Need and Time to Redo Selective Laser Trabeculoplasty in Glaucoma Patients


Journal of Clinical and Experimental Ophthalmology is a journal which provides rapid peer-review process with 6 issues per year (Bi Monthly). Journal of Clinical and Experimental Ophthalmology accepts all types of articles including case-reports, research, review, case-series, mini-review, opinion articles, short communications, commentary, perspective and video articles.

Journal of Clinical and Experimental Ophthalmology has recently release its 3rd issue in 2020 with 6 articles and 3 Research articles, 2 case reports and a short communication. Here we are mentioning about the case report entitled “Need and Time to Redo Selective Laser Trabeculoplasty in Glaucoma Patients” written and submitted by Myrjam De Keyser whose abstract was as follows:

Purpose: Examine the need and the timeframe to redo selective laser trabeculoplasty (SLT) that was applied in open angle glaucoma or ocular hypertensive patients. Methods: Patients received SLT as primary, adjunctive or replacement therapy. Data were recorded up to 5.5 years after SLT treatment. Target pressure was defined as intraocular pressure at least 20% lowered. On exceeding the target pressure, patients received a second SLT. Primary outcome were the need and the time to redo the SLT. We examined differences between the groups (primary, replacement or adjunct SLT) and correlations between time and need to redo and pre-SLT parameters. Results: 108 patients (194 eyes) could be followed for at least 0.5 year and up to 4.5 years, with a mean follow up of 22.35 ± 18.94 months. Our population at start was a varied one; 34% of patients received primary SLT, 50% had replacement SLT, 16% had SLT as adjunctive treatment. These three groups showed no difference in evolution of IOP or medication in time. Time to redo varied, with a mean of 31.13 ± 11.24 months. Conclusion: We set out to have a general idea of how many patients could be expected to need a retreatment with SLT after a first successful SLT in a private clinic setting. In our population, the percentage of redo needed was 5.6% after 2 years, 35.4% after 3 years and 45.4% after 4 years. No differences could be measured with regard to the type of SLT performed nor could any significant correlation be found between need to redo and pre-SLT characteristics.

Glaucoma is the leading cause of irreversible blindness in the world. Population growth and ageing are expected to additionally increase the number of people affected by this chronic disease [1,2]. Currently, only lowering of the intraocular pressure (IOP) has proven to delay disease onset and slow down its progression [3,4]. Medication has been the first choice treatment for several years but recent studies provide arguments to prefer selective laser trabeculoplasty (SLT) [5,6]. Selective laser trabeculoplasty (SLT) has proven to be a valid alternative to treat intraocular pressure (IOP) in several large, randomized controlled trials. It is as effective as medication and as argon laser trabeculoplasty (ALT) in glaucoma and ocular hypertension patients. It can be used as primary, adjacent and as replacement therapy [5-9].

The mechanism by which SLT lowers IOP is probably not mechanical but rather a biochemical response of the trabecular meshwork tissue [10,11] with increased cell division improving outflow and the attraction of macrophages that clear up debris at the trabecular meshwork [9,12-14]. Enhanced secretion of chemokines and increased expression of matrix metalloproteinase is expected to mediate these responses [15,16]. The effect of selective laser trabeculoplasty however lowers in time [17-19]. Fortunately, SLT can be repeated with equal success after more than 6 months [20,21]. The success of this second SLT lasts as least as long as the primary treatment [21-24]. It is less clear however how long after initially successful SLT therapy this redo commonly is needed.

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