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Editors Selection IGR 10-2

Laser Treatment: TLT versus ALT

Comment by Jay Katz on:

24408 Titanium:Sapphire laser trabeculoplasty versus argon laser trabeculoplasty in patients with open-angle glaucoma, Goldenfeld M; Melamed S; Simon G et al., Ophthalmic Surgery Lasers and Imaging, 2009; 40: 264-269

Find related abstracts

Goldenfeld et al. (1277) reported their results of a prospective, randomized clinical trial comparing titanium-sapphire laser trabeculoplasty (TLT) vs. argon laser trabeculoplasty (ALT) for medically uncontrolled open-angle glaucoma patients. The titanium-sapphire laser uses an infrared wavelength of 790 nm and a 200-micron spot size. A total of 37 patients were enrolled and 180 degrees of the angle was treated with 50 applications. The intraocular pressure reduction was 32% in the TLT treatment group vs. 25% in the ALT group with a mean followup period of 15 months. The results would suggest yet another potential laser system that may be used for IOP reduction via trabeculoplasty. Previous work cited demonstrated deeper tissue penetration with TLT then ALT which has been proposed as potentially advantageous for a better IOP reduction. Although the study was carefully crafted there were a number of flaws that cast doubt on the results and conclusions. The sample size is small which in view of the power calculations looking for any definite small differences between TLT and ALT effects in IOP reduction unlikely to be verified. The relatively short follow-up does not allow a glimpse of long-term comparative efficacy. Finally, the randomization process did not evenly distribute study subjects according to the number of glaucoma medications used pre-laser therapy. There were on average 1.4 medications in the TLT group and 2.1 drugs in the ALT subjects. It has been established that the efficacy of laser trabeculoplasty is inversely proportional to the number of glaucoma drugs being used. This point would suggest that the efficacy could be biased in favor of TLT in the present trial. The authors' conclusion that 'TLT offers similar efficacy to ALT' remains to be confirmed by larger trials for longer periods.

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