Regenerate - SLT for Glaucoma | Ellex

Efficacy of SLT in Ocular Hypertension and Primary Open-Angle Glaucoma:Primary Treatment Vs. Adjunct TreatmentPrimary Tarek Eid, Treatment MD, Associate vs. Adjunctive Professor of Therapy Ophthalmology, Tanta University, EgyptSelective lasertrabeculoplasty (SLT)has been gaining wideracceptance since itsintroduction in 1995 byLatina & Park 1 . Clinicalstudies suggest SLT isefficacious in lowering IOP,either as initial treatmentor when used adjunctive tomedical therapy. Responserates after one year rangefrom 59-96 percent, withaverage IOP reductionfrom 18-40 percent 2-4 .Dr. Tarek M. Eid, assistant professor at the Magrabi Eye & EarCenter in Jeddah, Saudi Arabia, has just completed a study todetermine the IOP-lowering effect of SLT when used as initialtreatment or as adjunctive therapy for primary open-angleglaucoma (POAG) or ocular hypertension (OH). The followingare his findings and observations.Patient selection and laser techniqueFor this study, patients were classified into two groups. The firstgroup included newly diagnosed eyes with POAG or OH, andthe second included patients diagnosed with POAG or OH andcurrently on medical treatment with or without previous ALTtreatment.All patients received one drop of brimonidine immediatelybefore the laser treatment to prevent post-operative pressurespikes. All eyes had surface anesthesia immediately before theprocedure.The patient was comfortably seated on the slit lamp chair anda Goldmann 3-mirror lens was inserted in the eye coupled withviscoelastic. The gonioscopic mirror of the lens was rotated toview the inferior angle. The aiming beam was focused on thetrabecular meshwork (TM) and a single 400µm spot with 0.8mJpower was delivered at the 12 o’clock position. The power wasincreased or decreased by 0.1mJ according to the absence orpresence of cavitation bubbles.The end point is maximum energy beyond which a bubbleappears in the TM.The procedure was then continued at this energy level withadjacent but non-overlapping laser spots. Throughout theprocedure, bubble formation was monitored with each pulseand energy level was adjusted as described before. Thetreatment plan was variable, with most of the eyes receiving270-degree or 360-degree treatment, with the average numberof shots ranging between 75 and 100.All eyes received non-steroidal anti-inflammatory drops everysix hours for five days. Patients were examined after one day,one week, one month, three months, and periodically everythree months. Withdrawal or addition of anti-glaucoma dropsor repetition of laser treatment in either group was performedaccording to the IOP level throughout the follow-up period.ResultsThe study included 27 eyes of 15 patients in the primarytreatment group (Group 1) and 45 eyes of 28 patients in theadjunctive treatment group (Group 2). Sixteen eyes (59.3percent) in Group 1 and 39 eyes (86.7 percent) in Group 2 haddiagnosis of POAG. Most of the eyes in Group 2 (77.7 percent)were using one or two anti-glaucoma medications.Laser treatment was confined to three or four quadrants ofangle circumference. Baseline IOP was significantly higher inGroup 1 (24.8 + 3.5 mmHg) than Group 2 (18.4 + 3.6 mmHg)(p