A COMPLICATION-FREE APPROACH TO GLAUCOMA THERAPY

e-BOOK
A COMPLICATION-FREE APPROACH
TO GLAUCOMA THERAPY
Madhu Nagar, FRCS Ophth, MS Ophth
Pinderfields Hospital, Wakefield, United Kingdom
Selective Laser Trabeculoplasty is a safe, simple and effective
treatment modality and is known for its high benefit-to-risk ratio.
Very few side effects have been noted and reported with SLT,
suggesting a limited risk of complications as compared to other
glaucoma therapies. Indeed, compared to medications, which
can cause various systemic and ocular side effects,
SLT is virtually free of complications.
| A COMPLICATION-FREE APPROACH TO GLAUCOMA THERAPY |
SLT
e-BOOK
Madhu Nagar, FRCS Ophth, MS Ophth
Since its introduction in 2001, Selective Laser
effects following SLT treatment, as reported in peer-
A study by Martinez-de-la-casa et al. in 2004 measured
with SLT and latanoprost in a randomized clinical trial
Trabeculoplasty (SLT) has been gaining steady
reviewed journals, refer to Appendix 1 on pages 28-33.)
flare using a laser flare meter and also found that
found that although the response rate and success rate
inflammation was significantly lower after SLT than
of SLT were higher with a greater degree of area treated,
after ALT.7 Furthermore, an 80-eye study by Ayala et al.
so was the incidence of adverse effects.9 Therefore,
published in Acta Ophthalmologica found that none of
while the success rate was greater with 360° than 180°
the eyes had anterior chamber inflammation after 90°
and 90° treatment (82% with 360°, 65% with 180°, and
SLT.8 Therefore, although these side effects are known to
34% with 90-degree treatment respectively), I found that
occur, they don’t necessarily occur in all patients.
the incidence of the most common adverse effect in the
popularity as a treatment option for various types of
glaucoma. Indeed, the number of laser trabeculoplasty
(LTP) procedures performed in the United States and
worldwide more than doubled between 2001 to 2004
alone.1,2 One of the reasons for the rapid adoption of
SLT has been the absence of complications, or only rare,
minor, and transient complications associated with the
procedure. In fact, the complications that I have observed
with SLT are minimal and self-limiting; hence I prefer to
call them adverse effects rather than complications.
Another common adverse effect seen with SLT is a
transient increase in intraocular pressure (IOP) following
the procedure. This has been seen in all published
reports and is independent of the use of pre-operative
hypotensive prophylaxis.3 This increase in IOP typically
ranges from 2 mmHg to >10 mmHg in 2-38% of
patients.3 In most cases, the IOP spike resolves
spontaneously within a day or two without the need for
anti-hypertensive medication.
My own research over the past several years with SLT
has revealed that factors such as baseline IOP and
Anterior uveitis is also another commonly reported
degree of treatment can affect the success of SLT, while
“… the complications that I have
adverse effect of SLT. Latina et al., in their multi-centre
increased pigmentation of the trabecular meshwork (TM)
observed with SLT are minimal and
trial published in 1998 in Ophthalmology, found that
is responsible for post treatment IOP spike. A study that
self-limiting; hence I prefer to call
approximately 83% of eyes had mild-to-moderate
I published in British Journal of Ophthalmology in 2005
anterior chamber inflammation. This was visible one
comparing the effect of 90°, 180°, and 360° treatment
them adverse effects rather than
complications”…”
Common Adverse Effects of SLT
4
180° and 90° treatment (50% after 360°, 41% after
180°, and 31% after 90°). (Refer to Figure 1.) Similarly,
post-SLT IOP spikes and transient pain and discomfort
during treatment were also more common after 360°
treatment (IOP spikes: 27% after 360°, 16% after 180°,
and 11% after 90°; pain/discomfort: 39% after 360°,
20% after 180°, and 6% after 90° SLT).9
was resolved within five days.4 Another recent single
case study by Koktekir et al. published in Clinical
Figure 1: Comparison of Treatment Success and Adverse Effects with 380°, 180° and 90° SLT
& Experimental Ophthalmology also demonstrated
severe bilateral anterior uveitis after unilateral SLT.5
blurred vision for 5-10 minutes after the procedure, mild
The inflammation disappeared within two weeks of
discomfort during laser delivery, redness for a few hours
topical anti-inflammatory therapy. On the other hand, a
to a day or two, and sore eyes and photosensitivity for
64-eye prospective study by Klamman et al. published
a day or two. However, these side effects are minor and
in Journal of Glaucoma found SLT to be effective
transient, require no treatment, and do not have any
without any adverse effects, such as anterior chamber
impact on long-term vision.3 (For a summary of adverse
inflammation or increased macular thickness.6
SLT: A New Standard in Glaucoma Treatment
study population, uveitis, was also higher with 360° than
hour after SLT treatment, decreased by 24 hours, and
The most common adverse effects of SLT include
1
Minimizing Side Effects While Maximizing Success
360 Degree
180 Degree
90 Degree
Success Rate (%)
82
65
34
Incidence of Uveitis (%)
50
41
31
IOP Spike (%)
27
16
11
Transient Pain/Discomfort (%)
39
20
6
SLT: A New Standard in Glaucoma Treatment
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| A COMPLICATION-FREE APPROACH TO GLAUCOMA THERAPY |
“... factors such as baseline IOP
instead of one session of 360° SLT with 100 shots in
and degree of treatment can
order to minimize the IOP spike. Interestingly, in the case
affect the success of SLT while
series by Harasymowycz et al., two of the patients had
1. Peripheral Anterior Synaechia
also previously undergone argon laser trabeculoplasty
Peripheral anterior synaechia (PAS) is a rare
complication associated with SLT. A prospective,
randomized clinical trial by Damji et al. published
in British Journal of Ophthalmology comparing SLT
and ALT found an incidence of 1.1% of PAS in SLT
patients, which was similar to the percentage of ALT
patients with PAS.12 There are no other reported
cases of PAS in the published literature.
increased pigmentation of the TM is
responsible for post treatment IOP
spike.”
(ALT) in the same eye, suggesting that patients with
previous ALT and a heavily pigmented TM may be at
increased risk for IOP spike.11
I have also observed that patients with increased
“in cases of heavy pigmentation, I
angle pigmentation, for example patients with
recommend using two applications
pigmentary glaucoma, pigment dispersion syndrome or
pseudoexfoliative glaucoma, tend to show higher IOP
spikes following SLT treatment. Writing in Eye News,
of 180° treatment spaced 2-4 weeks
apart instead of one session of
I reported the case of a young patient with pigment
360° SLT with 100 shots in order to
dispersion syndrome and heavily pigmented angles who
minimize the IOP spike.”
was treated with 100 laser shots of 0.4 mJ over 360°.10
She presented to us a day later with pain, blurred vision,
More recently, I performed a contralateral eye study
corneal edema, anterior chamber reaction and raised
comparing the effect of 50 shots of 360° SLT versus
IOP. She was treated symptomatically to reduce her
100 shots of 360° SLT, the results of which are yet to be
IOP and fortunately she responded well to treatment.
published. What I found was that by using only 50 shots
Serious IOP spikes in highly pigmented eyes were also
of SLT as opposed to 100 shots, I could still achieve the
reported in a case series presented by Harasymowycz
same 28-30% drop in IOP, while considerably reducing
et al. in American Journal of Ophthalmology that
adverse effects. Therefore, I am now moving towards a
demonstrated a sustained increase of IOP in patients
protocol of using 360-degree SLT with only 50-60 shots
with deeply pigmented trabecular meshwork (TM) that
to maximize success and minimize adverse effects. I
necessitated surgical trabeculectomy.11 Therefore, in
also no longer prescribe anti-inflammatory medications
cases of increased pigmentation, I recommend using two
following SLT though I still use Iopidine drops pre- and
SLT
e-BOOK
Madhu Nagar, FRCS Ophth, MS Ophth
Rare Adverse Effects Associated with SLT
2. Corneal Complications
Two case reports also demonstrate the incidence,
albeit rare, of corneal edema that is accompanied by
haloes, pain, and reduced vision following SLT.13,14
In a study by Regina et al. in Journal of Glaucoma,
the swelling was completely resolved with the use
of topical steroids over several weeks, but the two
patients were left with residual corneal scarring and
thinning after the stromal edema had resolved.14
Other corneal side effects include the appearance
of symptomless white or dark spots on the corneal
endothelium, as reported by Ong et al. in Clinical
and Experimental Ophthalmology.15,16 These spots
disappeared after one month. Although the reason
for these spots was unclear, the authors of the study
opined that they might have been the result of beam
absorption in pigmented cells of the endothelium.
They also cautioned against the risk of corneal
endothelium compromise in such patients with
repeated treatments.16 Similarly, other transient
corneal endothelial changes have also been noted;
however, they do not impact long-term visual acuity.17
3. Other Rare Adverse Effects
Other rare adverse effects that have been noted with
SLT include one case of hyphema three days following
treatment in a 77-year-old woman treated for openangle glaucoma, reported by Rhee et al. in Ophthalmic
Surgery, Lasers, and Imaging; one case of bilateral
diffuse lamellar keratitis following SLT in a patient
who previously underwent laser in situ keratomileusis
(LASIK) as reported by Holz et al. in Ophthalmic
Surgery, Lasers, and Imaging; and, one case of severe
iritis and choroidal effusion reported by Kim and Singh
in the same journal.18,19,20
The reasons for the observed adverse effects are not
well understood. However, they may be a result, at
least partially, of molecular changes that occur in the
TM upon laser treatment. A recent study by Izzotti
et al. published in PLoS One showed that although
TM cells do not undergo phenotypic alterations (as
measured by scanning electron microscope) following
exposure to SLT, they undergo a host of gene
expression changes. Genes involved in cell motility
and contraction, tissue integrity, and ion exchange
showed the greatest changes in expression.21
applications of 180° treatment spaced 2-4 weeks apart
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SLT: A New Standard in Glaucoma Treatment
SLT: A New Standard in Glaucoma Treatment
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| A COMPLICATION-FREE APPROACH TO GLAUCOMA THERAPY |
post-SLT to prevent/control or blunt the post-SLT IOP
but also reducing IOP fluctuations.27 Eventually, this
Safety Comes First with SLT
elevation. Though initial response to 360° treatment with
translates into reduced cost of glaucoma care, not
I strongly recommend SLT for the treatment of glaucoma
50-60 shots is comparable to 360° treatment with 100
only due to less dependence on medications but also
and ocular hypertension: it is more patient-friendly
shots, long term data (3-5 years) is awaited.
by reducing the number of clinic visits required. For
than medication, is associated with minimal, transient
instance, if a patient on eye drops returns to the clinic
adverse effects and is more cost effective over the
with elevated IOP a few years after initiation of medical
long-run. Personally, I find that SLT works best as a
treatment, a few clinic visits are typically required to
first-line therapy: if I were making a treatment decision
determine the reason for the IOP increase - Is the patient
for glaucoma for my family, or myself, I would certainly
being compliant? Is he/she using the drops correctly,
choose SLT. Today, I offer SLT to all my patients and find
spacing them as advised etc.? Or is tachyphylaxis the
that most of them prefer it. In fact, the most grateful
reason for elevated IOP? But with SLT, the management
patients are those who switch from topical drugs to
protocol is much simpler. If patients present with elevated
SLT since they no longer need to live with a constant
IOP a few years after treatment, it is because the effect
reminder of their condition.
Practically Risk Free
In spite of these few adverse effects, SLT provides a
safer and more effective treatment option than ALT and
medication. Indeed, SLT has one of the highest benefitto-risk ratios of all ophthalmic procedures. The greatest
advantage of SLT is that it is not associated with the
permanent scarring of the TM seen with ALT. Kramer and
Noecker reporting in Ophthalmology in 2001 compared
the effect of SLT and ALT on TM structure using scanning
and transmission electron microscopy and found that
SLT did not cause the same coagulative damage nor
trabecular beam structure disruption caused by ALT.
22
of SLT is wearing off and the management decision is
“SLT takes pressure control out
of the hands of the patient and
puts it back into the hands of the
ophthalmologist.”
“[SLT] works 24 hours a day, 7
days a week, not just keeping IOP
under control but also reducing IOP
fluctuations.”
“If I were making a treatment
decision for glaucoma for my family,
or myself, I would certainly choose
SLT.”
either to repeat SLT or start medical therapy depending
on clinical need and the patient’s choice. In short SLT
takes pressure control out of the hands of the patient
Furthermore, SLT is as good as first-line medical
and puts it back into the hands of the ophthalmologist.
treatment without the ocular and systemic side effects
Compared to glaucoma surgery too, the benefit-to-
of medications. Medications are associated with a host
SLT
e-BOOK
Madhu Nagar, FRCS Ophth, MS Ophth
risk ratio of SLT is incomparable. The complications
Madhu Nagar, FRCS Ophth, MS Ophth
Mrs. Nagar is a consultant ophthalmologist at Pinderfields
of surgery can be sight threatening whereas SLT is
Hospital, Wakefield. A leading proponent of SLT, she has
virtually free of complications. Most of the adverse
undertaken several studies investigating the efficacy of
effects associated with SLT are minimal and transient,
SLT for glaucoma management and offers it as a first-line
as outlined above. Additionally, patients who have
treatment, adjunctive treatment and as a replacement
As an added benefit, SLT is also free of the compliance
undergone SLT still respond to surgery if it is required
therapy. Mrs. Nagar has over 13 years’ experience with SLT
issues associated with medications. It works 24 hours a
and success rates of surgery are not affected by SLT as
and has performed the treatment on more than 1000 eyes.
day, 7 days a week, not just keeping IOP under control
may be the case with long-term medication use.
of ocular side effects such as itching, burning, change
in iris colour, and discolouration around the eyes, as well
as systemic side effects such as headaches, pain, vision
problems, brachycardia, and depression.22,23,24,25,26
5
SLT: A New Standard in Glaucoma Treatment
SLT: A New Standard in Glaucoma Treatment
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| A COMPLICATION-FREE APPROACH TO GLAUCOMA THERAPY |
SLT
e-BOOK
Madhu Nagar, FRCS Ophth, MS Ophth
Appendix 1: Summary of Adverse Effects Following SLT as Reported in Peer-Reviewed Journals
Paper/Study
Perioperative Hypotensive
Prophylaxis
Definition
Rate
Anterior Chamber
Inflammation
Pain/Discomfort During
or After Treatment
Other
Comments
1. Latina et al
None
≥ 5 mm Hg
13 eyes (25%)
83% mild-to-moderate reaction,
resolved within 5 days in all
cases
15%
Redness in 9%
No PAS in any case
≥ 8 mm Hg
5 eyes (9%)
10 mm Hg
1 eye (16.7%)
No “significant” inflammation
None
> 6 mm Hg
6 eyes (33.4%)
2. Lanzetta et al
None
3. Kajiya et al
No complications reported
No complications reported. No patient
needed acute IOP-lowering or antiinflammatory treatment
4. Chen et al
5. Grancer
6. Hodge et al
7. Damji et al
8. Damji et al
7
0.5% apraclonidine
IOP elevated 2 mm Hg
at 3 hours
IOP elevated 4 mm Hg
at 3 hours
3 eyes (6%)
None
Mean cells at 1 hour -1.6 after
SLT, 0.9 after ALT (statistically
significant)
None
1 eye (2%)
1% apraclonidine
≥ 6 mm Hg at 1 hour
1% apraclonidine
IOP elevated 3 mm Hg
at 1 hour
2 eyes (5.6%)
IOP elevated 4 mm Hg
at 1 hour
1 eye (2.8%)
IOP elevated ≥ 6 mm Hg
at 1 hour
4 eyes (2.8%)
apraclonidine or
brimonidine
“No significant anterior segment
inflammation”
4 eyes (6%)
n/a
1.
M.A. Latina, S.A. Sibayan, D.H. Shin et al. Q-switched 532nm Nd–YAG laser trabeculoplasty (selective trabeculoplasty), a multicenter, pilot, clinical study. Ophthalmology, 105 (1998), pp. 2082–2090.
2.
Lanzetta, U. Menchini, G. Virgili. Immediate intraocular pressure response to selective laser trabeculoplasty. Br J Ophthalmol, 83 (1999), pp. 29–32.
3.
S. Kajiya, K. Hayakawa, S. Sawaguchi Clinical results of selective laser trabeculoplasty Jpn J Ophthalmol, 44 (2000), pp. 574–575
4.
E. Chen, S. Golchin, S. Blomdahl A comparison between 90 degrees and 180 degrees selective laser trabeculoplasty J Glaucoma, 13 (2004), pp. 62–65
5.
T. Gracner Intraocular pressure response to selective laser trabeculoplasty in the treatment of primary open-angle glaucoma Ophthalmologica, 215 (2001), pp. 267–270
6.
AGIS Investigators The Advanced Glaucoma Intervention Study (AGIS), 9. Comparison of glaucoma outcomes in black and white patients within treatment groups Am J Ophthalmol, 132 (2001), pp. 311–320
7.
B. Cvenkel, A. Hvala, B. Drnovsek-Olup, N. Gale Acute ultrastructural changes of the trabecular meshwork after selective laser trabeculoplasty and low power argon laser trabeculoplasty Lasers Surg Med, 33 (2003), pp. 204–208
8.
K.F. Damji, A.M. Bovell, W.G. Hodge et al. Selective laser trabeculoplasty vs. argon laser trabeculoplasty: results from a one-year randomised clinical trial Br J Ophthalmol, 90 (2006), pp. 1490–1494
SLT: A New Standard in Glaucoma Treatment
No change in VA throughout study period
(6 months)
PAS developed in
1 eye (1.1%)
SLT: A New Standard in Glaucoma Treatment
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| A COMPLICATION-FREE APPROACH TO GLAUCOMA THERAPY |
SLT
e-BOOK
Madhu Nagar, FRCS Ophth, MS Ophth
Appendix 1: Summary of Adverse Effects Following SLT as Reported in Peer-Reviewed Journals continued
Paper/Study
Perioperative Hypotensive
Prophylaxis
Definition
Rate
Anterior Chamber
Inflammation
Pain/Discomfort During
or After Treatment
9. Martinez-de-la-Casa
et al
None
Mean IOP elevation
1.93 ± 3.4 mm Hg in 20 eyes
after SLT [3.0 ± 4.8 mm Hg in
20 eyes after ALT]
Flare (by laser flare meter)
significantly lower in eyes after
SLT compared with ALT
Pain significantly lower
after SLT compared with
ALT
10. Melamed et al
None
> 5 mm Hg at 1 hour
5 eyes (11%)
Mild flare and conjunctival
redness and injection in 30 eyes
(67%)
18 patients (58%)
11. Lai et al
1% apraclonidine
> 5 mm Hg
3 eyes (10.3%)
“No persistent reaction beyond 1
week”
12. Gracner et al
0.5% apraclonidine
IOP elevated 3 mm Hg
at 3 hours
20% of XFG 10% of POAG
“No significant anterior segment
inflammation”
IOP elevated 2 mm Hg
at 3 hours
10% of POAG
13. Song et al
Varied
IOP >30 mm Hg or
increased elevation >
30%
3 eyes (3.2%)
14. Francis et al
Brimonidine tartrate 0.2%
IOP increased between
5-9 mm Hg
6 eyes (9.1%)
IOP increased 10 or
more mm Hg
2 eyes (3.0%)
> 5 mmHg at 1 hour
3 eyes (9%) after 90° SLT, 8
eyes (16%) after 180°, and 12
eyes (27%) after 360°
15. Nagar et al
9
None
31% after 90° SLT, 41% after
180°, and 50% after 360°
10.
S. Melamed, G.J. Ben Simon, H. Levkovitch-Verbin Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study Arch Ophthalmol, 121 (2003), pp. 957–960
11.
J.S. Lai, J.K. Chua, C.C. Tham, D.S. Lam Five-year follow up of selective laser trabeculoplasty in Chinese eyes Clin Experiment Ophthalmol, 32 (2004), pp. 368–372
12.
T. Gracner Intraocular pressure response of capsular glaucoma and primary open-angle glaucoma to selective Nd:YAG laser trabeculoplasty: a prospective, comparative clinical trial Eur J Ophthalmol, 12 (2002), pp. 287–292
13.
J. Song, P.P. Lee, D.L. Epstein et al. High failure rate associated with 180 degrees selective laser trabeculoplasty J Glaucoma, 14 (2005), pp. 400–408
14.
B.A. Francis, T. Ianchulev, J.K. Schofield, D.S. Minckler Selective laser trabeculoplasty as a replacement for medical therapy in open-angle glaucoma Am J Ophthalmol, 140 (2005), pp. 524–525
15.
M. Nagar, A. Ogunyomade, D.P. O’brart et al. A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma Br J Ophthalmol, 89 (2005), pp. 1413–1417
SLT: A New Standard in Glaucoma Treatment
Other
Comments
No change in visual acuity, cup/disc
ratio, or visual filed mean defect
during 12 months follow-up
No patient had an increase in TM
pigmentation or formation of PAS
None
n/a
6% after 90° SLT, 20%
after 180°, 39% after 360
SLT: A New Standard in Glaucoma Treatment
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SLT
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Madhu Nagar, FRCS Ophth, MS Ophth
Appendix 1: Summary of Adverse Effects Following SLT as Reported in Peer-Reviewed Journals continued
Paper/Study
16. Cvenkel
Perioperative Hypotensive
Prophylaxis
Definition
None
≥ 5 mm Hg within 2
hours
Rate
4 eyes (9.1%)
Anterior Chamber
Inflammation
Pain/Discomfort During
or After Treatment
Other
Comments
Anterior chamber reaction was
observed 1h after SLT and disappeared
within 24h in all cases. No PAS noted 2
months after SLT
1+cells in 9 eyes (20.5%)
2+cells in 7 eyes (19.9%)
3+cells in 3 eyes (6.8%)
11
“Mild to moderate anterior
chamber reaction in 68.8% of
eyes”
None
≥ 5 mm Hg within 2
hours
6 eyes (37.5%)
2 eyes (12.5%)
18. Johnson et al
topical alpha agonist and
prednisolone acetate
19. Mcllraith et al
brimonidine 0.2% and
pilocarpine 1%
≥ 8 mm Hg within 2
hours
≥ 5 mm Hg or 10%
of baseline within 1
hour
> 2 mm Hg at 1
hour
20. Harasymowycz et al
4 eyes with a heavily pigmented TM developed markedly elevated IOP following SLT; three of which needed trabeculectomy.
21. Klamann et al
No significant increase in macular thickness was demonstrated due to SLT inflammatory reaction.
22. White et al
Transient corneal endothelial changes that have no impact on cell count or visual acuity.
23. Holz et al
One report of bilateral diffuse lamellar keratitis following consecutive SLT in a LASIK patient.
17. Kim et al
None of the eyes
None of the eyes
1+ cells in 48%, 1+ flare in 4% of
eyes after 1 hour
16.
K.F. Damji, K.C. Shah, W.J. Rock et al. Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial Br J Ophthalmol, 83 (1999), pp. 718–722
17.
Y.J. Kim, C.S. Moon One-year follow-up of laser trabeculoplasty using Q-switched frequency-doubled Nd:YAG laser of 523 nm wavelength Ophthalmic Surg Lasers, 31 (2000), pp. 394–399
18.
P.B. Johnson, L.J. Katz, D.J. Rhee Selective laser trabeculoplasty: predictive value of early intraocular pressure measurements for success at 3 months Br J Ophthalmol, 90 (2006), pp. 741–743
19.
D. Mchugh, J. Marshall, T.J. Ffytche et al. Ultrastructural changes of human trabecular meshwork after photocoagulation with a diode laser Invest Ophthalmol Vis Sci, 33 (1992), pp. 2664–2671
20.
Harasymowycz PJ, Papamatheakis DG, Latina M, De Leon M, Lesk MR, Damji KF. Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks. Am J Ophthalmol 2005;139:1110-3.
21.
Klamann MK, Maier AK, Gonnermann J, Ruokonen PC. Adverse Effects and Short-term Results After Selective Laser Trabeculoplasty (SLT). J Glaucoma 2012 Epub ahead of print.
22.
White AJ, Mukherjee A, Hanspal I, Sarkies NJ, Martin KR, Shah P. Acute transient corneal endothelial changes following selective laser trabeculoplasty. Clin Experiment Ophthalmol.2012 Epub ahead of print.
23.
Holz H, Pirouzian A. Bilateral diffuse lamellar keratitis following consecutive selective laser trabeculoplasty in LASIK patient. J Cataract Refract Surg;36:847-9.
SLT: A New Standard in Glaucoma Treatment
Anterior chamber reaction and early
rise in IOP quickly resolved with drops
None
No PAS noted
No persistent anterior chamber
inflammatory reaction
SLT: A New Standard in Glaucoma Treatment
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Madhu Nagar, FRCS Ophth, MS Ophth
SLT
e-BOOK
References
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2082-90.
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Adverse Effects and Short-term Results After Selective Laser
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pressure in ocular hypertension and open angle glaucoma Br J
Ophthalmol 2005;89:1413-1417.
13
SLT: A New Standard in Glaucoma Treatment
10. Kapoor B, Nagar M. Intraocular Pressure Spike following SLT in a
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11. Harasymowycz PJ, Papamatheakis DG, Latina M, De Leon M, Lesk
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by intraocular pressure elevation in eyes with heavily pigmented
trabecular meshworks. Am J Ophthalmol 2005;139:1110-3.
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and Pan YI. Selective laser trabeculoplasty versus argon laser
trabeculoplasty: results from a 1‐year randomised clinical trial. Br J
Ophthalmol. 2006;90: 1490–1494.
13. Moubayed SP, Hamid M, Choremis J, Li G. An unusual finding of
corneal edema complicating selective laser trabeculoplasty. Can J
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