SELECTIVE LASER TRABECULOPLASTY AS SECONDARY THERAPY IN PATIENTS WITH GLAUCOMA: FIVE-YEAR EXPERIENCE

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SELECTIVE LASER TRABECULOPLASTY AS SECONDARY
THERAPY IN PATIENTS WITH GLAUCOMA FIVE-YEAR
EXPERIENCE

• Arusha Gupta, MD
• Elaine M. Miglino
• Lawrence F. Jindra, MD

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Financial Disclosures

• 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.

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Introduction

• Selective Laser Trabeculoplasty (SLT) uses a
  Q-Switched frequency-doubled (532 nm) NdYAG
  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.
199560359-372. 2. Latina MA, et al. Q-switched
532-nm NdYAG laser trabeculoplasty (selective
laser trabeculoplasty) a multicenter, pilot,
clinical study. Ophthalmology. 19981052082-2090.
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Objective and Methods

• To 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.

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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 lt 0.01.

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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 lt 0.01.

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Data IOP
Secondary
Number of eyes (n) 756
Mean 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 lt 0.01
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Data Meds
Secondary
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 lt 0.01
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Results IOP Meds
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Summary

• Mean Post-SLT reduction in
• IOP 21
• Meds 43
• The results were significant with P lt 0.01.

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Conclusion

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