Abstract

FR.10.08

Selective Laser Trabeculoplasty (SLT) in patients with inadequate reduction of Intraocular Pressure (IOP) under maximal tolerated drug therapy. Results after 9 months follow-up.

Cornelia Hirn, Sandrine Zweifel, Annette Hediger, Jens Funk

Augenklinik, UniversitätsSpital Zürich, Zürich, Schweiz

Objective
The objective of the study is to measure the effect of SLT over 360° in glaucoma patients with inadequate IOP reduction despite maximal tolerated therapy. The results 9 months after SLT are presented.
Methods
Open, non-controlled, prospective single-center study. Patients with primary open-angle glaucoma (including normal pressure glaucoma), pseudoexfoliation glaucoma and pigment-dispersion glaucoma under maximum tolerated IOP lowering therapy were included. Technical performance: Frequency-doubled, Q-switched Nd:YAG laser (SLT Laser Tango, Ellex GmbH, Mainhausen), 100 non-overlapping spots over 360°, spot size 400microns, pulse duration 3ns and pulse energy variably adjustable 0.3-1.6mJ depending on the degree of pigmentation of the trabecular meshwork. One drop of brimonidine was administered preoperative. No antiinflammatory therapy was prescribed postoperative. IOP control 2 hours after SLT was obligatory. Further postoperative controls were performed after 1, 30, 90, 180 and 270 days; the examination included best-corrected visual acuity, IOP, anterior segment and fundus examination and gonioscopy. The therapy was continued unchanged until the 3-month control and then reduced if possible.
Results
30 eyes of 30 patients were treated. The mean IOP could be reduced from 19.6 mmHg ± 4.69 preoperative to 15.0 mmHg±3.21 (-23.3 %, p < 0.001) after 1 month, 15.7±3.30 mmHg (- 20.0%, p= 0.002) after 3 months, 16.3 ±2.91 mmHg (- 16.7%, p= 0.012) after 6 months and 16.8 ±3.4mmHg (p=0.028) after 9 months. The pressure-reducing therapy could be withdrawn in 3 patients. One day postoperative, 12 patients presented with mild irritation of the anterior segment which resolved spontaneously. 3 patients showed a paradox pressure increase 2 hours after SLT and were treated additionally with a single dose of 250 mg acetazolamide per os. There were no serious complications.
Conclusions
In our study, SLT reduced IOP by up to 23% without any serious adverse events or complications. Although the maximum IOP-reducing effect was measured 1 month postoperative, a reduction could still be measured 9 months after SLT. SLT is a good option for patients who cannot tolerate topical therapy or in whom the target pressure is not quite achieved.

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