The procedure, which has been used for approximately 3 years, employs an Nd:Yag laser which targets the melanocytes in the trabecular meshwork and induces the release of cytokines, macrophages and other changes that lead to reduced intraocular pressure (IOP), explained Lawrence Jindra, MD, Professor of Ophthalmology, Columbia University, New York, New York, United States.

The procedure is considerably safer than other treatments such as argon laser trabeculoplasty because it does not cause thermal or coagulative damage to the surrounding structures, Dr. Jindra said.

In his study, Dr. Jindra and colleagues treated 1031 eyes with SLT -- 486 patients had newly diagnosed glaucoma and had never had IOP-lowering treatment; 429 had already been on ocular hypotensives; 116 had previous SLT but IOP started to increase again.

Most of the subjects in each arm were female, and most were in their late 60s and early 70s.

Patients in the initial therapy group experienced a mean reduction in IOP of 7.3 mm Hg, which corresponds to a decrease of 35%. A decrease of 6.4 mm Hg was seen in the group that had already been on IOP-lowering drugs (an IOP reduction of 29%); patients having repeat therapy had a mean reduction in IOP of 5.9 mmHg (an IOP reduction of 25%).

These changes occurred over a period of at least 6 months and were highly significant (P < .0001).

In the initial treatment and secondary treatment groups, mean IOP was 20 to 21 mm Hg at baseline. At follow-up IOP was reduced to 13.3-15.4 mm Hg. Patients who were having repeat therapy had slightly higher IOP at baseline -- 23 mm Hg -- and this was reduced to around 17 mm Hg at follow-up.

Patients who were having secondary therapy had a reduction of 60% in the amount of medication they needed to control their IOP, while those who were having repeat therapy had a reduction of 45%. At follow-up, patients in the secondary group were using a mean of 1.0 medications, and those in the repeat therapy group were using a mean of 0.8 medications. These findings were highly significant (P < .0001).

The findings are important because not only do they show a lowering of IOP among these patients, but it also means compliance is no longer an issue, Dr. Jindra said. Patients should, in theory, be able to maintain their reduced IOP for longer periods because there is no risk that they will forget to use their medications.


[Presentation title: Selective Laser Trabeculoplasty Is Effective in Maintaining Lower IOP and Fewer Medications Over the Long Term in Patients with Glaucoma. Abstract PO075]

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