ABSTRACT
Glaucoma is the second leading cause of irreversible blindness worldwide.The treatment of glaucomatous eyes is a long-term procedure.Laser treatment is becoming one of the three major methods to lower intraocular pressure (IOP) of glaucomatous patients.Selective laser trabeculoplasty (SLT) mainly targets to the pigment cells on the trabecular meshwork and makes it easier for fluid to flow out of the front part of the eye,decreasing pressure in the eye.But,the actual mechanism of this surgery is below understood now.Compared with other laser therapy,SLT uses a lower-level laser to open the drainage angle of the eye,and therefore cause rare or slight complication,so it is thought to be a repeatable therapy to the patients who needs further treatment.The principle,clinical application,efficacy,safety and study progress about SLT for glaucomatous eyes are reviewed.
ABSTRACT
Background Glucocorticoid drugs have been used increasingly in ophthalmology.It has been established that glucocorticoid are associated with a rise in intraocular pressure (IOP) and the development of glaucoma.Selective laser trabeculoplasty (SLT) is thought to be effective in treating patients with glucocorticoidinduced elevated IOP.Objective This study was to assess the efficacy of SLT in lowering IOP in patients with glucocorticoid-induced ocular hypertension.Methods A retrospective case series study was adopted.SLT around 360° chamber angle was performed in 9 eyes of 9 patients with glucocorticoid-induced glaucoma in Eye & ENT Hospital of Fudan University,including 5 eyes of 5 patients owing to use of glucocorticoid eye drops for long-term after laser in situ keratomileusis (LASIK) and 4 eyes of 4 patients who received intravitreal injection of 0.1 ml triamcinolone acetonide (TA) (4.0 mg) for macular edema induced by central retinal vein occlusion(CRVO).All of the patients were lack of preexisting glaucoma or ocular hypertension and underwent unsuccessful maximum tolerated medical therapy before SLT treatment.The base IOP was 35-44 mmHg and glucocorticoid drugs were ceased for 2-12 months prior to the SLT.The patients were followed-up for 6 months.IOP was measured and recorded before and 1 hour,1 week,1 month and 3 months,6 months after SLT.The difference of IOP was compared by repeated measures analysis of variance and multiple comparison analysis.Results All the patients received single SLT operation.The mean IOP was (40.0±2.9) mmHg before operation,but the IOP was (37.9±8.1),(34.9±5.9),(27.6±6.7),(21.6±6.9) and (17.9±2.9)mmHg 1 hour,1 week,1 month,3 months and 6 months after SLT.The IOP at 1 month,3 months and 6 months after SLT were significantly lower than that before operation (all at P＜0.05).Two patients received a filtration surgery for uncontrolled IOP at 1 month and 3 months after SLT respectively,and another patient still used 2 kinds of lowing-IOP eye drops until the end of following-up duration.Conclusions SLT reduce IOP in 6 eyes of 9 patients with glucocorticoid-induced increased IOP from the initial 1 month through 6 months after SLT.
ABSTRACT
Background Selective laser trabeculoplasty (SLT) is one of common therapies for early-stage primary open angle glaucoma (POAG).However,it always been used as a method of treating medically uncontrolled open angle glaucoma in China.So the assessment of efficacy of SLT as the initial therapy for POAG is still lack.Objective This clinical study was to compare the efficacy of SLT in early-stage POAG eyes with or without primary medical therapy.Methods A prospective non-randomized controlled study was designed.Sixty-five eyes of 37 patients with early-stage POAG were divided into without pre-treated group (30 eyes of 16 patients) and with pretreated group (35 eyes of 21 patients).SLT was performed on the inferior trabecular meshwork of 180° in all the patients aged 12-57 years old using a 532 nm frequency-doubled,Q-switched Nd:YAG laser with the pulse 3 ns,spot diameter 400 μm.The emitting energy was set from an initial energy of 0.6 mJ to decreased energy successively at 0.1 mJ interval till bubbles coming out.The following-up was 6 months.Primary outcome of SLT included the changes of intraocular pressure (IOP) and effective rate,and the secondary outcome included the perimetry and C/D value.The safety index was evaluated as the incidence of irritative symptom.Results After SLT 1 day to 6 months,the IOP was lower than that before SLT in all the patients (all at P＜0.05).The IOP was (24.03± 3.76)mmHg and (19.18±3.86)mmHg respectively at preoperation and postoperative 1 month in without pretreated group,with a mean decreasing value of (4.85 ±4.31)mmHg,in with pretreated group,the IOP was (23.63±4.29)mmHg at preoperation and (17.07±4.15)mmHg at postoperative 1 month,with a mean difference of (6.28±3.57)mmHg,with a significant difference in the IOP lowing value between the two groups (P =0.045),but there were no significant differences in the IOP lowing value between without and with pretreated groups in 1 hour,1 day,3 months and 6 months after SLT (all at P＞0.05).The effective rate was 75.00％ and 76.67％ in without and with pretreated groups respectively at the end of following-up (P =0.882).No obvious changes were seen in visual field and C/D value before and after SLT in both groups.Also,no serious complication was found in the patients during the following-up duration.Conclusions SLT has a good outcome in lowing-IOP for early stage POAG.There is no obvious impact to the clinical efficacy of SLT whether with or without the primary administration of anti-glaucomatous eye drops.Long-term effect of SLT remains to be observed.
ABSTRACT
The management of open-angle glaucoma is a long-term,even lifelong procedure.A right medical decision can gain better efficacy and economic benefit and effectively avoid medical risk.Selective laser trabeculoplasty (SLT) is a therapy approved by FDA of USA and has been applied in China over decade.However,the clinical efficacy assessment is still controversial in China.For re-evaluation of the indication,methodology,technical parameters,and the efficacy of SLT will give full play to its advantage of the potential sufficient control of intraocular pressure (IOP) in glaucomatous treatment.The development of history,mechanism and effectiveness in control IOP,security and operation of SLT are reviewed.The suitable population,technique parameters,multiple centers clinical trial and the cost-effectiveness of SLT for Chinese glaucomatous patients are also proposed.