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Editors Selection IGR 23-3

Laser treatment: Selective laser trabeculoplasty 2

Comment by Kaweh Mansouri on:

106743 Effectiveness and safety of VISULAS green selective laser trabeculoplasty: a prospective, interventional multicenter clinical investigation, Pillunat KR; Kretz FTA; Koinzer S et al., International Ophthalmology, 2023; 43: 2215-2224

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The new VISULASR green (Carl Zeiss Meditec AG, Germany) is an integrated retina and glaucoma laser operating with a diode-pumped frequency-doubled Nd:YVO⁴ laser at 532 nm wave- length. Depending on the selected treatment mode, VISULAS green can for instance be operated in photocoagulation mode for the treatment of retinal pathologies or alternatively in selective mode for SLT treatment. The SLT mode applies a fixed multi-spot pattern consisting of 52 adjacent single pulses of squared spots sized 50 µm each forming an application of 400 µm in diameter, similar to conventional SLT.

This prospective, multicenter study by Pillunat et al. evaluated the efficacy and safety of the new laser in patients with POAG. They included 34 eyes of 34 patients. Mean baseline IOP of 21.0 ± 2.7 mmHg was reduced by -3.6 ± 3.4 mmHg at three months, corresponding to a -16.3% IOP reduction (p < 0.001). Medications were not stopped as per protocol. The treatment was safe and generally well tolerated with a few cases of uneventful IOP spikes and eye pain reported.

This was a small, non-comparative study of the new VISULAS green laser. Although the results are promising, more and larger studies are needed.

Some limitations of this study were the lack of ethnical diversity, inclusion of only primary open-angle glaucoma eyes, and the short follow-up period. Also, the protocol of the study did not allow to evaluate the effect of VISULAS SLT treatment on reduction of glaucoma medications.

Furthermore, since the laser treatment with VISULAS does not create visible cavitation bubbles, the manufacturer provides recommendations to set the energy level according to the grade of angle pigmentation. These recommendations, however, need to be evaluated in bigger trials, including a wide range of angle pigmentations and ethnicities.

The fact that one platform provides the ability to perform SLT, iridotomy, iridoplasty, capsulotomy, and retina lasers has important practical advantages

This new addition to the glaucoma laser landscape is to be welcomed. The fact that one platform provides the ability to perform SLT, iridotomy, iridoplasty, capsulotomy, and retina lasers has important practical advantages.

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