patients had undergone successful and uneventful SLT 3 and 4 years ago by the same surgeon performing the repeat SLT.…”

“…3 Unlike ALT, SLT has the theoretical advantage of being more repeatable because it uses about 100 times less energy than ALT and causes minimal damage to the trabecular meshwork with no subsequent contractile laser scars. [7][8][9] SLT is considered a low-risk procedure. The most frequent adverse effects are transient IOP spike, mild anterior chamber inflammation, photophobia, and conjunctival hyperemia.…”

Selective laser trabeculoplasty as an initial treatment option for open-angle glaucoma

“…Looking close at the more recent literature, one can note several studies showing that SLT can be repeated with similar efficacy when compared to the first SLT treatment. In these studies, POAG patients presented a significant IOP reduction at 1 (46) , 4 (47) , 6 (46) , 12 (19,48) , 15 (46) , and 24 months after repeating SLT (26,49) . Corroborating these findings, Gandolfi and Ungaro demonstrated that repeated low power SLT as initial treatment postponed the initiation of medical therapy by a mean time of 6.2 years in patients with OHT (19) .…”

“…Some success predictors are well established. For instance, better results are usually observed in patients with POAG (33,37,(51)(52)(53)(54)(55)(56) , pseudoexfoliative glaucoma (31,40,57,58) , and higher baseline IOP (40,41,46,47) . A few isolated studies observed better results in eyes with thinner corneas (59) , with earlier disease stage (60) , and with higher refractive errors (52) .…”

“…With this in mind, we believe it is reasonable to consider alternative treatments, such as laser therapy, as first-line treatment options (17,28,29) . SLT has a good safety profile, does not rely on patient compliance, and has shown to be at least as effective as topical medications in lowering IOP as an initial treatment (for at least one year) (70)(71)(72) and can be repeated when IOP control is lost over time (19,(46)(47)(48) , possibly allowing patients to remain free of topical medication for years (73,74) . In a chronic disease such as OAG, time is always a key parameter.…”