SELECTIVE LASER TRABECULOPLASTY AS SECONDARY THERAPY IN PATIENTS WITH GLAUCOMA: FIVE-YEAR EXPERIENCE Arusha Gupta, MD Elaine M. Miglino Lawrence F. Jindra, MD

Financial Disclosures

1 st and 2 nd authors have no financial disclosure.

3 rd author has independently conducted and financed clinical research study presented and provides technical advice and consultant services to Lumenis Corporation.

Introduction

Selective Laser Trabeculoplasty (SLT) uses a Q Switched frequency-doubled (532 nm) Nd:YAG laser which targets melanocytes in the pigmented trabecular meshwork.

1,2 When treated with SLT, a primarily biologic response is induced in the trabecular meshwork which involves the release of cytokines that trigger macrophage recruitment and other changes leading to IOP reduction.

2 It treats the meshwork without causing any thermal coagulative damage to surrounding structures.

1,2 or 1. Latina MA, et al. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and cw laser interactions. Exp Eye Res . 1995;60:359-372. 2. Latina MA, et al. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology . 1998;105:2082-2090.

Objective and Methods

To evaluate SLT as secondary therapy (eyes treated with medications) in decreasing intraocular pressure (IOP) and in reducing usage of glaucoma medication (meds) in patients with glaucoma.

A retrospective chart review was performed on 756 of 2056 eyes in a consecutive case series from patients treated with SLT as secondary therapy over 5 years between 2002 and 2007. Two-tailed paired t-test was used to compare maximum pre- and post-SLT IOP and pre and post-SLT number of meds.

Results: IOP

756 eyes received SLT as secondary treatment for glaucoma; mean follow-up time was 362 days.

IOP decreased from a mean of 20.0 mm Hg ± 6.0 to 15.8 mm Hg ± 4.9. This represents a 21% decrease in IOP or 4.2 mm Hg.

Data were significant with P < 0.01.

Results: Meds

Mean number of meds decreased from 2.3

to 1.3 meds; this represents a 43% decrease in meds used.

Success rate (no meds needed post-SLT) was 42% of eyes treated.

Data were significant with P < 0.01.

Data: IOP

Number of eyes (n) Mean follow-up (days) Pre-SLT IOP (mm Hg) Post-SLT IOP (mm Hg) IOP change (mm Hg) % ↓ IOP P -value

Secondary

756 362 20.0

15.8

4.2

21% < 0.01

Data: Meds

Number of eyes (n) Mean follow-up (days) Mean # Pre-SLT meds Mean # Post-SLT meds % ↓ meds Success rate (no meds) P -value

Secondary

756 362 2.3

1.3

43% 42% < 0.01

Results: IOP & Meds

Summary Mean Post-SLT reduction in: IOP Meds 21% 43%

The results were significant with P < 0.01.

Conclusion

In this clinical series, SLT significantly lowered intraocular pressure and the amount of medications required, when used as secondary treatment for glaucoma.