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Editors Selection IGR 16-4
Surgical treatment: Post-surgery SLT
Comment by Tony Realini on:
66671 Selective laser trabeculoplasty in treating post-trabeculectomy advanced primary open-angle glaucoma, Zhang H; Yang Y; Xu J et al., Experimental and therapeutic medicine, 2016; 11: 1090-1094
Zhang and colleagues have conducted an interesting study in which Chinese subjects with POAG uncontrolled with medications following trabeculectomy underwent 360-degree SLT (using standard settings) for IOP control. Pre-treatment mean IOP was 21.3 ± 3.4 mmHg using an average of 2.8 medications. IOP at last follow-up (mean 6.3 months) was 16.2 ± 3.0 mmHg. Nearly 80% of patients experienced a minimum 20% IOP reduction from baseline at last follow-up. IOP reductions were achieved within one week of treatment and maintained throughout the relatively short follow-up period.
The current study validates SLT's utility in post-trabeculectomy IOP management
Diurnal IOP variability was collapsed from 4.1 mmHg to 2.6 mmHg on average. No new safety issue were identified in this population. SLT has proven to be useful at virtually every stage of glaucoma. The treatment has been successfully applied as prophylactic therapy in ocular hypertension, as primary therapy for newly-diagnosed POAG, as adjunctive therapy with medications, and now the current study validates its utility in post-trabeculectomy IOP management.
Of all the methods we have for lowering IOP, SLT arguably has the most favorable safety profile. Considering its safety and efficacy at all stages of POAG, SLT offers the best benefit-risk profile of all our therapies for many if not most of our patients. On top of this, SLT lowers IOP throughout the 24-hour period, compresses IOP variability, requires no ongoing adherence on the patient's part, and can be safely and effectively repeated multiple times when its effect wanes. Zhang and colleagues are to be congratulated for demonstrating a novel aspect of SLT's broad applicability. This therapy is underutilized in current clinical practice.
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