Therapeutic Performance of Selective Laser Trabeculoplasty (SLT) in Patients with End-Satge Glaucoma. Report of One-Year Results

Abstract

Purpose : Selective laser trabeculoplasty (SLT) reduces intraocular pressure (IOP) by increasing aqueous outflow through the trabecular meshwork with a single, painless outpatient laser procedure, minimal recovery time, and good safety profile. End-stage glaucoma is a fragile condition requiring low and stable IOP in order to maintain vision in the patient affected. The aim of this retrospective study was to investigate the results of SLT in patients with the more advanced stages of open-angle glaucoma.

Methods : Seventeen consecutive cases of end-stage glaucoma which underwent SLT in a glaucoma referral center in Western Mexico were analyzed. All cases had at least one year of follow-up. The information of only one eye was randomly selected for the purposes of this study. Using a Latina treatment lens under a slit-lamp view, energy was placed in the trabecular meshwork. Variables under analysis were baseline and post-SLT IOP, BCVA, perimetric indexes, optic tomographic, disc and nerve fiber layer parameters, number of antiglaucoma medications, collateral procedures, success procedural rate (pre-established criteria) and presence of complications.

Results : Mean age of patients was 65.32 ± 9.27 years (10 female, 7 male). Mean DM was -24.71 ± 6.88 dB. Baseline IOP was 17.3 ± 3.15 mm Hg. Mean IOP after one year was 14.7 ± 4.08 mm Hg. IOP reduction equal or greater than 25% of the preoperative IOP-value and reduction of medication were achieved in 11 eyes (64.7%). Successful re-treatment occurred in 3 eyes (17.64%). In 4 eyes (23.55%) a mitomycin-C supplemented trabeculectomy was necessary after initial SLT. Success rate after one year was 70.5%. A transient IOP spike occurred was present in only 2 cases solved with a conservative approach. No serious complications were reported.

Conclusions : SLT could be offered as an additive treatment for end-stage glaucoma when target pressure is not achieved for a few mm Hg due to good reproducibility in results and few adverse effects.

This is a 2020 ARVO Annual Meeting abstract.