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SLT safe, effective first line treatment for OAG, surgeon says

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ORLANDO, Fla. — Selective laser trabeculoplasty is a safe and effective treatment for patients with either open-angle glaucoma or ocular hypertension, according to Madhu Nagar, MBBS, FRCS. Patients with uncontrolled ocular hypertension responded slightly better to the treatment than those with open-angle glaucoma, she added.

Mrs. Nagar discussed her results with the procedure here at the joint meeting of the American Academy of Ophthalmology and Pan-American Association of Ophthalmology.

Mrs. Nagar enrolled 207 patients in a study and divided them into two groups. One group had medically uncontrolled OAG or ocular hypertension; a second group consisted of patients newly diagnosed with OAG or ocular hypertension. The patients received selective laser trabeculoplasty (SLT) around 90°, 180° or 360° using the Lumenis Selecta 7000.

“On day 1, there was about a 40% reduction in intraocular pressure. The pressure creeps up a bit at week 1 but stabilizes after that,” she said. Results with the SLT were “slightly better” for hypertensive patients (33%) than for OAG patients (25.6%) in the first group. The newly diagnosed group also responded well to treatment, with a 28.5% drop of IOP in patients with OAG and a 29.5% drop of IOP in patients with ocular hypertension, Mrs. Nagar said.

A second study was initiated, comparing three types of shots; about 31 eyes were enrolled in each of three groups. Follow-up to date is about 6 months, Mrs. Nagar said. All three groups showed a drop in IOP.

“As the treatment area increased, the failure rate was reduced,“ she said. “But the adverse events increased as the treatment area increased.” She attributed this to her own discomfort with the procedure at the time of treatment delivery.

As discussant of Mrs. Nagar’s paper, Michael Stiles, MD, identified some areas of concern with the second part of the study. “It lacks a control group, it lacks well-defined outcome criteria, details of patients excluded or treatment failures and it lacks protocol changes,” he said. In addition, baseline characteristics of the patients were not included, so results may be difficult to generalize to the population at large.