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Intraocular pressure changes after selective laser

trabeculoplasty (SLT) in open-angle glaucoma


Amalia Mayasari, Maharani
Departement of Ophthalmology Faculty of Medicine
Diponegoro University/ dr. Kariadi Hospital Semarang
Introduction :
Open-angle glaucoma (OAG) is insidious in onset, slowly progressive,
and painless, with optic nerve damage and visual field loss as the
characteristic patterns. The mainstay treatment for open angle glaucoma is to
lower intraocular pressure (IOP) preventing further glaucomatous damage of the
optic nerve. Nowadays, there are three methods available to achieve this goal:
medication, laser treatments and surgery. When a patient is diagnosed as
glaucoma, doctor will recommend one or a combination of one or two above
strategies. The treatment options are based upon the following factors: type of
glaucoma, the situation of the optic nerve damage, patient's symptoms and
compliance with daily medications.
Selective laser trabeculoplasty (SLT) used laser to selectively target
pigmented trabecular meshwork without producing collateral damage to adjacent
non-pigmented cells or structures. Thermal diffusion from targeted cells to
surrounding non-pigmented trabecular meshwork cells is minimized. Study by
Latina and Park, SLT was proposed as a new laser treatment for chronic open-angle
glaucoma. A synthesis of previous data suggests that SLT is effective at every stage
for OAG. SLT can be used as a first- line therapy, alternative to medical therapy, or
as an adjunctive therapy to topical glaucoma drops.
The aim of this study were to determine the changes in intraocular

pressure (IOP) after selective laser trabeculoplasty (SLT) in patients with


open-angle glaucoma.

Materials and Methods:


Design of this research was cohort-prospective study. 26 eyes of 18 patients with
OAG were participated in this study. A comprehensive medical and ocular history was
obtained. Ophthalmological examinations such as visual acuity, IOP measurement, optic nerve
status, and gonioscopy were performed to all patients before including patient to the study. All
the eyes were undergoing the medical therapy before performing SLT. All the patients had

been fully informed about the procedure and informed consent was obtained
from all of them.
Immediately before the laser procedure, a single application of
tetracain 0,5% was instilled into the eye. All the patients were treated with
180 SLT to the temporal trabecular meshwork, and followed by 180 SLT to
the nasal trabecular meshwork 1 week after the first treatment. A frequencydoubled (532-nm) Q-switched Nd:YAG laser with a 400-m spot size is used to
deliver 0,4-1.0 mJ of energy for 0,3 ns to perform the procedure. Additionally, IOP

in the treated eye was assessed and measured with Goldman applanation
before SLT, and 1 hour, 1 week, and 2 weeks following complete SLT (360).
If there was an IOP rise greater than 21 mmHg, the elevation of the IOP was
treated with appropriate antiglaucoma medications. All patients were given
corticosteroid (prednisolone acetat 1% eyedrop) 4 times a day for 7 days
after SLT to prevent elevation IOP caused by inflammation. All of the
glaucoma medication were stopped after SLT.

Result:
The average pre-SLT IOP were 19,94 mmHg. The mean IOP 1 hour post SLT
was slightly increase. Pre-SLT and post-SLT IOP are shown in table 1.
Table 1. Results of SLT
Variabel
Before SLT

Mean

SD

Median

Min.

Maks.

19,94

7,063

18

11

40

0,004

1 hour post 360 SLT

20,15

6,977

18,75

10

40

0,017

1 week post 360 SLT

17,23

6,692

17

10

39

0,004

2 weeks post 360 SLT

14,58

6,912

13

38

0,000

IOP 2 weeks after complete SLT showed a significant decrease compared to


before SLT (Wilcoxon-test, before: P=0.033; 1 hours: P=0.915; 1 week:
P=0.098; 2 week: P=0.009).
Table 2. The course of the mean IOP during the follow up period.
Variabel

1 hour
1 week
2 weeks
post 360 post 360 post 360
SLT
SLT
SLT

Before 180 SLT


1 hour post 360 SLT
1 week post 360 SLT

Befor
e SLT

0,915

0,098

0,009*

0,087

0,001*

0,091

1 hour
post SLT

1 week
post SLT

2 weeks
post SLT

Figure 1. distribution of IOP before and after SLT

Discussion :
The mean IOP 1 hour before SLT was slightly increase. It might be caused by
inflammatory reaction after SLT treatment. To prevent increasing IOP, all of
the patients were gained steroid topical using prednisolone acetat 1%.
Efek SLT baru muncul ppenurunan signifikannya ada 2 mgg post slt mungkin
krn efek inflamasi mereda
This study was limited by the small number of patients and by lack of followup period. In summary, SLT treatment is an effective laser procedure for
lowering IOP in open-angle glaucoma after 2 weeks SLT. Further long-term

prospective studies on larger subject population are needed to determine


long term effect of SLT.
Conclusion:
SLT effectively reduce IOP in open-angle glaucoma. It can be used as primary
or adjunctive therapy in patient with open-angle glaucoma.
Keywords:
Intraocular pressure, selective laser trabeculoplasty, open-angle glaucoma