An economic analysis of selective laser trabeculoplasty versus topical prostaglandin analogues as initial therapy for primary open-angle glaucoma in a tertiary government hospital in the Philippines

Objective@# This study compared the economic viability of initial medical therapy with topical prostaglandin analogues (PGAs) versus selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG).@*Method@#This was an economic analysis using actual, current treatment costs of PGA therapy versus SLT applied to theoretical, literature-derived clinical efficacy data projected for a period of 19 years. A socioeconomic and demographic survey conducted among POAG patients at the Department of Health Eye Center of the East Avenue Medical Center from March-April 2022 provided the economic context and setting for the analysis. The treatment regimens were compared in terms of total cost, clinical efficacy, cost-effectiveness and cost-utility in the setting of a tertiary government hospital.@*Results@#Thirty-one (31) patients were included in the study. The total annual cost of topical PGAs was Philippine Pesos (Php) 13,532 versus Php 6,195 for SLT. Cost-effectiveness was Php 1,933 for PGAs/mmHg reduction in intraocular pressure (IOP) versus Php 983 for SLT. Cost-utility was Php 59,793/Quality Adjusted Life Years (QALY) gained for PGAs versus Php 27,373/QALY gained for SLT projected for 19 years. With government insurance coverage, cost-utility ratio was Php 47,831/QALY gained for topical PGAs versus 16,327/QALY gained for SLT.@*Conclusion@#In POAG patients, SLT was more cost-effective versus PGAs with a lower cost per mmHg IOP reduction, and lower cost-utility ratio for every QALY gained. SLT can be recommended as initial therapy for POAG especially for patients being treated at tertiary government hospitals.

Association between the function of Schlemm canal and outcome following selective laser trabeculoplasty for primary open-angle glaucoma / 中华实验眼科杂志

Objective:To investigate the relationship between the function of Schlemm canal and the efficacy of selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG).Methods:An observational case series study was conducted.Seventeen POAG patients (25 eyes), including 12 males (18 eyes) and 5 females (7 eyes), were enrolled in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from March to December, 2017.The three-mirror contact lens was adopted to observe the presence of blood reflux in Schlemm canal before aerobic exercise, and positive referred to that blood reflux was observed in any region of Schlemm canal, and negative was defined as that no blood reflux was observed in Schlemm canal.The intraocular pressure (IOP) and blood pressure of subjects were measured before and after exercise test by the non-contact tonometer and automatic blood pressure monitor respectively.Positive referred to the IOP reduction ≥4.6 mmHg (1 mmHg=0.133 kPa) and negative was defined as the IOP reduction <4.6 mmHg.Optical coherence tomography (OCT) was used to observe whether Schlemm canal was dilated or not and the dilated area before and after exercise test.Positive referred to the opening clock position of Schlemm canal was larger and/or the Schlemm canal was dilated at one or more clock position.The subjects presenting positive in above three indicators were classified as the positive Schlemm canal function group (8 eyes). The subjects presenting positive in above one or two indicators were classified as the mixed Schlemm canal function group (11 eyes). The subjects presenting negative in above three indicators were classified as the negative Schlemm canal function group (6 eyes). All subjects received SLT treatment.The IOP was examined at postoperative 1 week, 2 weeks and 1 month.The IOP, IOP reduction and rate of IOP reduction were compared among the three groups at various time points.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (No.TJ-IRB20160306). Written informed consent was obtained from each subject.Results:The preoperative IOP and postoperative 1-week, 2-week and 1-month IOP were (20.33±9.22), (17.10±2.98), (19.00±3.94) and (19.33±4.32) mmHg of negative Schlemm canal function group, (25.75±9.03), (20.00±7.60), (19.18±4.46) and (18.00±3.63) mmHg of mixed Schlemm canal function group and (22.28±4.78), (18.75±8.53), (15.50±4.98) and (14.38±3.24) mmHg of positive Schlemm canal function group, respectively.There was no statistical significance in the IOP value among the three groups ( Fgroup=1.028, P=0.374). The difference in IOP before and after surgery was statistically significant ( Ftime=6.751, P=0.002). Compared with preoperative IOP, the postoperative 1-week IOP of the negative Schlemm canal function group, the postoperative 1-week, 2-week and 1-month IOP of the mixed Schlemm canal function group, and the postoperative 2-week and 1-month IOP of positive Schlemm canal function group were significantly decreased (all at P<0.05). There was no significant difference in IOP reduction or the rate of IOP reduction among the three groups after operation ( Fgroup=0.952, P=0.401; Ftime=0.828, P=0.402; Fgroup=1.840, P=0.182; Ftime=0.419, P=0.660). Conclusions:POAG patients with better function of Schlemm canal have a better IOP-lowering efficacy after SLT treatment.Blood reflux in Schlemm canal before exercise, reduced IOP and dilated Schlemm canal after exercise can be considered as indicators to evaluate Schlemm canal function.

Effect of selective laser trabeculoplasty on primary open angle glaucoma in different stages / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To assess and compare the effectiveness of selective laser trabeculoplasty(SLT)in preventing primary open angle glaucoma(POAG)with various stages.<p>METHODS: Fifty-one eyes of 27 patients 51 eye with POAG were included in this retrospective study. All the cases were divided into three groups depending on the mean deviation(MD): the early stage group(MD>-6dB, 15 eyes), middle stage group(-12dB≤MD≤-6dB, 15 eyes)and late stage group(MD<-12dB, 21 eyes). All subjects underwent SLT on 360° of the angle between July 2018 to March 2020. The laser parameters of a 532nm, Q-switched, frequency-doubled Nd: YAG laser, with 3ns pulse time, 400μm spot diameter were set to selectively target pigmented trabecular meshwork cells without visible damage to the adjacent non-pigmented tissue. Intraocular pressure(IOP)reduction was observed at 1h, 1d, 1, 3, 6 and 12mo after the laser procedure. Meanwhile, the ratio of the IOP reduction, visual field index(VFI), MD, medication, adverse reactions and efficiency were assessed as well.<p>RESULTS: Within the 12mo post-SLT, there were no statistically significant differences for the IOP and IOP decline rate between each group(all <i>P</i>>0.05). There were significant differences in VFI and MD among early, middle and late groups(<i>P</i><0.001), within the 12mo post-SLT, no statistically significant differences were detected for the decline of VFI and MD in each group. In terms of the early stage group, the effective rates of SLT at 1, 3, 6 and 12mo after treatment were 100%, 93%, 87%, 67%, respectively. For the middle stage group and late stage group, the effective rates were 87%, 80%, 93%, 60%, and 67%, 71%, 62%, 19%, respectively. <p>CONCLUSION: SLT was an effective treatment for POAG patients in various stages, while the effective rate decreased with time.

Effect of selective laser trabeculoplasty in silicone oil related glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the efficacy of selective laser trabeculoplasty(SLT)for lowering intraocular pressure(IOP)in patients with emulsified- silicone oil related secondary open angle glaucoma(SO-OAG).<p>METHODS: By a retrospective case study, consecutive case series of 120 eyes with sustained elevation of IOP after SO-OAG removal were treated by 360° SLT treatment. The mean IOP, mean number of glaucoma medications, and success rates at baseline 1wk, 1mo, 3mo were evaluated.<p>RESULTS: After the SLT treatment, the mean baseline IOP was significantly decreased from 25.02±5.93mmHg to 17.64±4.52mmHg at 1wk(<i>P</i>=0.002), 18.96±3.33mmHg at 1mo(<i>P</i>=0.04), and 18.03±5.69mmHg at 3mo(<i>P</i>=0.03). The mean number of glaucoma medications significantly decreased from 3.11±0.62 to 1.78±0.14 at 1wk(<i>P</i>=0.006), 1.95±0.56 at 1mo(<i>P</i>=0.04), and 1.87±0.53 at 3mo(<i>P</i>=0.02). The complete and qualified success rate were 68.3%(82 eyes)and(20.0%)(24 eyes)at 1wk, 61.7%(74 eyes)and 17.5%(21 eyes)at 1mo, and 64.2%(77 eyes)and 12.5%(15 eyes)at 3mo.<p>CONCLUSION: SLT may be effective for lowering IOP in patients with SO-OAG which was not controlled with maximum antiglaucomatous medical treatment.

Predictors of Success of Selective Laser Trabeculoplasty Adjusted for Intraocular Pressure Variations

PURPOSE: To investigate the efficacy, and identify predictors of success of selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG) patients after adjusting for intraocular pressure (IOP) changes in the untreated fellow eye. METHODS: This retrospective chart review included 52 eyes of 52 OAG patients who underwent SLT in one eye and were followed-up for at least 1 year after the procedure. The IOP was measured before the treatment, at 1, 2, and 3 months posttreatment, and every 3 months thereafter. To account for the possible influence of IOP fluctuations on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed, after adjusting for IOP changes in the untreated fellow eye. Success was defined as an IOP decrease ≥20% of the pretreatment IOP. The success rate was determined based on Kaplan-Meier survival analysis and factors predictive of success were analyzed using the Cox proportional hazard model. RESULTS: The mean pretreatment IOP was 23.17 ± 6.96 mmHg. The mean IOP reduction was 5.59 ± 4.78 mmHg (29.7%) and the success rate was 65.4% at 1 year. The adjusted mean IOP reduction was 4.70 ± 4.67 mmHg (23.9%) and the adjusted success rate was 53.9%. Pretreatment IOP was associated with SLT success; the higher the pretreatment IOP, the greater the post-laser IOP reduction (p = 0.025). Age and mean deviation index did not show a significant association with SLT success (p = 0.066 and p = 0.464, respectively). CONCLUSIONS: SLT is a safe and effective alternative method of IOP reduction in OAG patients. Herein, pretreatment IOP was the only factor significantly associated with SLT success. IOP fluctuations of the untreated eye should be considered for a better understanding of the impact of treatment.

Clinical effects of selective laser trabeculoplasty in the treatment of ocular hypertension and different course of primary open angle glaucoma / 眼科新进展

Objective To compare the efficacy of selective laser trabeculoplasty (SLT) on the intraocular pressure (IOP) reduction in the treatment of ocular hypertension (OHT),early and moderate primary open angle glaucoma (POAG).Methods Non-randomized controlled study was conducted in 120 patients (120 eyes),who were divided into 3 groups according to the patients' condition,including OHT group with 40 eyes of 40 patients,early-stage POAG group (40 eyes of 40 patients) and medium-stage POAG group (40 eyes of 40 patients),aged rang from 16 to 79 years.SLT was performed on the 360° trabecular meshwork using 532 nm frequency-double Q-switched Nd:YAG laser (Selecta duet),with the pulse of 3 ns and spot diameter of 400 nm.The initial energy was 0.6 m J,which decreased at 0.1 mJ interval till champagne bubble appeared.The following-up was postoperative 1 day,1 week,1 month,3 months and 6 months,respectively,and changes in IOP before and after SLT was recorded and analyzed statistically.Resuits Postoperative IOP at different time points was significantly lower than that of preoperation in the three groups,with significant difference (all P ＜ 0.05).There was also significant difference in IOP of the each group at different time points after the operation (all P ＜ 0.05).The preoperative baseline IOP of OHT group,early-stage POAG group and medium-stage POAG group was (25.95 ± 1.80) nmHg (1 kPa =7.5 mmHg),(24.66 ± 1.55) mmHg and (25.62 ± 2.67) mmHg,respectively,approaching significant difference (P ＜0.05).After eliminating the influence of baseline IOP,intergroup differences of postoperative IOP at each time point in the three groups were statistically significant (all P ＜ 0.05),and intragroup differences were also significant (all P ＜ 0.05).When compared with corrected baseline IOP,the reduction of IOP was the largest in OHT group after SLT,followed by the early-stage POAG group,and the lowest was in the medium-stage POAG group.Conclusion SLT has a good effect on IOP reduction for OHT and POAG,and the treatment effect of SLT declines successively according to the severity of POAG.

The Effectiveness of Selective Laser Trabeculoplasty in Patients with Medically Uncontrolled Open-angle Glaucoma

PURPOSE: To determine the effect of intraocular pressure (IOP) reduction of selective laser trabeculoplasty (SLT) on medically uncontrolled open-angle glaucoma (OAG) and the factors associated with the treatment result. METHODS: Forty-seven eyes of 47 OAG patients were enrolled for 180° SLT or 360° SLT, all under maximal tolerated medical therapy and with IOP above their target pressure. All patients were followed-up for at least 1 year after the procedure. Treatment success was defined as IOP reduction ≥20% from baseline at 12 months after SLT treatment without additional anti-glaucomatous intervention. RESULTS: The treatment success rate was 65.96%. Baseline IOP was 23.84 ± 4.52 mmHg in the success group and 21.44 ± 2.97 mmHg in the failure group (p = 0.035). Significant mean IOP reduction was observed at 6, 9, and 12 month follow-ups (p = 0.001 at 6 months; 0.041 at 9 months, and <0.001 at 12 months). The success rate did not vary significantly by sex (p = 0.362), age (p = 0.081), history of cataract surgery (p = 0.470), number of medications (p = 0.857), duration of medication (p = 0.613), or angular degree of SLT treatment (180° vs. 360°) (p = 0.137). There was a positive correlation between mean baseline IOP and mean reduction of IOP from baseline in the success group (p < 0.001, r = 0.861), while there was no such correlation in the failure group (p = 0.272, r = −2.921). CONCLUSIONS: SLT was an effective treatment for IOP reduction until 12 months in medically uncontrolled OAG patients. A greater amount of IOP reduction is expected in patients with higher baseline IOP in the success group.

The efficacy and safety of selective laser trabeculoplasty in the treatment of silicone oil glaucoma / 中国医师进修杂志

Objective To evaluate the efficacy of selective laser trabeculoplasty (SLT) as treatments of secondary glaucoma after intravitreal silicone oil injection. Methods Forty-five cases(45 eyes) of silicone oil glaucoma (SOG) from June 2014 to April 2016 were enrolled and divided into two groups according random digits table. The SLT treatment group had 21 cases (21 eyes), and drug treatment group had 23 cases(23 eyes).Intraocular pressure(IOP)changes were recorded 1 d, 1 week, 3 weeks, 1 month, 2 months, 3 months,4 months,5 months and 6 months after treatment.Results The decrease of IOP in SLT group was (11.47 ± 2.23), (11.27 ± 2.59), (10.43 ± 2.55), (11.93 ± 2.71), (13.75 ± 2.57),(13.93 ± 2.65),(10.45 ± 2.53)and(12.73 ±2.86)mmHg(1 mmHg=0.133 kPa).IOP of the control group decreased respectively (7.53 ± 3.29), (9.57 ± 3.49), (8.78 ± 4.21), (8.74 ± 3.86), (6.12 ± 4.41),(7.84 ± 3.26),(8.84 ± 4.25),(8.24 ± 3.56)mmHg.There was significant difference between the two groups 1 week, 1 month, 2 months, 3 months,4 months,5 months and 6 months after treatment (t = 4.17, 1.38, 2.89, 6.32, 3.89, 5.32, 5.19, P < 0.05 or < 0.01). Conclusions SLT is a safe and effective option for the treatment of patients with SOG.

Laser intervention on trabeculo‑Descemet’s membrane after resistant viscocanalostomy: Selective 532 nm gonioreconditioning or conventional 1064 nm neodymium‑doped yttrium aluminum garnet laser goniopuncture.

Purpose: To compare the results of conventional 1064 nm neodymium‑doped yttrium‑aluminum garnet laser goniopuncture (Nd:YAG‑GP) and selective 532 nm Nd:YAG laser (selective laser trabeculoplasty [SLT]) gonioreconditioning (GR) on trabeculo‑Descemet’s membrane in eyes resistant to viscocanalostomy surgery. Methods: Thirty‑eight eyes of 35 patients who underwent laser procedure after successful viscocanalostomy surgery were included in the study. When postoperative intraocular pressure (IOP) was above the individual target, the eyes were scheduled for laser procedure. Nineteen eyes underwent 532 nm SLT‑GR (Group 1), and the remaining 19 eyes underwent conventional 1064 nm Nd:YAG‑GP (Group 2). IOPs before and after laser (1 week, 1 month, 3 months, 6 months, 1 year, and last visit), follow‑up periods, number of glaucoma medications, and complications were recorded for both groups. Results: Mean times from surgery to laser procedures were 17.3 ± 9.6 months in Group 1 and 13.0 ± 11.4 months in Group 2. Mean IOPs before laser procedures were 21.2 ± 1.7 mmHg in Group 1 and 22.8 ± 1.9 mmHg in Group 2 (P = 0.454). Postlaser IOP measurements of Group 1 were 12.1 ± 3.4 mmHg and 13.8 ± 1.7 mmHg in the 1st week and last visit, respectively; in Group 2, these measurements were 13.6 ± 3.7 mmHg and 14.9 ± 4.8 mmHg, respectively. There were statistically significant differences (P < 0.001) in IOP reduction at all visits in both groups; the results of the two groups were similar (P > 0.05). Mean follow‑up was 16.6 ± 6.4 months after SLT‑GR and 18.9 ± 11.2 months after Nd:YAG‑GP. Conclusions: While conventional Nd:YAG‑GP and SLT‑GR, a novel procedure, are both effective choices in eyes resistant to viscocanalostomy, there are fewer complications with SLT‑GR. SLT‑GR can be an alternative to conventional Nd:YAG‑GP.

A review on selective laser trabeculoplasty / 中华实验眼科杂志

Glaucoma is an irreversible blinding disease.The aim of glaucoma therapy is to lower the intraocular pressure (IOP),and then slow down glaucoma progression.Currently,this goal can be achieved by medication,laser treatment and surgery.Selective laser trabeculoplasty (SLT) involves using a 532 nm wave length Nd:YAG laser selectively target cells of the trabecular meshwork without causing thermal or collateral damage to the surroundings structures.The exact mechanism by which SLT lowers IOP remains unknown.It has become gradually one of the most preferred methods for the treatment of open angle glaucoma.SLT seems to have a similar IOP lowering effect with argon trabeculoplasty or monotherapy of topical prostaglandin medication.Mean IOP reduction after SLT was 3.8-8.0 mmHg in 6 months to 1 year.The long-term effect of SLT in the treatment of open angle glaucoma remains to be further studied.The relationship between the range of SLT treatment and its therapeutic effect has not been recognized.SLT is efficacious and safe,also has repeatable and less adverse effects.It can be used as an efficacious primary,adjunctive and replacement therapy for treating open angle glaucoma.In this paper,we reviewed the effects of SLT as an initial and repeat treatment,also the factors that could affect therapeutic effects.

Long-term Results of Selective Laser Trabeculoplasty versus Latanoprost or Dorzolamide/Timolol Fixed Combination

PURPOSE: To compare the efficacy of selective laser trabeculoplasty (SLT) in patients treated with either latanoprost or dorzolamide/timolol fixed combination (DTFC) for primary open-angle glaucoma. METHODS: This retrospective study included 92 consecutive patients who underwent a 180-degree SLT for the first time. The subjects divided into two groups:patients who received latanoprost (n = 63) or DTFC (n = 29) before and after SLT. The main outcome measure was intraocular pressure (IOP) decrease over five years after SLT. The mean IOP change, mean percentage of IOP reduction, and success rates were compared between the patients treated with latanoprost and the patients treated with DTFC. Success was defined as an IOP decrease ≥ 3 mm Hg or IOP reduction ≥ 20% without additional medications, laser surgery, or glaucoma surgery. RESULTS: At the postoperative one-year follow-up, the mean IOP was 15.7 ± 2.2 mm Hg in the latanoprost group and, 16.2 ± 2.4 mm Hg in the DTFC group. At the postoperative five-year follow-up, the mean IOP was 15.1 ± 2.5 mm Hg in the latanoprost group and, 14.6 ± 1.7 mm Hg in the DTFC group. There were no statistically significant differences in IOP change, percentage IOP reduction, or success rate between the groups at each time point after the SLT (p > 0.05). CONCLUSIONS: Selective laser trabeculoplasty showed a reasonable efficacy in lowering the IOP over a five-year follow-up period. There were no significant differences in IOP lowering effect or success rate between the patients treated with latanoprost or DTFC.

A Case of Hyphema after Selective Laser Trabeculoplasty

PURPOSE: To report a case of hyphema after selective laser trabeculoplasty (SLT) in a patient with pseudoexfoliative glaucoma. CASE SUMMARY: A 77-year-old female was referred for elevation of intraocular pressure (IOP). Previously, she had been diagnosed with pseudoexfoliative glaucoma in the right eye and was using topical IOP-lowering agents. The best corrected visual acuity was 20/100 in the right eye and 20/40 in the left eye. IOP, measured with Goldmann applanation tonometer, was 32 mm Hg in the right eye and 20 mm Hg in the left eye. Gonioscopy revealed open-angle glaucoma with +2 trabecular meshwork pigmentation but without peripheral anterior synechiae or neovascularization. SLT was performed in the right eye. Two days later, the patient had sudden onset of blurred vision and pain in the right eye. Visual acuity was limited to light perception, and IOP was 34 mm Hg in the right eye. Slit-lamp examination revealed 1.1 mm hyphema with 4+ red blood cell count in the anterior chamber. Three weeks after the SLT, hyphema in the right eye disappeared, but IOP was measured to be 42 mm Hg. The patient underwent trabeculectomy in the right eye. CONCLUSIONS: SLT is an effective means of lowering IOP with low risk of complications. However, hyphema can rarely occur after SLT and can affect the outcome of the treatment.

Effect of Prior Cataract Surgery on the Clinical Outcome of Selective Laser Trabeculoplasty

PURPOSE: To compare the efficacy of selective laser trabeculoplasty (SLT) in phakic and pseudophakic eyes in primary open-angle glaucoma. METHODS: Charts of 55 phakic eyes and 24 pseudophakic eyes that underwent 360-degree SLT were retrospectively reviewed. Intraocular pressure (IOP) was measured before SLT and 1 week, 1, 3, 6, 9, 12, 18 and 24 months after SLT. Treatment success was defined as IOP reduction > or = 20% without additional medications, laser or glaucoma surgery. Mean IOP change, mean percentage of IOP reduction and success rates of phakic and pseudophakic eyes were compared. RESULTS: Mean percentage of IOP reduction after SLT at 1 week and 1, 3, 6, 9, 12, 18, and 24 months were 18.8%, 23.9%, 24.6%, 23.3%, 24.0%, 22.1%, 20.8%, and 17.9%, respectively, in the phakic group and 15.7%, 22.3%, 23.7%, 25.3%, 25.6%, 25.2%, 21.9%, and 19.3%, respectively, in the pseudophakic group. Success rates were 57.6 +/- 11.9% in the phakic group and 61.3 +/- 10.4% in the pseudophakic group. No statistically significant differences in IOP change, percentage of IOP reduction, and success rates were observed between the groups at each time point after SLT (p > 0.05). CONCLUSIONS: Application of 360-degree SLT appears an efficient treatment option for the management of phakic and pseudophakic open-angle glaucoma. Evaluating the success of SLT 1 month postoperatively may be premature.

Myopic Shift Following Selective Laser Trabeculoplasty: A Case Report.

Introduction: Selective laser trabeculoplasty (SLT) (Lumenis, Santa Clara, CA) was developed in 1999 as a means to lower IOP in patients with glaucoma. It is a relatively safe procedure. We report a rare side effect of anterior chamber shallowing with myopic following SLT. Case Presentation: A 48 year-old white female who underwent SLT OD developed a 4- diopter myopic shift and anterior chamber shallowing 1 week following SLT. Both the anterior chamber shallowing and the myopic shift resolved within 5 weeks. Conclusion: Anterior chamber shallowing and myopic shift following SLT is a rare side effect but is reversible. Physicians and patients should be aware of this potential side effect of SLT.

Corneal Thinning and Opacity following Selective Laser Trabeculoplasty: A Case Report.

Aims: Selective laser trabeculoplasty (SLT) (Lumenis, Santa Clara, CA) was developed in 1999 as a means to lower IOP in patients with glaucoma. It is a relatively safe procedure. We report a rare side effect of corneal opacity and stromal haze with corneal thinning and hyperopic shift following SLT. Presentation of Case: Case report. Results: A 50 year-old Asian male who underwent SLT OD developed mild corneal edema and slightly elevated intraocular pressure (IOP) one day after procedure. He was prescribed anti-inflammatory drops. One week afterwards, he developed a small corneal abrasion centrally. He was given topical antibiotics and asked to continue antiinflammatory drops. On postoperative day 8, his corneal abrasion healed, but he developed stromal corneal haze. Topical steroids were begun. By postoperative week #2, his visual acuity and stromal haze had improved. His corneal thickness decreased from 600 μms to 468 μms. After one year, he had almost complete resolution of his corneal pathology but had residual corneal thinning and flattening. Discussion: Corneal stromal haze following SLT is a rare side effect. This can result in corneal scarring with corneal thinning and a hyperopic shift due to corneal flattening. Physicians and patients should be aware of this potentially vision threatening side effect. Conclusion: More studies are needed to identify risk factors for the development of corneal pathology following selective laser trabeculoplasty.

Long-Term Outcomes and Predictive Factors for Success of Selective Laser Trabeculoplasty

PURPOSE: To investigate long-term outcomes and predictive success factors for selective laser trabeculoplasty (SLT). METHODS: This retrospective chart review included 66 eyes of 66 glaucoma or ocular hypertension patients who underwent SLT between 2004 and 2011. All patients were followed-up for at least 2 years after the procedure. The intraocular pressure (IOP) was measured before the treatment, at postoperative 1 week, 1 month and every 3 months thereafter. Success was defined as an IOP decrease > or = 3 mm Hg or > or = 20% of the pretreatment IOP. The success rate was determined based on the Kaplan-Meier survival analysis. The predictive success factors were analyzed using the Cox proportional hazard model. RESULTS: The mean follow-up period was 4.78 +/- 1.98 (2-8) years. The mean pretreatment IOP was 23.79 +/- 2.83 mm Hg. The mean IOP reduction was 6.64 +/- 3.21 mm Hg. The success rates were 80%, 75%, 69%, 63%, 50%, 45%, and 42% after 1, 2, 3, 4, 5, 6, and 7 years, respectively. Only high pretreatment IOP was significantly correlated with success (p = 0.044). CONCLUSIONS: SLT was an effective tool for lowering IOP in glaucoma patients. Higher pretreatment IOP was a predictive success factor.

Researching progress in selective laser trabeculoplasty for glaucoma / 中华实验眼科杂志

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.

Establishment of selective laser trabeculoplasty effect model in human trabecular cell in vitro / 中华实验眼科杂志

Background Selective laser trabeculoplasty (SLT) plays lowing-intraocular pressure (IOP)effect by irradiating pigmented trabecular cells selectively using 532 nm Nd:YAG laser.However,its affect pattern is not fully known.Objective This study was to establish a human trabecular cells (HTCs) model of SLT effect,and to observe the morphological changes of HTCs after they were exposed to different energies of SLT.Methods Immortalized HTCs were incubated in DMEM/F12 with pigmental granules for 16 hours (overnight) to prepare pigmented trabecular cells.The cells were irradiated with modified laser lens with the spot of 400 μm and emitting duration of 3 ns.The energy scale of 0.2 mJ was set for standardized energy and 0.1 mJ was used as the low energy.The morphology and ultrastructure of the cells were examined under the light microscope and transmission electron microscope 1 hour,4,8,12,24 hours after irradiation.Trypan blue staining and TUNEL fluorescence staining were used to evaluate the death and apoptosis of the cells after laser irradiation.Results The brown pigment particles were seen in cytoplasm around nuclei of trabecular cells after cultured for 16 hours.After laser irradiation,there was no obvious change in the shape of nonpigmented trabcular cells,but a 400 μm spot was found in the pigmented trabecular cells under the light microscope,and the pigmented particles released as the cell disruption.After 0.2 mJ laser irradiation,cell loss zone was seen at the center of the laser spot,and the positive cells for trypan blue and TUNEL staining were found;while the abnormal manifestations were slight after the 0.1 mJ irradiation.With the lapse of the time,the number of positive staining cells was gradually decreased.Twenty-four hours after laser irradiation,proliferative trabecular cells emerged and migrated to the center area of laser spot.Statistical analysis showed that the numbers of the positive cells for trypan blue and TUNEL staining were significantly reduced in the lower energy group in comparison with the standardized energy group at various time points (all at P＜0.001),and those of both energy groups were gradually reduced with lapse of time with the significant differences between any two time points (all at P＜0.01).Conclusions An in vitro laser effect model of HTCs can be established by exposing pigmented HTCs to SLT laser.After exposed to SLT,the gasification,necrosis-like death,apoptosis-like change appear at the laser center.The laser destroyed cells can be replaced by proliferative cells with the lapse of time.Low-energy laser irradiation cause a similar morphological change of the cells to high-energy irradiation,but the number of abnormal cells is much less.

Effect of selective laser trabeculoplasty on intraocular pressure in patients with glucocorticoid induced glaucoma / 中华实验眼科杂志

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.

Clinical outcome evaluation of selective laser trabeculoplasty as the initial therapy for primary open angle glaucoma / 中华实验眼科杂志

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.