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Effect of Selective Laser Trabeculoplasty on Diurnal Fluctuations of Intraocular Pressure ASCRS 2009 Richard A. Luck, DO

Effect of Selective Laser Trabeculoplasty on Diurnal Fluctuations of Intraocular Pressure ASCRS 2009 Richard A. Luck, DO Winthrop University Hospital. Joseph A. Donnelly Hofstra University. Lawrence F. Jindra, MD Columbia University Winthrop University Hospital. Elaine M. Miglino

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Effect of Selective Laser Trabeculoplasty on Diurnal Fluctuations of Intraocular Pressure ASCRS 2009 Richard A. Luck, DO

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  1. Effect of Selective Laser Trabeculoplasty on Diurnal Fluctuations of Intraocular Pressure ASCRS 2009 Richard A. Luck, DO Winthrop University Hospital Joseph A. Donnelly Hofstra University Lawrence F. Jindra, MD Columbia University Winthrop University Hospital Elaine M. Miglino Floral Park Ophthalmology • 1st, 2nd and 3rd authors have no financial disclosure • 4th author has independently conducted and financed clinical research study presented and has provided technical advice and consultant services to Lumenis Corporation in the past year

  2. Introduction • Selective Laser Trabeculoplasty (SLT) uses a Q-Switched frequency-doubled (532 nm) Nd:YAG laser, which targets melanocytes in the trabecular meshwork1,2 • SLT treatment induces a biologic response in the trabecular meshwork, which involves the release of cytokines that trigger macrophage recruitment and other changes, leading to IOP reduction2 • SLT treats the meshwork without causing any thermal or coagulative damage to surrounding structures1,2 1. Latina MA, et al. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and CW laser interactions. Exp Eye Res. 1995;60:359-372. 2. Latina MA, et al. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998;105:2082-2090.

  3. Purpose and Methods • Purpose • To examine the effect of Selective Laser Trabeculoplasty (SLT) on diurnal fluctuations of intraocular pressure (IOP) in patients receiving primary or secondary therapy. • Methods • Retrospective chart review was performed on 48 eyes out of a consecutive case series of 2056 eyes treated with SLT. Eyes were selected for analysis which had follow-up IOP values over four years after primary or secondary treatment with SLT.

  4. Results (Primary) • For eyes with SLT as primary treatment, morning and afternoon IOP values were not significantly different (p > 0.05)

  5. Results (Secondary) • For eyes with SLT as secondary treatment, morning and afternoon values were significantly different (p < 0.01)

  6. Results • Total follow up time after SLT was 1600 days • Mean fluctuation in IOP for primary / secondary groups: 000-1600 days 0.3 ± 2.0 / 2.1 ± 2.2 mmHg 000-533 days 0.2 ± 0.9 / 0.2 ± 1.9 mmHg 534-1067 days 0.4 ± 1.0 / 1.8 ± 3.2 mmHg 1068-1600 days 0.9 ± 1.7 / 4.3 ± 4.2 mmHg • Results were significant with p < 0.01; 95% confidence intervals (p < 0.05)

  7. Discussion 1. The GLT Research Group. GLT. Ophthalmology. 1990;97:1403-1413. 2. Kass MA, et al. OHTS. Arch Ophthalmol. 2002;120:701-713. 3. Heijl A, et al. EMGT. Arch Ophthalmol. 2002;120:1268-1279. • The Glaucoma Laser Trial • Established the efficacy of laser trabeculoplasty to lower IOP in previously untreated glaucoma patients1 • The Ocular Hypertensive Treatment Study & • The Early Manifest Glaucoma Trial • Established the efficacy of early and effective treatment to preserve long-term visual function in glaucoma patients2,3 • Our findings build on these studies and suggest treatment with SLT controlled IOP better in eyes with primary therapy than in eyes with secondary therapy (p < 0.01).

  8. Conclusion • In this series over the long-term: • Eyes in which SLT was used as primary therapy, the diurnal fluctuation of IOP appeared to be eliminated. • Eyes in which SLT was used as secondary therapy, the diurnal fluctuation of IOP appeared to remain. • Further study with controlled clinical trials is indicated.

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