Evaluation of selective laser trabeculoplasty as an intraocular pressure lowering option

Abstract

Purpose Selective laser trabeculoplasty (SLT) is one of the many treatment options for lowering intraocular pressure (IOP) in patients with glaucoma. This study aimed to evaluate the effect of SLT. Methods Data were collected from medical records of 289 patients who underwent SLT treatment (180° of trabecular meshwork) during 2014 and 2015 at the Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden. Baseline characteristics and information from a follow‐up within 100 days were also recorded. The study analysed different subtypes of glaucoma with regard to SLT, with a particular focus on exfoliative glaucoma, a common subtype in Sweden. Successful treatment was defined as an IOP lowering effect of >20% with no further changes in treatment. The impact of surgeon's experience on treatment outcome was also analysed. Results Both patients with exfoliative glaucoma and those with primary open‐angle glaucoma showed a reduction in mean IOP; no significant difference was found between these two subtypes before treatment or at the first follow‐up. The success rate at follow‐up (within 100 days) was 52%. There was a significant difference in outcome between surgeons with different levels of experience, but this difference could likely be explained by differences in treatment strategies and total energy used. Conclusion For many patients with glaucoma, SLT was an effective treatment option for lowering IOP. It was also effective for several glaucoma subtypes. However, not all patients had a significant reduction in IOP after treatment with SLT, and some may require additional treatment.

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

“…Some of the previously published work excluded patients with advanced visual field defects, systemic steroid use, and previous eye surgeries. [2,3,8] No such exclusions were made in this study, which could contribute to the observed disparity in the success rates of SLT.…”

“…It is generally regarded as effective and safe. Prior studies have indicated that the IOP-reducing ability of SLT is comparable to that of topical glaucoma drops [2][3][4]. However, SLT may be preferred over topical drops as it potentially avoids any associated side effects as well as issues that may arise from variable patient adherence [1,5].…”

“…It has been well established that the effects of SLT are not permanent. Specifically, prior studies have indicated that approximately 50% of SLT treatments fail within a 2-year period and require further treatment [1,2]. However, the comparative longevity of 180°and 360°of SLT application has not been definitively established.…”

Laser in Glaucoma and Ocular Hypertension Trial (LIGHT) in China – A Randomized Controlled Trial: Design and Baseline Characteristics

“…In China, medication currently serves as the mainstream first-line treatment for POAG and OHT 14 . Studies in China 15,16 and other countries [17][18][19] have reported greatly varied treatment efficacy for SLT which is possibly due to differences in severity of glaucoma, ethnic background 20,21 , laser energy used, treatment area and length of follow-up. In the past, SLT has been mainly used for cases with uncontrolled IOP, intolerance to medical therapy and poor compliance in mild POAG [46][47][48] .…”

Selective laser trabeculoplasty as the primary treatment for open angle glaucoma: time for change?

“…Where efficacy is concerned, most SLT studies have reported a high success rate of~6.9-35.9% reduction in IOP for OAG [10]. However, the predictability of SLT has been reported to be variable in some studies [11], with this inconsistency attributed to factors such as the patient population, type of glaucoma, SLT treatment protocol, or even surgeon factors-with failure rates of up to 60% reported in certain studies [12]. Furthermore, the effect of laser trabeculoplasty has been reported to decrease over time [13], with 68% of eyes in the GLT requiring additional IOP-lowering interventions after 5 years.…”