SELECTIVE LASER TRABECULOPLASTY AS SECONDARY

THERAPY IN PATIENTS WITH GLAUCOMA: FIVE-YEAR EXPERIENCE

Arusha Gupta, MDElaine M. Miglino

Lawrence F. Jindra, MD

1st and 2nd authors have no financial

disclosure.

3rd author has independently conducted

and financed clinical research study

presented and provides technical advice and

consultant services to Lumenis Corporation.

Financial Disclosures

IntroductionSelective Laser Trabeculoplasty (SLT) uses a Q-Switched

frequency-doubled (532 nm) Nd:YAG laser which targets

melanocytes in the pigmented trabecular meshwork.1,2 When

treated with SLT, a primarily biologic response is induced in the

trabecular meshwork which involves the release of cytokines that

trigger macrophage recruitment and other changes leading to IOP

reduction.2 It treats the meshwork without causing any thermal or

coagulative damage to surrounding structures.1,2

1. Latina MA, et al. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and cw laser interactions. Exp Eye Res. 1995;60:359-372. 2. Latina MA, et al. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998;105:2082-2090.

Objective and MethodsTo evaluate SLT as secondary therapy (eyes

treated with medications) in decreasing intraocular pressure (IOP) and in reducing usage of glaucoma medication (meds) in patients with glaucoma.

A retrospective chart review was performed on 756 of 2056 eyes in a consecutive case series from patients treated with SLT as secondary therapy over 5 years between 2002 and 2007. Two-tailed paired t-test was used to compare maximum pre- and post-SLT IOP and pre- and post-SLT number of meds.

Results: IOP

756 eyes received SLT as secondary treatment for glaucoma; mean follow-up time was 362 days.

IOP decreased from a mean of 20.0 mm Hg ± 6.0 to 15.8 mm Hg ± 4.9. This represents a 21% decrease in IOP or 4.2 mm Hg.

Data were significant with P < 0.01.

Results: Meds

Mean number of meds decreased from 2.3 to 1.3 meds; this represents a 43% decrease in meds used.

Success rate (no meds needed post-SLT) was 42% of eyes treated.

Data were significant with P < 0.01.

Data: IOP

SecondaryNumber of eyes (n) 756Mean follow-up (days)

362

Pre-SLT IOP (mm Hg)

20.0

Post-SLT IOP (mm Hg)

15.8

IOP change (mm Hg)

4.2

% ↓ IOP 21%P-value < 0.01

Data: MedsSecondary

Number of eyes (n)

756

Mean follow-up (days)

362

Mean # Pre-SLT meds

2.3

Mean # Post-SLT meds

1.3

% ↓ meds 43%Success rate (no meds)

42%

P-value < 0.01

Results: IOP & Meds

Summary

Mean Post-SLT reduction in:

IOP 21% Meds 43%

The results were significant with P < 0.01.

Conclusion

In this clinical series, SLT significantly lowered intraocular pressure and the amount of medications required, when used as secondary treatment for glaucoma.