Selective Laser Trabeculoplasty as Primary Therapy in Patients with ...

Selec%ve Laser Trabeculoplasty as Primary Therapy in
Pa%ents with Glaucoma: 10 Year Experience
ASCRS 2013
Joseph A. Donnelly
Albert Einstein College of Medicine
Elaine M. Miglino
Floral Park Ophthalmology
Yeshiva University
Lawrence F. Jindra, MD
Columbia University
Winthrop University Hospital
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1 st and 2 rd co-­‐authors have no financial interest in the subject maPer of this poster.
3 rd author has independently conducted and financed the clinical research study presented herein and received honoraria
from Ellex Corpora%on in the last year.

Introduc%on
Ø Selec%ve Laser Trabeculoplasty (SLT) uses a Q-­‐Switched frequency-­‐doubled
(532 nm), low energy Nd:YAG laser, which targets melanocytes in the
trabecular meshwork 1,2 .
Ø SLT treatment induces a biologic response in the trabecular meshwork,
which involves the release of cytokines that trigger macrophage recruitment
and other changes, leading to reduc%on in intraocular pressure (IOP).
Ø SLT treats the trabecular meshwork without causing thermal nor coagula%ve
damage to surrounding structures.
1. La%na MA, et al. Selec%ve targe%ng of trabecular meshwork cells: in vitro studies of pulsed and CW laser interac%ons.
.
Exp Eye Res. 1995;60:359-­‐372.
2. La%na MA, et al. Q-­‐switched 532-­‐nm Nd:YAG laser trabeculoplasty (selec%ve laser trabeculoplasty): a mul%center, pilot,
clinical study. Ophthalmology. 1998;105:2082-­‐2090.

Purpose and Methods
Purpose
Ø
To evaluate SLT as primary therapy, to decrease IOP, in pa%ents
with glaucoma.
Methods
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Retrospec%ve chart review was performed on 1983 eyes from a
consecu%ve case series of 4048 eyes treated with SLT over 10 years.
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Two-­‐tailed paired t-­‐test was used to compare maximum pre-­‐ and
average post-­‐procedure IOP.

Results
Ø Mean follow-­‐up was 917 days.
Ø Mean IOP decreased 29% from mean of 18.1 mmHg to 12.8 mmHg.
Ø Cumula%ve Probability of Success at 10 years was 90%.
Ø Results were significant with p < 0.01.

Results
Parameter
Mean Follow–up
Pre-­‐SLT Mean IOP
Post-­‐SLT Mean IOP
Mean IOP Drop
Measured Value
917 Days
18.1 mmHg
12.8 mmHg
29%

Results
Time
Interval
Cumula%ve Probability of
Success
0 Years 98%
1 years 97%
2 years 95%
3 years 94%
4 years 93%
5 years 92%
6 years 91%
7 years 90%
8 years 90%
9 years 90%
10 years 90%

Discussion
Ø The Glaucoma Laser Trial
§ Established efficacy of laser trabeculoplasty in lowering IOP in previously
untreated glaucoma pa%ents 1 .
Ø The Ocular Hypertensive Treatment Study and
Ø Early Manifest Glaucoma Trial
§ Established efficacy of early and effec%ve treatment to preserve long-­term
visual func%on in glaucoma pa%ents 2,3 .
Ø Our findings build on these studies and suggest SLT as primary therapy
significantly lowered mean IOP 29% in pa%ents with glaucoma and had a
cumula%ve probability of success of 90% over ten years (p

Conclusion
In this series of over 4,000 eyes followed for more than 10 years:
• Selec%ve Laser Trabeculoplasty (SLT) as primary (ini%al) therapy
significantly lowered intraocular pressure (IOP) in pa%ents with
glaucoma.
• Results were significant with p < 0.01.