Where does selective laser trabeculoplasty stand now? A review

Abstract

BackgroundChronic treatment of glaucoma can present a challenge in patients who lack the means and/or the discipline to use daily glaucoma medication. We wondered if selective laser trabeculoplasty (SLT) could be a useful alternative.MethodsInclusion criteria: controlled trials comparing efficacy of SLT in adult patients with any form of open angle glaucoma or ocular hypertension and case reports on side effects of SLT. Two recent meta-analyses identified eight randomized clinical trials (RCTs) comparing the effect of SLT with medication (prostaglandin analogs) and with argon laser trabeculoplasty (ALT). We took these eight RCTs as reference base and calculated their success rates where they were not given. Other articles were added to elaborate on technique and side effects.ResultsMean intraocular pressure (IOP) reduction after SLT was 3.8–8.0 mmHg after 6 months to 1 year. Mean success rate of SLT at 6 months to 1 year is 55–82 %. Higher IOP before laser predicts a higher IOP-lowering effect. In terms of mean IOP reduction, reduction in number of medications and treatment success, the effect of SLT was found to show no clinically relevant difference from that of contemporary medication (prostaglandin analogs) and from ALT.ConclusionsThe evidence indicates that SLT is an efficacious primary or adjunctive therapy for treating glaucoma.

Predictive Factors for Outcomes of Selective Laser Trabeculoplasty

“…It may also be due to the flexible patient-specific definition of success used in that trial compared to our singular success criteria. Our success rate was consistent with other existing literature that included medically treated glaucoma that generally report rates from 15-66% [29][30][31][32] .…”

Efficacy of selective laser trabeculoplasty in primary angle closure disease

“…Selective laser trabeculoplasty (SLT) has been shown to result in IOP reduction in POAG, pigment dispersion syndrome and pseudo-exfoliation syndrome [8]. SLT has fewer complications compared to surgery, addresses the issue of compliance associated with medications and therefore maybe considered as a cost-effective treatment option in a developing country like India [8,9]. SLT offers the advantage due to its mechanism where it uses a selective wavelength which specifically targets only the pigmented epithelium of trabecular meshwork.…”

Selective laser trabeculoplasty in exfoliative glaucoma eyes with prior argon laser trabeculoplasty

“…The baseline IOP was shown to be a significant determinant for the success of SLT in uncontrolled open-angle glaucoma (Damji et al 1999;Hodge et al 2005;Mao et al 2008;Ayala & Chen 2011;Martow et al 2011). Many previous studies have defined the SLT success by achieving over 20% IOP reduction (Gracner 2002;Song et al 2005;Kara et al 2013;Kent et al 2015;Miraftabi et al 2016;De Keyser et al 2016;Zhou & Aref 2017;Katsanos et al 2018). Here, regardless that all eyes had previously underwent ALT, the success rates 50% at 3 months and 42% at 9 months after SLT were in accordance with previous reports in XFG eyes without ALT; 73-94% at 6 months and 25-78% at 1 year (Kara et al 2013;Kent et al 2015;Miraftabi et al 2016).…”