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Pranav Patel, C Stephen Foster; Safety and Efficacy of Selective Laser Trabeculoplasty in Uveitic Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6154.
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Selective Laser Trabeculoplasty (SLT) has been shown to be safe and effective at lowering IOP in patients with primary open angle glaucoma, pseudoexfoliation glaucoma, and glaucoma secondary to pigment dispersion syndrome. We studied the effectiveness of SLT in patients with uveitic glaucoma and risk of uveitis flare.
A chart review of 41 eyes from 35 patients with uveitis and glaucoma was performed. Patients were selected from the Massachusetts Eye Research and Surgery Institute (MERSI) database that underwent SLT from Jan 1st 2009 to June 1st 2012. The primary outcomes studied were the time to next flare after SLT and the number of patients who achieved 20% IOP reduction after SLT treatment at 1, 3, 6, and 12 month follow-up. Secondary outcome studied was the percentage of patients requiring further treatments after SLT.
7 of 41 eyes developed a flare during the 1 year follow up time. One eye was noted to have a mild flare post-op day 1. One patient developed a flare at day 10 and another at day 14. The remaining 4 eyes had a flare beyond one month follow up period at day 32, 50, 99, and 178. At 1 month follow up, 15 of 39 eyes or 38% achieved a 20% IOP reduction without the need for further procedures. At 3 month follow up, 9 of 34 eyes or 26% achieved a 20% reduction without the need for further procedures. The number of eyes achieving a 20% IOP reduction without further procedures was 11 of 36 or 31% at 6 month follow up and 10 of 38 eyes or 26% at 1 year follow up. 11 of 41 eyes underwent a second glaucoma procedure or needed additional medicines for better IOP control within the 1 year follow up period.
SLT appears to be a safe and efficacious procedure in uveitic patients with glaucoma. Only one eye had a mild flare within a week of SLT. The remainder of the flares are likely not triggered by SLT given the delayed onset. SLT achieved a significant IOP reduction of 20% throughout the one year follow up period in approximately a quarter of the patients at the final follow up period. The results of this study suggest that SLT should be considered to uveitic patients with uncontrolled glaucoma.
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