Regenerate - SLT for Glaucoma | Ellex

Clinical TipsPrateep Vyas, MD, Choithram Netralaya, Indore, IndiaGlaucoma is a chronic disease whichaffects an increasing proportionof the global population. Medicaltherapy has become the mainstaytreatment for glaucoma; however,there are a number of complianceissues and side effects associatedwith medical therapy. Selective LaserTrabeculoplasty (SLT) has emergedas a non-invasive laser techniquefor managing elevated intraocularpressure (IOP). Indeed, SLT hasbecome an important addition to my practice; in particular, I have foundSLT to be virtually free from side effects, and it demonstrates goodefficacy in controlling elevated IOP in the majority of my glaucomapatients.SLT is Non-ThermalSLT uses a 532nm wavelength at 3 nanosecond pulse duration, andfeatures a 400 micron spot size. SLT is a non-thermal mechanism whichaffects an immunological process in the treated eye – hence, it is gentleand does not cause permanent damage to the trabecular meshwork(TM). Given this, SLT is repeatable, and does not preclude anti-glaucomasurgery – a distinct advantage over Argon Laser Trabeculoplasty (ALT).SLT as Primary TherapyThere is strong evidence to support the role of SLT as primary therapy.SLT reduces IOP by an average of 20% from baseline, and its IOPloweringeffect is long-lasting. As such, SLT is suitable as a primarytherapy for elevated IOP in patients with ocular hypertension. SLT is alsosuitable as a primary therapy option in the following situations:1. Lactating mothers2. Pregnancy3. Severe dry eye4. Where short term IOP reduction is required i.e. steroid responders(after intravitreal or sub Tenons injection).SLT as Adjunct TherapySLT is also suitable as an adjunct therapy for the following patients:1. Patients on multiple anti-glaucoma medication suffering frominadequate IOP control2. Patients with systemic CAI; Note: SLT can assist in the removal ofsystemic CAI3. Patients with inadequate control of IOP in need of surgery4. Patients suffering from poor compliance and intolerance tomedication.2regenerate March 2009SLT Clinical TipsUse the lowest energy setting neededin order to release champagnebubbles; start at 0.6-0.8 mJ and titrateupwards or downwards, as required.In order to prevent post-proceduralIOP spike, always administer mioticsand a tab of Diamox 250mg one-hourprior to treatment.Use a Latina lens due to its zeromagnification.Apply 50 spots over 180-degrees ofthe trabecular meshwork (TM); apply100 spots over 360-degrees of theTM.Note: it is possible to perform 360-degree treatment in one sitting, butalways apply topical NSAID postproceduree.g. Acular LS tid for threedays, in order to prevent IOP spike.A heavily pigmented TM requires lessenergy. Take care not to confusepigmentation of Schwalbe’s line withpigmentation of the TM.Focus the treatment beam over thefull height of the TM in order to achieveoptimal results.Check IOP post procedure at onehourand four-hour intervals, at day3 and 7, at week 4 and week 14,followed by quarterly check-ups.Note: approximately 20 percent ofpatients experience an IOP spikefollowing the procedure.When performing repeat SLT, do nottreat the same area of the TM within 12months of initial treatment.Wait one month in order to evaluatetreatment performance; if target IOP isnot achieved, continue anti-glaucomamedication.