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

Abstract

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

Evaluation of selective laser trabeculoplasty effectiveness in cases with pseudoexfoliation glaucoma and ocular hypertension

“…[2,3,5,6,8] In literature, most of the studies related to SLT were investigated the SLT application as an adjuvant treatment choice, such as for OAG patients responding insufficiently to topical drugs or using medications irregularly, or for delaying the glaucoma surgery. [3,8,14] The number of studies evaluating the SLT as primary therapy was relatively low. [3,8,14] Gracner applied the 180° SLT as adjuvant treatment to uncontrolled PEG cases.…”

“…[3,8,14] The number of studies evaluating the SLT as primary therapy was relatively low. [3,8,14] Gracner applied the 180° SLT as adjuvant treatment to uncontrolled PEG cases. The authors reported an IOP reduction of 22.9% at 3rd month in eyes with a baseline IOP of 23.6 mmHg.…”

Evaluation of selective laser trabeculoplasty effectiveness in cases with pseudoexfoliation glaucoma and ocular hypertension

“…[2,3,5,6,8] In literature, most of the studies related to SLT were investigated the SLT application as an adjuvant treatment choice, such as for OAG patients responding insufficiently to topical drugs or using medications irregularly, or for delaying the glaucoma surgery. [3,8,14] The number of studies evaluating the SLT as primary therapy was relatively low. [3,8,14] Gracner applied the 180° SLT as adjuvant treatment to uncontrolled PEG cases.…”

“…[3,8,14] The number of studies evaluating the SLT as primary therapy was relatively low. [3,8,14] Gracner applied the 180° SLT as adjuvant treatment to uncontrolled PEG cases. The authors reported an IOP reduction of 22.9% at 3rd month in eyes with a baseline IOP of 23.6 mmHg.…”

Real-World Data from Selective Laser Trabeculoplasty in Brazil

“…18,19 Previous studies have investigated predictors of success and the use of SLT as rst line therapy, but to date, there is no real-world evidence based on large SLT data obtained from Glaucoma Services in Brazil. [20][21][22] Such results would certainly add clinicians regarding best clinical indications and predictors of success for SLT in Brazilian patients.…”

Cost-analysis of Surgical Intraocular Pressure Management in Glaucoma

“…Representative index studies were identified as bases to estimate the mean IOP and glaucoma medications reduction for each surgical treatment modality of glaucoma including tube, [16][17][18][19][20] trabeculectomy, [16][17][18]21,22 cyclophotocoagulation (CPC), 23,24 gonioscopy-assisted transluminal trabeculotomy, 25 iStent, 11,26,27 Kahook dual blade, 28 Hydrus, 29 XEN, 30 trabectome, 31 and SLT surgery. 9,[32][33][34][35][36] Combined MIGS-cataract extraction was not factored in the DOI: 10.1097/IJG.0000000000001938 calculations since accounting for this is very difficult given the varied indications between practitioners. Similarly, we presumed all MIGS modalities resulted in a similar postoperative drop regimen since the variation seems to be more practitioner-related than evidence-based indication-related.…”

“…All research was performed in accordance with the Declaration of Helsinki. Representative index studies were identified as bases to estimate the mean IOP and glaucoma medications reduction for each surgical treatment modality of glaucoma including tube,16–20 trabeculectomy,16–18,21,22 cyclophotocoagulation (CPC),23,24 gonioscopy-assisted transluminal trabeculotomy,25 iStent,11,26,27 Kahook dual blade,28 Hydrus,29 XEN,30 trabectome,31 and SLT surgery 9,32–36. Combined MIGS-cataract extraction was not factored in the calculations since accounting for this is very difficult given the varied indications between practitioners.…”

Evaluation of selective laser trabeculoplasty effectiveness in cases with pseudoexfoliation glaucoma and ocular hypertension

“…[2,3,5,6,8] In literature, most of the studies related to SLT were investigated the SLT application as an adjuvant treatment choice, such as for OAG patients responding insufficiently to topical drugs or using medications irregularly, or for delaying the glaucoma surgery. [3,8,14] The number of studies evaluating the SLT as primary therapy was relatively low. [3,8,14] Gracner applied the 180° SLT as adjuvant treatment to uncontrolled PEG cases.…”

“…[3,8,14] The number of studies evaluating the SLT as primary therapy was relatively low. [3,8,14] Gracner applied the 180° SLT as adjuvant treatment to uncontrolled PEG cases. The authors reported an IOP reduction of 22.9% at 3rd month in eyes with a baseline IOP of 23.6 mmHg.…”

Real-World Data from Selective Laser Trabeculoplasty in Brazil

“…18,19 Previous studies have investigated predictors of success and the use of SLT as rst line therapy, but to date, there is no real-world evidence based on large SLT data obtained from Glaucoma Services in Brazil. [20][21][22] Such results would certainly add clinicians regarding best clinical indications and predictors of success for SLT in Brazilian patients.…”

Cost-analysis of Surgical Intraocular Pressure Management in Glaucoma

“…Representative index studies were identified as bases to estimate the mean IOP and glaucoma medications reduction for each surgical treatment modality of glaucoma including tube, [16][17][18][19][20] trabeculectomy, [16][17][18]21,22 cyclophotocoagulation (CPC), 23,24 gonioscopy-assisted transluminal trabeculotomy, 25 iStent, 11,26,27 Kahook dual blade, 28 Hydrus, 29 XEN, 30 trabectome, 31 and SLT surgery. 9,[32][33][34][35][36] Combined MIGS-cataract extraction was not factored in the DOI: 10.1097/IJG.0000000000001938 calculations since accounting for this is very difficult given the varied indications between practitioners. Similarly, we presumed all MIGS modalities resulted in a similar postoperative drop regimen since the variation seems to be more practitioner-related than evidence-based indication-related.…”

“…All research was performed in accordance with the Declaration of Helsinki. Representative index studies were identified as bases to estimate the mean IOP and glaucoma medications reduction for each surgical treatment modality of glaucoma including tube,16–20 trabeculectomy,16–18,21,22 cyclophotocoagulation (CPC),23,24 gonioscopy-assisted transluminal trabeculotomy,25 iStent,11,26,27 Kahook dual blade,28 Hydrus,29 XEN,30 trabectome,31 and SLT surgery 9,32–36. Combined MIGS-cataract extraction was not factored in the calculations since accounting for this is very difficult given the varied indications between practitioners.…”

Evaluation of selective laser trabeculoplasty effectiveness in cases with pseudoexfoliation glaucoma and ocular hypertension

“…[2,3,5,6,8] In literature, most of the studies related to SLT were investigated the SLT application as an adjuvant treatment choice, such as for OAG patients responding insufficiently to topical drugs or using medications irregularly, or for delaying the glaucoma surgery. [3,8,14] The number of studies evaluating the SLT as primary therapy was relatively low. [3,8,14] Gracner applied the 180° SLT as adjuvant treatment to uncontrolled PEG cases.…”

“…[3,8,14] The number of studies evaluating the SLT as primary therapy was relatively low. [3,8,14] Gracner applied the 180° SLT as adjuvant treatment to uncontrolled PEG cases. The authors reported an IOP reduction of 22.9% at 3rd month in eyes with a baseline IOP of 23.6 mmHg.…”

Real-World Data from Selective Laser Trabeculoplasty in Brazil

“…18,19 Previous studies have investigated predictors of success and the use of SLT as rst line therapy, but to date, there is no real-world evidence based on large SLT data obtained from Glaucoma Services in Brazil. [20][21][22] Such results would certainly add clinicians regarding best clinical indications and predictors of success for SLT in Brazilian patients.…”

Cost-analysis of Surgical Intraocular Pressure Management in Glaucoma

“…Representative index studies were identified as bases to estimate the mean IOP and glaucoma medications reduction for each surgical treatment modality of glaucoma including tube, [16][17][18][19][20] trabeculectomy, [16][17][18]21,22 cyclophotocoagulation (CPC), 23,24 gonioscopy-assisted transluminal trabeculotomy, 25 iStent, 11,26,27 Kahook dual blade, 28 Hydrus, 29 XEN, 30 trabectome, 31 and SLT surgery. 9,[32][33][34][35][36] Combined MIGS-cataract extraction was not factored in the DOI: 10.1097/IJG.0000000000001938 calculations since accounting for this is very difficult given the varied indications between practitioners. Similarly, we presumed all MIGS modalities resulted in a similar postoperative drop regimen since the variation seems to be more practitioner-related than evidence-based indication-related.…”

“…All research was performed in accordance with the Declaration of Helsinki. Representative index studies were identified as bases to estimate the mean IOP and glaucoma medications reduction for each surgical treatment modality of glaucoma including tube,16–20 trabeculectomy,16–18,21,22 cyclophotocoagulation (CPC),23,24 gonioscopy-assisted transluminal trabeculotomy,25 iStent,11,26,27 Kahook dual blade,28 Hydrus,29 XEN,30 trabectome,31 and SLT surgery 9,32–36. Combined MIGS-cataract extraction was not factored in the calculations since accounting for this is very difficult given the varied indications between practitioners.…”