Diligent follow-up needed after laser therapy

VANCOUVER, British Columbia — Both argon laser trabeculoplasty and selective laser trabeculoplasty are safe and effective adjunctive treatments for glaucoma and may be considered as first-line therapy in early- to moderate-stage open-angle glaucoma when IOP is less than 35 mm Hg, according to a speaker.

“We’re facing a number of steroid-induced glaucomas from our retina and cornea colleagues, and it is gratifying to know that SLT has a role there,” Karim F. Damji, MD, said at the World Glaucoma Congress here, adding that SLT has been shown to be fairly effective after triamcinolone intravitreal injection-induced glaucoma.

SLT provides short-pulsed Nd:YAG 532 nm focal thermal effects, disrupting melanosomes and targeting cell lysis, whereas ALT provides continuous wave 488 nm to 514 nm diffuse thermal effects, coagulating collagen fibrils. Both laser treatments improve outflow facility.

In pigmentary glaucoma, initial literature suggested better outcomes when more pigmentation was present, with efficacy of ALT being more dependent on pigment grade than SLT. A recent study by Ayala showed long-term efficacy with 180° of SLT at 0.4 mJ/pulse to 0.8 mJ/pulse declined after initial success, and by year 4, only 14% of patients were doing well, Damji said.

“That’s something I’d like to flag,” Damji said. “Laser trabeculoplasty is not a cure. … In essence, one has to follow these patients diligently to make sure there’s no escape over time.”

Reference:

Ayala M. J Glaucoma. 2013;doi:10.1097/IJG.0b013e318287abb7.

Disclosure: Damji has no relevant financial disclosures.