Selective Laser Trabeculoplasty Versus Medical Therapy as Initial Treatment of Glaucoma

Katz, L. Jay; Steinmann, William; Kabir, Azad A; Molineaux, Jeanne; Wizov, Sheryl S.; Marcellino, George

doi:10.1097/ijg.0b013e318218287f

Cited by 177 publications

(165 citation statements)

References 55 publications

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“…After 1 year of follow-up, there was a similar IOP reduction between the two groups with a 26.4 and 27% reduction in SLT and medication groups, respectively. There was a trend toward more treatment steps necessary for adequate IOP control in the medication arm with 27% requiring additional drops compared to 11% in the SLT group receiving additional laser [8]. Other prospective studies have been done which corroborate with our findings [86][87][88].…”

Section: Selective Laser Trabeculoplasty As Initial Treatmentsupporting

confidence: 82%

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Laser Trabeculoplasty and Aqueous Dynamics

Lee¹,

Rahmatnejad²,

Waisbourd³

et al. 2016

Glaucoma - Intraocular Pressure and Aqueous Dynamics

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For the past four decades, laser trabeculoplasty has been a staple in the treatment armamentarium against glaucoma. Although the exact mechanism of laser trabeculoplasty has not been fully elucidated, its clinical utility in lowering intraocular pressure has been well established. Aqueous dynamic studies uniformly reveal an increase in aqueous outflow facility at the trabecular meshwork. Accumulating evidence suggests that the mechanism is the result of complex cellular and biochemical processes. Histopathological studies of the trabecular meshwork tissue after argon laser suggest an additional mechanical role. The traditional treatment algorithm for glaucoma placed laser trabeculoplasty as an intermediary between medical therapy and incisional surgery. However, because of the safety profile of selective laser trabeculoplasty, recent studies have challenged this treatment paradigm. One such study was a multicenter trial headed by our department that compared laser trabeculoplasty and medical therapy as initial treatment for glaucoma. We showed a similar efficacy between the two modalities, reinforcing the possibility of using laser as the initial treatment in the right clinical setting.

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Section: Selective Laser Trabeculoplasty As Initial Treatmentsupporting

confidence: 82%

“…In contrast to its predecessor, SLT delivers a fraction of the energy delivered by ALT, avoiding most of the untoward effects that can arise from thermal damage [7]. Due to its superior safety profile and potential repeatability, SLT has challenged the traditional treatment paradigm [8].…”

Section: Introductionmentioning

confidence: 99%

Laser Trabeculoplasty and Aqueous Dynamics

Lee¹,

Rahmatnejad²,

Waisbourd³

et al. 2016

Glaucoma - Intraocular Pressure and Aqueous Dynamics

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“…Katz et al 30 published the results of a multicentre RCT in the United States comparing 3601 SLT to prostaglandin eye drops in a group of patients with POAG or OHT. Patients underwent a 'washout' period for 4 weeks.…”

Section: Slt Vs Medical Therapymentioning

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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“…Overall, in an attempt to summarize IOP data from the available studies, we found that average absolute IOP-reduction following SLT as first treatment ranges from 3 to 8 mmHg (percentage IOP reduction: 20% to 38%) (17,18,29,31,33,34) . Other studies compared SLT versus PGA as a primary therapy, with similar efficacy between the two treatment modalities (16)(17)(18) . When the extension of the laser was considered, PGA showed better results than 90° and 180° SLT, but not 360° ( 18) .…”

Section: Efficacy (Iop Reduction)mentioning

confidence: 99%

“…With the advent of SLT, there was a shift in the focus of most clinical studies related to laser trabeculoplasty (12,15) . Looking carefully at the most recent publications, one can note that SLT has been evaluated as a first-line treatment option for IOP-lowering in OAG patients without topical medication and less severe damage, with quite encouraging results (16,17) . In the current review, we critically evaluated the published data regarding the use of laser trabeculoplasty as a first treatment option for OAG patients.…”

Section: Introductionmentioning

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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Selective Laser Trabeculoplasty Versus Medical Therapy as Initial Treatment of Glaucoma

Cited by 177 publications

References 55 publications

Laser Trabeculoplasty and Aqueous Dynamics

Laser Trabeculoplasty and Aqueous Dynamics

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

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

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