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Editors Selection IGR 15-1

Surgical treatment: Selective Laser Trabeculoplasty

Comment by Steven Vold on:

52894 Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia, Realini T, JAMA ophthalmology, 2013; 131: 321-327

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Successful glaucoma management in developing countries can be difficult for a variety of reasons. Access to quality medical care may often be inadequate to meet the needs of patients with glaucomatous disease. Furthermore, the cost of topical glaucoma medications and other obstacles to medical compliance may prove to make effective glaucoma treatment impossible. Consequently, utilizing safe and effective procedures such as selective laser trabeculoplasty (SLT) as first line therapeutic options makes a great deal of sense in this setting. Furthermore, SLT tends to work especially well in the pigmented eyes found in African-derived races. In this study, Dr. Realini evaluated the efficacy of SLT over a 12-month time period in 61 medically treated open-angle glaucoma patients living in St. Lucia. These patients underwent a 30-day washout followed by bilateral 360-degree SLT treatments. Postoperatively, mean IOP reductions from baseline ranged from 7.3 to 8.3 mmHg (34.1% to 38.9%) in both eyes at the end of 12 months. The 12-month Kaplan-Meier survival rate was 77.7% with 93% of successful subjects experiencing IOP levels lower than with-medication values. No serious adverse events occurred in this treated population.

To summarize, SLT proved to be a very effective and safe glaucoma treatment option in this population for a 12-month time period. Clearly, longer follow-up is necessary to determine how to best manage these patients over the course of this chronic disease. New micro-invasive glaucoma surgical options also offer reasonable treatment alternatives to topical medication that should be evaluated. However, the results of this study are encouraging, and point to the fact that SLT should strongl y be considered as an early treatment option in this challenging patient population.

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