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Editors Selection IGR 7-3
Surgical treatment: SLT and medical therapy
Comment by Yasuaki Kuwayama on:
13188 High failure rate associated with 180 degrees selective laser trabeculoplasty, Song J; Lee PP; Epstein DL et al., Journal of Glaucoma, 2005; 14: 400-408
Selective laser trabeculoplasty (SLT) specifically targets pigmented trabecular meshwork cells, thereby minimizing coagulation and collateral damage to the non-pigmented cells or adjacent structures. Thus, unlike argon laser trabeculoplasty (ALT), it may have the potential for multiple repetitions. Many studies have shown that SLT successfully lowers IOP, although not significantly better than ALT.
However, Song (1078) et al. report a higher failure rate associated with 180° SLT than any other studies. In their retrospective study in a tertiary care referral center, overall failure rates were 68% when failure was defined as an IOP decrease of <3 mmHg, and 75% when failure was defined as an IOP decrease of <20%, yet an average of 2.1 mmHg reduction of IOP (p < 0.001) was obtained after SLT. Any number of factors may have led to this poor result. For example, the baseline IOP was lower than that reported in other studies (average pre-SLT IOP was 17.6 mmHg in this study). The patients studied also had advanced glaucoma (65% of patents were on multiple medication, 28% of patients had prior intraocular surgery). Additionally, they used fewer laser spots (one third of patients received less than 35 spots).
We need not be pessimistic about SLT because of this data. Older studies on ALT have already shown that when treating advanced glaucoma, surgery rather than laser trabeculoplasty should be the primary option for treatment. Furthermore, this report still leaves open the possibility of using SLT as the first-line treatment for open-angle glaucoma.
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