Trials find SLT safe, effective in different populations

KUALA LUMPUR, Malaysia — Selective laser trabeculoplasty safely lowered IOP in trials conducted in Australia and China, according to two speakers here. The two physicians said the laser procedure could become a first-line treatment for glaucoma, either in combination with or in lieu of medical treatment.

The studies, presented here at the Asia Pacific Academy of Ophthalmology meeting, were conducted by Jimmy S.M. Lai, MD, MBBS, FRCSEd, FRCOphth, and colleagues in Hong Kong and by Ivan Goldberg, MBBS, FRANZCO, FRACS and colleagues in Sydney, Australia.

In selective laser trabeculoplasty (SLT) a non-thermal laser beam is used to “selectively target pigmented trabecular meshwork cells without causing structural damage,” Dr. Goldberg said.

“SLT appears to cause no structural damage to the trabecular meshwork,” he said.

Dr. Goldberg retrospectively studied 324 eyes of 324 patients followed for a mean of 21 months after SLT treatment.

The minimally invasive procedure “could well be considered an alternative to ALT and medical therapy for patients who want it,” Dr. Goldberg said. “It is a useful option for patients on maximum medical therapy.” He added that he began using SLT instead of argon laser trabeculoplasty more than 3 years ago.

In his study, 226 eyes (70%) achieved their targeted pressures at 6 months. Of the 98 eyes that did not reach their target IOPs, 37 showed an IOP reduction of more than 25% from baseline IOP, 35 had an IOP reduction of less than 25% and 26 showed no change from baseline.

The study also found that following SLT 87 patients (26.9%) used fewer medications, 217 patients (67.0%) used the same number of medications and 20 patients (6.2%) needed an increase in their medications.

Dr. Lai’s study, conducted in Hong Kong, included 58 eyes of 29 Chinese patients. In this prospective randomized trial, one eye of each patient underwent SLT and the fellow eye received medical treatment. All patients had dark brown irides and a pigmented trabecular meshwork.

Patients were administered 1% apraclonidine 1 hour prior to the laser treatment. They were also treated with 1% apraclonidine after treatment. Topical steroids (1% prednisolone acetate) were administered four times per day for 1 week. Following SLT, IOP was measured hourly for 2 hours, and continued hourly if IOP was greater than 5 mm Hg. Slit-lamp examination was also performed.

In the medically treated eyes, topical glaucoma medications were commenced 2 hours after SLT. Follow-up was performed at 1 day; 1 and 2 weeks; 1, 3 and 6 months; and then yearly.

“With fewer medications, SLT gives similar IOP reduction to medical therapy alone in Chinese patients with primary open-angle glaucoma or ocular hypertension,” Dr. Lai said.