Selective laser trabeculoplasty (SLT): 1-year results in early and advanced open angle glaucoma

Abstract

The purpose of this study was to examine the efficacy of selective laser trabeculoplasty (SLT) in eyes with early and more advanced stages of open angle glaucoma within 1 year of follow-up. Retrospective chart review in a consecutive series of patients treated by SLT to reduce intraocular pressure (IOP) or decrease number of topical medications in cases of discomfort and allergy. The cup-to-disc ratio of the optic nerve and the GSS 2 (glaucoma staging system 2) was used to differentiate between early (group 1) and more advanced (group 2) stages of glaucoma. At the time of SLT treatment, no new signs of glaucoma progression were seen. Only the first treated eye of every patient was included in the analysis. In group 1 (early glaucoma), 27 eyes were included. IOP reduction <21 mmHg/>20 % of the preoperative IOP-value and reduction of medication were achieved in 17 eyes (62.96 %). Successful re-treatment was necessary in 2 eyes (7.4 %). In group 2 (advanced glaucoma), 44 eyes underwent SLT. In eight eyes (18.18 %), filtrating surgery was necessary after initial SLT. In the remaining 36 eyes, IOP reduction <21 mmHg/>20 % of the baseline IOP was achieved in 26 eyes (59.09 % of 44 eyes) and IOP reduction <18 mmHg/> 30 % of the baseline IOP in 22 eyes (50 % of 44 eyes). SLT was safe and effective in nearly 2/3 of early glaucoma patients and also in 50 % of advanced glaucoma patients using stronger criteria of success. Failure of SLT in advanced glaucoma should lead to immediate filtrating surgery, which seems not to be associated with higher risk of fibrosis.

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

“…The success rates were 63% and 59.1% for early and advanced OAG, respectively. Results from this study allow clinicians to consider SLT as an alternative to higher-risk incisional therapies in advanced stages of OAG [13]. …”

Stellenwert der selektiven Lasertrabekuloplastik (SLT)

“…Da die SLT im Normalfall einen Zieldruckbereich zwischen 15 und 20 mmHg erreichen kann, ist sie kein Verfahren der ersten Wahl zur Behandlung fortgeschrittener Glaukome, für die oft ein Zieldruckbereich < 15 mmHg definiert wird. Bei kompensierten fortgeschrittenen Glaukomen kann sie aber bei reduzierter Verträglichkeit der medikamentösen Glaukomtherapie oder fehlenden Alternativen eingesetzt werden [18]. Bei Zeichen der Progression im Gesichtsfeld oder OCT sollte aber nach anderen Möglichkeiten der Drucksenkung gesucht werden.…”

“…Schon bei der ALT war ein möglicher negativer Einfluss auf eine nachfolgende Trabekulektomie diskutiert worden und hat auch teilweise zu einer zurückhaltenden Position gegenüber der ALT beigetragen. Nach eigenen Erfahrungen scheint die SLT aber nicht das Vernarbungsrisiko einer nachfolgenden filtrierenden Chirurgie zu erhöhen [18].…”

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

“…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) . Conversely, the use of PGA before laser was associated with a decreased IOP-lowering response (61) , and SLT treatment had limited results in eyes with OAG receiving maximal-tolerable medical therapy (50,62) .…”