SLT is the sensible option

Selective laser trabeculoplasty (SLT) should be used before alteration of treatment or trabeculectomy, according to the findings of a study conducted by Bharat Kapoor and a team of colleagues from the UK.

The team conducted a retrospective analysis of case notes in order to evaluate the success rate, duration of success and the factors that influence the outcome of SLT in patients with open angle glaucoma and ocular hypertension (OHT) uncontrolled on maximum tolerated medical treatment (MTMT). A total of 88 case notes (155 eyes) were reviewed with success being defined as a reduction in intraocular pressure (IOP) of 20% from baseline. Patients showing no response up to three months following treatment were classified as non-responders.

The average number of topical medication drops per patient prior to SLT was 1.86. A total of 92% of eyes responded to SLT treatment and, of these, 88% achieved target IOP by month 12. Target IOP was reached by 69% at two years, 36.8% at three years, 20.8% at four years and 18% at five years. Those patients using prostaglandin analogues prior to SLT demonstrated an average duration of success of 29 months compared with 31 months for patients not using the analogues. A significant number of patients were able to stop using eye drops following the treatment.

Kapoor and colleagues recommended that SLT should be used before alteration of treatment or trabeculectomy. It is able to omit patient compliance factor whilst also reducing the cost burden of additional topical medication. In addition to these factors, it is also a repeatable procedure since it does not damage the trabecular meshwork.

Ophthalmology Times Europe reporting from the XXIV Congress of the ESCRS, London, 9-13 September, 2006.