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Six-Year Longevity of Selective Laser Trabeculoplasty as Primary Therapy in Patients with Glaucoma

Six-Year Longevity of Selective Laser Trabeculoplasty as Primary Therapy in Patients with Glaucoma ASCRS 2009 Lawrence F. Jindra, MD Columbia University Winthrop University Hospital. Arusha Gupta, MD New York Eye and Ear Infirmary. Elaine M. Miglino Floral Park Ophthalmology.

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Six-Year Longevity of Selective Laser Trabeculoplasty as Primary Therapy in Patients with Glaucoma

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  1. Six-Year Longevity of Selective Laser Trabeculoplasty as Primary Therapy in Patients with Glaucoma ASCRS 2009 Lawrence F. Jindra, MD Columbia University Winthrop University Hospital Arusha Gupta, MD New York Eye and Ear Infirmary Elaine M. Miglino Floral Park Ophthalmology Author has independently conducted and financed clinical research study presented and was a consultant for Lumenis Corporation within the past year Coauthors have no financial disclosure

  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 six-year longevity of Selective Laser Trabeculoplasty (SLT) as primary therapy, in decreasing intraocular pressure (IOP) in patients with glaucoma. • Methods • Retrospective chart review was performed over six years, from a consecutive case series of sixty eyes treated with SLT. • Two-tailed paired t-test was used to compare maximum pre- and post- procedure IOP.

  4. Results (Primary) • Mean follow-up was 1152 days. Average mean IOP decreased by 34% from mean of 18.5 mmHg to 13.8 mmHg at six years. • Results were significant with p < 0.01 *Eyes considered to have uninterrupted follow up were those that did not have any meds or SLT after primary SLT. Twenty-six eyes completed the study over six years.

  5. Discussion • The Glaucoma Laser Trial • Established efficacy of laser trabeculoplasty in lowering IOP in previously untreated glaucoma patients1 • The Ocular Hypertensive Treatment Study & • The Early Manifest Glaucoma Trial • Established efficacy of early and effective treatment to preserve long-term visual function in glaucoma patients2,3 • Our findings build on these studies and suggest SLT significantly lowered IOP 34% over six years (p < 0.01). • Further study with controlled clinical trials is indicated. 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.

  6. Conclusion • In this series over the long-term: • As primary therapy in patients with glaucoma, SLT significantly lowered and maintained IOP over six years. • Results were significant with p < 0.01.

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