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Editors Selection IGR 18-2

Surgical Treatment: Scanning Laser vs. Selective Laser Trabeculoplasty

Comment by Ahmad Aref on:

70420 Comparing pattern scanning laser trabeculoplasty to selective laser trabeculoplasty: A randomized controlled trial, Mansouri K; Shaarawy T, Acta Ophthalmologica, 2017; 95: e361-e365

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Laser trabeculoplasty has revolutionized the treatment of glaucomatous optic neuropathies. This non-invasive surgical treatment modality has undergone numerous modifications in laser delivery technique since its initial description by Wise and Witter.¹ Despite numerous studies supporting the central role of laser trabeculoplasty in the glaucoma treatment paradigm, its variable and waning effect leave room for further innovation. Mansouri and Shaarawy should therefore be commended for investigating a novel laser delivery technique, pattern scanning laser trabeculoplasty (PSLT) in their recent study comparing this modality to standard selective laser trabeculoplasty (SLT).²

Pattern scanning laser trabeculoplasty involves application of a computer-generated arc-shaped laser pattern to the trabecular meshwork. The pattern automatically rotates in order to ensure complete 360^o treatment of the trabecular meshwork over a given session. Longer pulse duration, smaller spot size, and higher pulse energy differentiate PSLT from SLT laser parameters.

Pattern scanning laser trabeculoplasty involves application of a computer-generated arc-shaped laser pattern to the trabecular meshwork

In their randomized study of 58 eyes with primary and secondary open-angle glaucomas, Mansouri and Shaarawy found that PSLT yielded greater IOP reduction at one and three months and similar reduction at six months postoperatively compared to SLT. The PSLT technique was better tolerated by patients. Major strengths of this study include performance of a power analysis to ensure adequate sample size as well as designating fellow eyes of the same study subjects to serve as active controls, thus eliminating selection bias. An important limitation, however, is the relatively short-term nature of the study. Long-term results with PSLT are required to adequately assess the value of this novel technology in the treatment of glaucomatous individuals.

The results described by Mansouri and Shaarawy are consistent with those previously described in the literature. However, as a randomized, controlled trial, their study adds considerable support to the promise of PSLT technology.

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