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Editors Selection IGR 16-4

Surgical treatment: Repeatability of SLT outcomes

Comment by Tony Realini on:

69409 Repeatability of selective laser trabeculoplasty for open-angle glaucoma, Francis BA; Loewen N; Hong B et al., BMC Ophthalmology, 2016; 16: 128

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Francis and colleagues have reported the results of a retrospective study evaluating the intraocular pressure (IOP)-lowering efficacy of repeat selective laser trabeculoplasty (SLT) in eyes inadequately controlled with a mean of approximately two topical IOP-lowering medications. The research team found that when initial SLT's effect waned, repeat SLT (360-degree treatment both times) restored the level of IOP reduction seen after initial SLT both six and 12 months after retreatment. These results are consistent with a half-dozen other studies documenting the efficacy and safety of repeat SLT. The repeatability of SLT has been controversial in the past. Unlike argon laser trabeculoplasty (ALT), which causes permanent scarring in the trabecular meshwork precluding safe repeatability, SLT causes no such scarring and has been theorized to be repeatable. In fact, the safe and effective repeatability of SLT has now been conclusively established and is no longer controversial at all.

Based on its attributes (efficacy comparable to a prostaglandin, safe, long-lasting, no need for adherence, no exposure to preservatives, and repeatable when its effect wanes), it remains unclear why SLT has not yet supplanted medical therapy as the preferred first-line treatment for POAG

The implication of this important finding is that SLT - repeated as needed - can provide long-term IOP control in patients with open-angle glaucoma. Several studies have established that when used as primary therapy (as was not the case in the Francis study) SLT provides IOP reduction comparable to a prostaglandin analogue. Based on the various studies of repeat SLT, initial SLT seems to last about a year before its effect wanes, and repeat SLT often lasts even longer. Based on its attributes (efficacy comparable to a prostaglandin, safe, long-lasting, no need for adherence, no exposure to preservatives, and repeatable when its effect wanes), it remains unclear why SLT has not yet supplanted medical therapy as the preferred first-line treatment for POAG.

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