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Robert T Swan, C Stephen Foster; Incidence of Inflammation following Selective Laser Trabeculoplasty in Uveitic Eyes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6119.
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Selective Laser Trabeculoplasty (SLT) has not been widely studied in eyes with uveitis and glaucoma. The history of inflammation is typically a research and clinical exclusion criteria in SLT. We studied the incidence of clinically-significant flares within 30 days of SLT in eyes with a history of uveitis via retrospective case series.
We performed a chart review of all patients at the Massachusetts Eye Research and Surgery Institution (MERSI) who underwent SLT in an eye with a history of uveitis. Patients were excluded if data regarding presence or absence of inflammation was not available for a minimum of 90 days prior or 30 days after SLT. Patients were assigned to one of three groups: Quiet (no inflammation for at least 90 days prior to SLT), Controlled inflammation (active inflammation within 90 days of SLT but quiet at the time of procedure), and uncontrolled inflammation (active inflammation at the time of procedure). The primary outcome was the presence of a clinically-significant inflammation within 30 days of SLT.
291 SLT’s performed in 182 consecutive patients with uveitis and glaucoma met criteria for this study. There were 29 clinically-significant flares of uveitis in 26 patients. In SLT’s on eyes that were quiet for more then 90 days, 18/229 (7.9%) resulted in a flare. In eyes with controlled inflammation, 5/37 (13.5%) eyes flared. In eyes with uncontrolled inflammation, 6/26 (23.1%) eyes flared. Of 76 patients that underwent more than one SLT, 14 flared once, and 2 patients flared after more than one. 12/29 (41.3%) of flares had confounding variables that may have resulted in the flare. There were no flares in any of the 25 eyes with an active fluocinolone acetonide implant. (See Figure 1)
Overall, 10% of uveitic eyes flared after SLT, with the incidence of post-operative flare inversely proportional to preoperative duration of uveitic quiescence. There are confounding variables that explain some but not all of the flares in this study and we believe our reported incidence of flares represents a conservatively high estimate. We conclude that SLT is a viable treatment modality for select patients with quiet uveitis.
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