Acute ultrastructural changes of the trabecular meshwork after selective laser trabeculoplasty and low power argon laser trabeculoplasty

Cvenkel, Barbara; Hvala, Anastazija; Drnovšek-Olup, Brigita; Gale, Nina

doi:10.1002/lsm.10203

Cited by 73 publications

(77 citation statements)

References 16 publications

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“…This low-power setting indicates that the energy delivered to the eye by SLT is significantly less than that of ALT, which results in less tissue damage to the trabecular meshwork. 6,7 The purpose of this systematic review is to compare SLT to other treatment options in terms of their IOP-lowering effect. This will include only randomised controlled trials (RCTs) in which SLT has been compared to any other treatment options.…”

Section: Introductionmentioning

confidence: 99%

Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review

McAlinden

2013

Eye

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Purpose Systemic review to compare selective laser trabeculoplasty (SLT) to other glaucoma treatment options in terms of their intraocular pressure (IOP)-lowering effect. Methods Searches of the following databases were performed: PubMed, Cochrane Central Register of Controlled Trials, Ovid, EMBASE, metaRegister of Controlled Trials, and ClinicalTrials.gov. Only randomised controlled trials (RCTs) published in peer-reviewed journals comparing SLT to other glaucoma treatment options were considered. The main outcome measure was the change in IOP from baseline. Results An initial search of PubMed identified 23 RCTs with 17 meeting the inclusion criteria. Nine RCTs compared 1801 SLT to 1801 argon laser trabeculoplasty (ALT) and one trial compared 3601 SLT to 3601 ALT, all reporting no difference in terms of IOP reduction from baseline. One RCT reported better outcomes with SLT at 1 year but this effect regressed at 2 years. Three trials compared 3601 SLT to medical therapy and found no difference between the two treatment options. One trial found greater IOP reduction with latanoprost vs 901 and 1801 SLT, and greater IOP reduction with 1801 and 3601 SLT versus 901 SLT, however no differences were found between 3601 SLT versus latanoprost or 3601 vs 1801 SLT. Two trials compared 1801 SLT to 3601 SLT finding no difference in IOP reduction. Two trials compared 1801 SLT to 901 SLT, one finding no significant difference and one finding greater IOP reduction with 1801 SLT over 901 SLT. One trial compared excimer laser trabeculotomy (ELT) to 1801 SLT, finding no differences in IOP reduction up to 3 months follow-up but greater IOP reduction with ELT at time intervals between 9 and 24 months. There were no RCTs identified that compared SLT to surgery. Conclusion In terms of the IOP lowering effect, there is no difference between SLT and ALT. Three trials indicate no difference between 3601 SLT and medical therapy, with one of the trials indicating greater IOP reduction with latanoprost over 901 and 1801 SLT. Three trials indicate no difference between 1801 SLT and 3601 SLT. It is inconclusive whether 901 is less efficacious than 1801 SLT. One trial reports greater IOP reduction with ELT over 1801 SLT in the long term.

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Section: Introductionmentioning

confidence: 99%

Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review

McAlinden

2013

Eye

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“…[11][12][13] Ultrastructural analysis of the TM in human eyes after SLT showed no alteration of the collagen structure and central core regions of the trabecular beams with no evidence of coagulative damage of the trabecular structure. 14,15 To date, several reports comparing 1801 SLT vs 1801 ALT 13,[16][17][18] and studies evaluating the efficacy and safety of ELT ab interno over one-half of the TM 9,19,20 have been published.…”

Section: Introductionmentioning

confidence: 99%

Excimer laser trabeculotomy vs 180° selective laser trabeculoplasty in primary open-angle glaucoma. A 2-year randomized, controlled trial

Babighian

Caretti

Tavolato

et al. 2009

Eye

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Purpose To compare the effectiveness and safety of excimer laser trabeculotomy (ELT) ab interno vs selective laser trabeculoplasty (SLT) over 24 months of follow-up in patients with primary open-angle glaucoma (POAG) refractory to medical therapy. Patients and methods This prospective, randomized study included 30 consecutive eyes assigned randomly to either ELT or SLT group. ELT was carried out using a XeCl Excimer Laser with an emission wavelength of 308 nm. Eight spots were equally distributed at a distance of 500 lm from one another over the anterior trabeculum. The SLT patients were treated with a frequencydoubled q-switched neodymium : yytriumaluminum-garnet laser (wavelength 532 nm). Approximately 50 adjacent, but not overlapping, laser spots were distributed over 1801 of the trabecular meshwork, using an energy level ranging from 0.7 to 1.0 mJ per pulse. The main outcome measure was intraocular pressure (IOP) lowering after ELT and SLT. Success was defined as X20% reduction in IOP without further glaucoma intervention. Results At 24 months, complete success rates were 53.3% for the ELT group and 40% for the SLT group (P ¼ 0.35, Fisher's exact test); qualified success rates were 33.3% for the ELT and 26.6% for the SLT group (P ¼ 0.5, Fisher's exact test).Mean IOP decreased from 25.0 ± 1.9 to 17.6 ± 2.2 mmHg (À29.6%; Po0.0001) in the ELT group and from 23.9 ± 0.9 to 19.1 ± 1.8 mmHg (À21%;Po0.0001) in the SLT group.Conclusions Both ELT and SLT proved to be effective techniques in the treatment of POAG refractory to medical therapy.

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“…Cvenkal et al performed a similar comparison wherein ALT or SLT were performed on three eyes from patients awaiting enucleation due to choroidal melanoma. 21 In contrast to Kramer and Noecker, these authors found disruption of the trabecular beams after either form of LTP, although less after SLT than ALT. After both ALT and SLT, lasered tissue was sharply demarcated from surrounding tissue with few pigmented cells observed.…”

Section: Histological Studiesmentioning

confidence: 71%

“…Histological studies have confirmed that ALT does not allow for SP, and indeed causes nonselective tissue disruption and photocoagulation of the TM. [19][20][21][22] Laser-mediated photocoagulation of the TM has become, in fact, a primary method of experimentally increasing IOP in primates. 23 SLT, in contrast, has a much shorter pulse duration (3 ns), which prevents heat dissipation outside of pigmented TM cells, thereby permitting greater localization of damage.…”

Section: Selective Laser Trabeculoplastymentioning

confidence: 99%

Mechanisms of selective laser trabeculoplasty: a review

Kagan

Gorfinkel

Hutnik

2014

Clinical Exper Ophthalmology

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Selective laser trabeculoplasty is a safe and effective treatment for glaucoma, with greater cost effectiveness than its pharmacological and surgical alternatives. Nevertheless, although the basic science literature on selective laser trabeculoplasty continues to grow, there remains uncertainty over the mechanism by which laser trabeculoplasty reduces intraocular pressure. To address this uncertainty, the evidence behind several potential biological and mechanical mechanisms of selective laser trabeculoplasty were reviewed. In particular, cytokine secretion, matrix metalloproteinase induction, increased cell division, repopulation of burn sites and macrophage recruitment were discussed. Refining our understanding of these mechanisms is essential both to understanding the pathophysiology of ocular hypertension and developing improved therapies to treat the condition.

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Acute ultrastructural changes of the trabecular meshwork after selective laser trabeculoplasty and low power argon laser trabeculoplasty

Cited by 73 publications

References 16 publications

Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review

Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review

Excimer laser trabeculotomy vs 180° selective laser trabeculoplasty in primary open-angle glaucoma. A 2-year randomized, controlled trial

Mechanisms of selective laser trabeculoplasty: a review

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