Selective Laser Trabeculoplasty Safe, Effective for Open-Angle Glaucoma

Laurie Barclay, MD

July 21, 2003

July 21, 2003 -- Selective laser trabeculoplasty (SLT) is a safe and effective primary treatment for open-angle glaucoma, according to the results of a prospective pilot study published in the July issue of the Archives of Ophthalmology. Only 4% of eyes did not respond.

"Histologic studies evaluating SLT have shown that, unlike argon laser trabeculoplasty (ALT), there is no scarring of the trabecular meshwork (TM)," write Shlomo Melamed, MD, and colleagues from the Goldschleger Eye Institute, Sheba Medical Center, in Tel Hashomer, Israel. "Clinical results have shown the treatment to be effective and safe in patients with primary open-angle glaucoma and in patients treated previously with ALT."

In this nonrandomized trial, 45 eyes of 31 patients with open-angle glaucoma or ocular hypertension, defined as intraocular pressure [IOP] of 23 mm Hg on two consecutive measurements, had SLT as primary treatment.

After the procedure, mean IOP decreased by 7.7 ± 3.5 mm Hg (30%), from 25.5 &± 2.5 mm Hg to 17.9 ± 2.8 mm Hg ( P < .001). SLT was ineffective in two eyes (4%), and three eyes (7%) required topical antiglaucoma medications to control IOP at the end of 18-month follow-up. IOP decreased by at least 5 mm Hg in 40 eyes (89%). There were no changes in visual acuity, visual fields, or gonioscopic findings.

Short-term complications included conjunctival redness and injection within one postoperative day in 30 eyes (67%). One hour after SLT, IOP increased by more than 5 mm Hg in five eyes (11%), and it increased between 2 and 5 mm Hg in three eyes (7%).

"To our knowledge, this is the first report of the safety and efficacy of SLT as a primary treatment for open-angle glaucoma," the authors write. "As there were very minor and temporary complications of SLT in our patients, this treatment modality may be a good alternative to long-term medical therapy even in the ocular hypertension group. Only a randomized, multicenter study comparing SLT with medical therapy as primary treatment in glaucoma will provide a more definite role of SLT in such patients."

The authors report no relevant financial interest in this article.

Arch Ophthalmol. 2003;121:957-960

Reviewed by Gary D. Vogin, MD