Standard and long duration repeat argon laser trabeculoplasty

Hugkulstone, Charles E.

doi:10.1111/j.1755-3768.1990.tb04790.x

Cited by 3 publications

(2 citation statements)

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“…In fact, repeat ALT sometimes produced paradoxical IOP elevations (presumably because of cumulative coagulative damage to the trabecular outflow pathway 61 ) that often required surgical intervention. [62][63][64][65][66][67] On this basis, repeat ALT was not incorporated into the Glaucoma Laser Trial study design: when additional IOP reduction was required in laser-first eyes, medical therapy was initiated. 68 SLT uses the Q-switched, frequency-doubled Nd:YAG laser platform and consists of ∼100 contiguous nonoverlapping treatment spots over the full 360 degrees of TM.…”

Section: The Case For Low Energy Slt Standard Slt Causes Trabecular M...mentioning

confidence: 99%

“…Cumulative TM damage ultimately compromised IOP control with repeat ALT as a critical mass of TM was destroyed and too little intervening TM remained to permit aqueous outflow. In fact, repeat ALT sometimes produced paradoxical IOP elevations (presumably because of cumulative coagulative damage to the trabecular outflow pathway61) that often required surgical intervention 62–67. On this basis, repeat ALT was not incorporated into the Glaucoma Laser Trial study design: when additional IOP reduction was required in laser-first eyes, medical therapy was initiated 68…”

Section: The Case For Low Energy Sltmentioning

confidence: 99%

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Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial

Realini

Gazzard

Latina

et al. 2021

Journal of Glaucoma

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The recent Laser in Glaucoma and Ocular Hypertension Trial provided the evidentiary basis for a paradigm shift away from the historical medication-first approach to glaucoma-which has numerous limitations, the most important of which is poor adherence to therapy -and toward a laser-first approach. Now 20 years after its commercialization, selective laser trabeculoplasty (SLT) is routinely performed consistently with its initial description, with energy titrated to the appearance of fine, champagne-like cavitation bubbles. A recent data set suggested that lower energy SLT, applied as primary therapy and repeated annually irrespective of intraocular pressure-rather than pro re nata when its effect wanes and irrespective of intraocular pressure rises -yields longer medication-free survival than standard energy SLT repeated pro re nata. A new study-Clarifying the Optimal Application of SLT Therapy -has been initiated to explore this preliminary finding in a pair of consecutive randomized trials. Herein, we provide an evidence-based rationale for the use of low-energy SLT repeated annually as primary therapy for mild to moderate primary open-angle glaucoma or high-risk ocular hypertension.

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Section: The Case For Low Energy Slt Standard Slt Causes Trabecular M...mentioning

confidence: 99%

Section: The Case For Low Energy Sltmentioning

confidence: 99%

Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial

Realini

Gazzard

Latina

et al. 2021

Journal of Glaucoma

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Two‐year follow‐up of intra‐ocular pressure control with long duration argon laser trabeculoplasty

Hugkulstone

1993

Acta Ophthalmologica

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The two-year results of intra-ocular pressure control in the first prospective study of standard (0.1 second) and long (0.2 second) duration argon laser trabeculoplasty are presented. The two groups were comparable for intra-ocular pressures and treatment scores at the start of the study. An early benefit in intra-ocular pressure reduction was found for 0.2 second trabeculoplasty in the first year, which disappeared during the second-ond year of follow-up. No reduction in medications occurred following laser trabeculoplasty. There was no difference in the frequency of further interventions (repeat trabeculoplasty or drainage surgery) between the two groups. There was a strong correlation between the intra-ocular pressures of the first and second treated eyes. No clinical benefit was demonstrated for the longer duration over standard argon laser trabeculoplasty.

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Membrane formation in the chamber angle after failure of argon laser trabeculoplasty: analysis of risk factors

Koller¹

2000

British Journal of Ophthalmology

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Aim-Membrane formation in the chamber angle induced by argon laser trabeculoplasty (ALT) can be a cause of treatment failure. Identification of risk factors for membrane formation was the primary aim of this retrospective study. Methods-Semithin sections of trabeculectomy specimens obtained in a 2 year period were examined by light microscopy. 122 eyes which were treated with one or more ALTs before trabeculectomy were identified. In 46 eyes, a suYcient amount of trabecular meshwork was obtained to permit morphological analysis. Conclusions-Membrane formation in the chamber angle is a frequent cause of ALT failure. The major risk factor is the number of ALTs performed. (Br J Ophthalmol 2000;84:48-53) Since the introduction of argon laser trabeculoplasty (ALT) in 1979 by Wise and Witter 1 it has become one of the standard treatments for glaucoma. Recent reports, however, reveal a failure rate of 15-25% in the first year and annual failure rates of 5-10% thereafter. Within 10 years most patients (68-95%) fail 2-5 and require further intervention. Since 1973, we have gathered trabeculectomy specimens in order to determine if intraocular pressure (IOP) regulation is dependent on the anatomical site of excision, specifically comparing excisions that were fashioned in proximity to the cornea with those more peripherally based to include uveal tissue and scleral spur. More recently, we have seen repeat ALT treated patients with acutely elevated IOP in the 50s, despite intensive medical therapy, who required emergency trabeculectomy. We investigated a possible cause of such a pressure rise by more closely examining trabeculectomy specimens using light and electron microscopy. In many specimens we found a significant membrane covering the trabecular meshwork. 6 The aim of this retrospective study was to find out if there is any relation between membrane formation, pressure elevation, and previous ALT. Results-Eyes Material and methodsOver a period of 2 years, 388 eyes of 290 patients underwent filtering surgery at our department. A standard trabeculectomy with a fornix based conjunctival flap was performed. The inner block of tissue at the trabeculectomy site was excised using a diamond knife and straight corneal scissors. Immediately after excision, the tissues were immersed in fixative consisting of 2.5% glutaraldehyde in 0.1 M cacodylate buVer, pH 7.3. The tissues remained in this fixative for 12 hours at 4°C. They were then postfixed in osmium tetroxide for 1 hour, gently dehydrated and embedded in Epon 812. Sections of 0.5 µm were cut, stained with methylene blue, and observed with Zeiss Axiophot. Thin sections were cut, stained with uranyl acetate and lead citrate, and observed with a Hitachi 7000 transmission electron microscope. Tissues were oriented so that sagittal sections through the trabecular region were cut (Fig 1).Of these 388 eyes 122 had one or more previous argon laser trabeculoplasties. We selected only those specimens in which all important structures (that is, Schwalbe's line, canal of Sc...

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Standard and long duration repeat argon laser trabeculoplasty

Cited by 3 publications

References 13 publications

Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial

Low-energy Selective Laser Trabeculoplasty Repeated Annually: Rationale for the COAST Trial

Two‐year follow‐up of intra‐ocular pressure control with long duration argon laser trabeculoplasty

Membrane formation in the chamber angle after failure of argon laser trabeculoplasty: analysis of risk factors

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