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SLT efficient, safe for phakic, pseudophakic eyes
Selective laser trabeculoplasty proved to be an effective treatment option for pseudophakic and phakic open-angle glaucoma and ocular hypertension, according to a study recently published in the Journal of Glaucoma.
Seymenoğlu and colleagues retrospectively reviewed the charts of 88 eyes that had undergone 360-degree selective laser trabeculoplasty (SLT). Participants included 60 phakic eyes and 28 pseudophakic eyes that were assessed at 1 month, 3 months, 6 months and 12 months.
Researchers compared success rates, mean intraocular pressure change and mean percentage of IOP reduction and defined success as at least a 20% reduction in IOP.
Results showed that success varied from 58% to 73% in phakic participants and 60% to 64% in pseudophakic participants. Researchers reported that the mean percentage of IOP reduction was 22.8%, 25.0%, 25.7% and 21.2% in the phakic group and 21.4%, 25.8%, 24.8% and 23.7% in the pseudophakic group at 1 month, 3 months, 6 months and 12 months, respectively.
"Our study demonstrates no negative effect of prior uncomplicated cataract surgery on the outcome of SLT in patients with ocular hypertension, primary open-angle glaucoma and pseudoexfoliation glaucoma," the authors concluded.
They continued: "Results from our study suggest that clinicians may choose to treat pseudophakic eyes with open-angle glaucoma and ocular hypertension with the expectation of similar efficacy as in phakic eyes. Further studies with larger number of patients and longer follow-up are needed to further establish the role of SLT in pseudophakic eyes." – by Chelsea Frajerman
Disclosure: The authors report no relevant financial disclosures.
Perspective
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SLT, known for its efficacy, repeatability and lack of scar formation within the treated area, is becoming a mainstay in glaucoma management. Naturally, as SLT becomes a more common treatment choice for reducing IOP in glaucoma and ocular hypertension patients, its effectiveness will be vetted under various conditions that may influence the treatment outcome.
As detailed in this study, SLT generally does not have a preferential effect upon intraocular pressure lowering with factors such as age, sex, trabecular meshwork pigmentation and current glaucoma medication use, among others. Notably, the effects of SLT seem to be greatest when pretreatment IOP is higher and when applied 360º.
The study authors investigated potential limitations of SLT treatments among pseudophakic eyes; however, none could be found when compared to a matched phakic cohort. As pseudophakic patients represent a large subset of our glaucoma practice, this study provides assurance that SLT can be effective for those who require lower IOP.
Furthermore, this study helps us understand what SLT can and cannot do, allowing for a more tailored approach to glaucoma management.