Optimal Selective Laser Trabeculoplasty Energy for Maximal Intraocular Pressure Reduction in Open-Angle Glaucoma

Lee, Jacky; Wong, Michael; Liu, Catherine; Lai, Jimmy S. M.

doi:10.1097/ijg.0000000000000215

Cited by 37 publications

(28 citation statements)

References 20 publications

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“…26 For SLT, delivering a higher total energy has been demonstrated to increase the amount of IOP reduction with no permanent changes to the cornea. 27,28 In MLT, no such evidence exists on the optimal number of laser shots but Ahmed et al reported that at 4 months postlaser, the greatest IOP reduction was achieved when using an energy of 1000 mW per shot as compared to 300 mW or 700 mW. 29 This formed the basis of our treatment protocol in delivering a mean of 1000 mW per shot in each patient.…”

Section: Discussionmentioning

confidence: 97%

MicroPulse Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma

et al. 2015

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The aim of the study was to investigate the safety and efficacy of using MLT in the treatment of open-angle glaucoma (OAG).This prospective cohort included subjects ≥18 years of age with OAG, defined as the open angle on gonioscopy with glaucomatous optic neuropathy evident from optical coherence tomography. Subjects with IOP < 21 mm Hg were classified as normal tension glaucoma and those with IOP ≥21 mm Hg were classified as primary open-angle glaucoma. Those with angle closure, secondary glaucoma, prior laser trabeculoplasty, use of systemic IOP-lowering medications, corneal pathologies, follow-up <6 months, recent intraocular surgery, or only 1 functional eye were excluded. A single session of unilateral MLT treatment was delivered using a 577 nm diode laser to 360° of the trabecular meshwork to reduce IOP or medication load. Medications were titrated up or down at 1 month after laser to achieve a 25% IOP reduction from presentation or an IOP <18 mm Hg, whichever was lower. The following were compared using the Repeated Measures ANOVA with Bonferroni's Multiple Comparison Test: IOP (on presentation, pre-MLT, day 1, 1 week, 1 month, 3 months, and 6 months after MLT) and the number of medications (pre-MLT, 3 months, and 6 months after MLT). After 6 months, responders with initial success to MLT (IOP reduction ≥20% at 1 month) received treatment in the fellow eye.In 48 subjects with OAG, the mean number of MLT shots applied was 120.5 ± 2.0 shots using a mean energy of 1000 mW per shot. Only 7.5% had a mild, self-limiting anterior uveitis postlaser with no change in the Snellen visual acuity at 6 months (P's > 0.5). The IOP and number of medications were significantly reduced at all time intervals following MLT compared to the pre-MLT level (P's < 0.0001). At 6 months, the IOP was reduced by 19.5% in addition to a 21.4% reduction in medication compared to pretreatment levels. The MLT success rate was 72.9%. During the first 6 months only 2.1% required a repeated laser trabeculoplasty.MLT was effective in reducing IOP and medications in OAG with minimal postlaser inflammation and low failure rate at 6 months following laser.

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Section: Discussionmentioning

confidence: 97%

MicroPulse Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma

et al. 2015

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“…The average IOP reduction at 1 month following SLT was 20.2 ± 14.6%. A total energy level of 226.1 mJ (95% confidence interval: 214.58–234.87 mJ) was found to result in a significant reduction in IOP greater than 25% [28]. Results from this study suggest that a total SLT energy level in the range of 214.6–234.9 mJ may lead to higher success rates.…”

Section: Surgical Techniquementioning

confidence: 94%

“…The energy level employed in SLT therapy may also be an important prognostic factor [28]. Age, gender, race, central corneal thickness, history of ALT, history of cataract surgery, and standard automated perimetry mean deviation were not found to be associated with greater IOP reduction after SLT [25–27].…”

Section: Prognostic Factorsmentioning

confidence: 99%

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

Zhou

Aref

2017

Ophthalmol Ther

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Selective laser trabeculoplasty (SLT) has been widely used in the clinical management of glaucoma, both as primary and adjunctive treatment. As new evidence continues to arise, we review the current literature in terms of indications and efficacy, surgical technique, postoperative care, repeatability, and complications of this therapy. SLT has been shown to be effective in various glaucomas, including primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), steroid-induced glaucoma, pseudoexfoliation glaucoma (PXFG), and primary angle-closure glaucoma (PACG), as well as other glaucoma subtypes. Relatively high preoperative intraocular pressure (IOP) may predict surgical success, while other parameters that have been studied do not seem to affect the outcome. Different techniques for performing the procedure have recently been explored, revealing that minor modifications may lead to a more favorable or safer clinical outcome. The utilization of postoperative medications remains controversial based on the current evidence. A short-term IOP increase may complicate SLT and can also persist in certain cases such as in exfoliation glaucoma. The efficacy and safety of repeat SLT are shown in multiple studies, and the timing of repeat procedures may affect the success rate.

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“…While some studies found a positive correlation between these factors and success rates, others did not. Regarding laser parameters itself, although good results have been recently reported with low power SLT (0.4 mJ per shot; repeated annually) (19) , most studies have suggested better outcomes with higher power settings (energy per shot), more extensive laser treatment (360 degree), and greater number of shots (18,25,65,66) . There is also a strong correlation between SLT outcomes when we consider both eyes from the same patient (67) .…”

Section: Success Predictors Of Selective Laser Trabeculoplastymentioning

confidence: 99%

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

Freitas¹,

Ushida²,

Almeida³

et al. 2016

Arquivos Brasileiros De Oftalmologia

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Although eye drops are frequently used as an initial treatment option for open angle glaucoma (OAG), side effects, and poor adherence, among others, may compromise treatment efficacy. In this scenario, laser trabeculoplasty is an interesting therapeutic option for open angle glaucoma cases. Commonly used for many years as a last alternative prior to glaucoma incisional surgery, laser trabeculoplasty has been changing its indication after the advent of selective laser trabeculoplasty (SLT ). In the current review, we critically evaluated the published data regarding the use of laser trabeculoplasty as a first treatment option for open angle glaucoma patients. Studies using SLT as a first-line treatment have encouraging findings. One-year efficacy results are comparable to those obtained with prostaglandin analogues, with a good safety profile. Although the laser´s effect is known to be transitory, recent data suggest it can be successfully repeated in cases with good response to the first SLT treatment.

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Optimal Selective Laser Trabeculoplasty Energy for Maximal Intraocular Pressure Reduction in Open-Angle Glaucoma

Abstract: A higher SLT energy, in the range of 214.6 to 234.9 mJ, seems to be associated with an improved IOP-lowering response. Further randomized control trials with treatment stratification are needed to confirm these results.

Cited by 37 publications

References 20 publications

MicroPulse Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma

MicroPulse Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma

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

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

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