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Short-term postop use of NSAIDs or steroid may improve IOP after SLT

Issue: February 25, 2019

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WAIKOLOA, Hawaii — The SALT trial was born from discussion about “the mechanism of action of laser trabeculoplasty and the idea that the laser might work by activating what we would call proinflammatory pathways so maybe the steroids would actually be inhibiting the SLT from having a good effect,” said a speaker here.

“So what drops should be prescribed after SLT? There is no current consensus or preferred practice pattern,” Jeffrey L. Goldberg, MD, PhD, said at Hawaiian Eye 2019. Common approaches are no drops, prednisolone for 3 to 7 days, or NSAIDs for 3 to 7 days.

“The purpose [of the SALT trial] was to determine whether the short-term use of steroids over the first 4 to 7 days or nonsteroidal agents could affect the efficacy of SLT in patients,” he said.

The Steroids After Laser Trabeculoplasty (SALT) trial was a double-masked, randomized, placebo-controlled, dual-center, multi-surgeon trial of 96 eyes of 85 patients. Patients in all groups were similar in demographics and baseline IOP. All eyes were treated with apraclonidine immediately before laser treatment. After SLT, 28 eyes received NSAIDs, 37 eyes received steroids, and 31 eyes received saline tears.

At 12 weeks, mean decrease in IOP was 6.4 mm Hg (P = .002) in the NSAID group and 5.2 mm Hg in the steroid group (P = .02), both statistically significant decreases compared with a mean decrease of 3 mm Hg in the saline placebo group.

Goldberg said there was no inflammation detected in any group past 1 hour and no difference in comfort in any of the groups.

While there is a need for longer studies and follow-up, the SALT trial “does show in the study that both steroids or NSAIDs actually resulted —counter to our initial hypothesis —in improved IOP lowering compared to placebo.”– by Joan-Marie Stiglich, ELS

Reference: Goldberg JL. The SALT trial: Steroids after laser trabeculoplasty. Presented at: Hawaiian Eye; Jan. 19-25, 2019; Waikoloa, Hawaii.

Disclosure: Goldberg reports no relevant financial disclosures.