Effectiveness of Selective Laser Trabeculoplasty Applied to 360° vs. 180° of the Angle

Abstract

Purpose. To compare the effectiveness and safety of 360° and 180° of Selective Laser Trabeculoplasty (SLT) for the treatment of elevated intraocular pressure (IOP). Methods. Retrospective cohort study. The main outcome measure was the Kaplan–Meier analysis comparing the cumulative probabilities of survival between the 360° and 180° SLT groups in terms of IOP reduction. Success was defined as ≥20% IOP reduction from baseline with an IOP between 5–18 mmHg and ≤1 glaucoma medication added postoperatively. Additional outcome measures included changes in average IOP, number of glaucoma medications, and the incidence of postoperative IOP spikes. Measurements were obtained at 6 weeks, 1 year, and 2 years postoperatively. Results. Two hundred and fifty-eight eyes of 258 patients were included in the 360° group, and 196 eyes of 196 patients were included in the 180° group. The mean IOP reductions at 2 years were 2.21 ± 2.02 mmHg and 2.43 ± 1.81 mmHg ( p = 0.33 ) in the 180° and 360° groups, respectively. There were no significant differences in the incidence of postoperative IOP spikes between the two groups. There was a significant difference in the survival curves of the two groups ( p = 0.035 ). The Cox proportional-hazard model indicated that 360° of SLT application was a significant predictor of long-term success ( p = 0.030 ). Conclusions. 360° of SLT application seems to provide for greater long-term IOP control than 180° of application without putting patients at an elevated risk for postoperative IOP spikes.

A Review of Selective Laser Trabeculoplasty: “The Hype Is Real”

“…Many studies and meta-analyses have compared the treatment of different degrees of the TM. While some found a significant difference in the IOP-lowering effect between treating 180 • and 360 • of the TM in POAG [34,65], others did not [66][67][68], but one study showed lesser diurnal IOP fluctuations when treating 360 • [69]. Most reviews have concluded that there is no significant difference when treating 180 • or 360 • [11,38,70], as confirmed by a recent meta-analysis [71].…”

Five-year outcomes of selective laser trabeculoplasty: A retrospective study

“…Although SLT has been shown to provide significant IOP reduction for glaucomatous eyes receiving concurrent medical therapy during the short-term follow-up period ( 10 , 11 , 19 – 21 ), we found that 49% of eyes received a subsequent surgical intervention in addition to continued medical therapy within 5 years to control IOP in response to progressively decreasing visual function. For the other 51% of eyes, one-time SLT with continued medical therapy significantly lowered IOP without subsequent surgical intervention.…”

Selective laser trabeculoplasty: An updated narrative review

“…SLT can be administered in 1–4 quadrants of the eye (90°, 180°, 270°, and 360°), and multiple studies have compared the variability in IOP outcomes based on the extent of treatment. 360° of SLT has been associated with better efficacy in comparison to 180° at 6 months,[ 68 ] 12 months,[ 69 ] 18 months,[ 70 ] and 24 months[ 71 ] of follow-up. Prasad et al .…”