Contents

Selective laser trabeculoplasty

Edited by:

Last updated: February 8th, 2022

Menu

Summary of Evidence

Efficacy

First-line treatment in treatment naive patients

 

Selective laser trabeculoplasty is an effective first-line treatment for open angle glaucoma and ocular hypertension.(LIGHT, 2019) {Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, Ambler G, Bunce C, Wormald R, Nathwani N, Barton K, Rubin G, Buszewicz M; LiGHT Trial Study Group. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019 Apr 13;393(10180):1505-1516.}

 

Repeat treatment

 

Repeat SLT can maintain IOP at or below target IOP in medication-naive OAG and OHT eyes requiring retreatment with at least an equivalent duration of effect to initial laser.{Garg A, Vickerstaff V, Nathwani N, Garway-Heath D, Konstantakopoulou E, Ambler G, Bunce C, Wormald R, Barton K, Gazzard G; Laser in Glaucoma and Ocular Hypertension Trial Study Group. Efficacy of Repeat Selective Laser Trabeculoplasty in Medication-Naive Open-Angle Glaucoma and Ocular Hypertension during the LiGHT Trial. Ophthalmology. 2020 Apr;127(4):467-476.}

Technique

Anti-inflammatory treatment

 

Short-term postoperative use of NSAID or steroid drops may improve IOP reduction after SLT.(SALT, 2019) {Groth SL, Albeiruti E, Nunez M, Fajardo R, Sharpsten L, Loewen N, Schuman JS, Goldberg JL. SALT Trial: Steroids after Laser Trabeculoplasty: Impact of Short-Term Anti-inflammatory Treatment on Selective Laser Trabeculoplasty Efficacy. Ophthalmology. 2019 Nov;126(11):1511-1516.}

Evidence

1. Background

1.1 First line treatment

Review

2018 Garg & Gazzard

Article link | Metrics cited by count

2018
Review

Review of selective laser trabeculoplasty’s origins, current role in clinical practice and future directions of SLT research.{Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye (Lond). 2018 May;32(5):863-876.}

Garg & Gazzard
Journal full text Metrics

cited by count

2. Efficacy

2.1 General

Observational study

2020 Khawaja et.al.

Article link | Metrics cited by count

2020
Observational study

Survival analysis demonstrated treatment success in 70%, 45%, and 27% of eyes at 6, 12, and 24 months post-first SLT procedure, respectively. Higher baseline IOP was strongly associated with treatment success.{Khawaja AP, Campbell JH, Kirby N, Chandwani HS, Keyzor I, Parekh M, McNaught AI; UK Glaucoma Real-World Data Consortium. Real-World Outcomes of Selective Laser Trabeculoplasty in the United Kingdom. Ophthalmology. 2020 Jun;127(6):748-757.}

Khawaja et.al.
Journal full text Metrics

cited by count
Meta-analysis

2020 Chi et.al.

Article link | Metrics cited by count

2020
Meta-analysis

There is no significant differences between SLT-related and medication-only treatments regarding the IOP reduction.{Chi SC, Kang YN, Hwang DK, Liu CJ. Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials. Br J Ophthalmol. 2020 Nov;104(11):1500-1507.}

  • Analysis of 1229 patients in 8 trials comparing the efficacy of SLT-related and medication-only treatments for OAG
  • Findings:
    • There was no significant differences between SLT-related and medication-only treatments regarding the IOP reduction
    • The SLT-related therapy group required significantly fewer medications compared with the medication-only group

Chi et.al.
Journal full text Metrics

cited by count
Meta-analysis

2020 Zhou et.al.

Article link | Metrics cited by count

2020
Meta-analysis

All the available types of laser trabeculoplasty are equally effective for decreasing IOP compared to medication-based therapy. The 180° SLT was slightly more effective than ALT in terms of reducing the number of medications needed.

  • Analysis of 22 studies involving 2,859 eyes of 2,704 patients.
    • Interventions evaluated included argon LT, medications, 180° selective LT (SLT), 270° SLT, 360° SLT, new LT, transscleral 360° SLT with SLT performed without gonioscopy, and low-energy 360° SLT.
  • Findings:
    • There were no statistically significant differences in both medicated and unmedicated IOP between any pairs of interventions
    • The individuals treated with 180° SLT required fewer medications than those treated with ALT at 12 months

Zhou et.al.
Journal full text Metrics

cited by count

2.2 First line treatment (treatment-naive patients)

Clinical Trial

2020 Ang et.al. (GITS)

Article link | Metrics cited by count

2020
Clinical Trial

SLT was superior to medication in improving glaucoma-specific QoL at 24 months in treatment naive POAG/PXF glaucoma patients. The medication arm however achieved superior IOL reduction.{Ang GS, Fenwick EK, Constantinou M, Gan ATL, Man REK, Casson RJ, Finkelstein EA, Goldberg I, Healey PR, Pesudovs K, Sanmugasundram S, Xie J, McIntosh R, Jackson J, Wells AP, White A, Martin K, Walland MJ, Crowston JG, Lamoureux EL. Selective laser trabeculoplasty versus topical medication as initial glaucoma treatment: the glaucoma initial treatment study randomised clinical trial. Br J Ophthalmol. 2020 Jun;104(6):813-821.}

  • Randomized controlled trial of Selective laser trabeculoplasty vs topical medications in treatment-naive primary open angle glaucoma or exfoliative glaucoma (167 patients)
  • Findings (2-years)
    • SLT patients reported a greater between-group improvement in ‘social well-being’ compared with medication patients.
    • The rate of successful IOP reduction was 18.6% higher in the medication compared with SLT group.
    • More individuals in the medication group however had conjunctival hyperaemia and eyelid erythema vs SLT group.

Ang et.al. (GITS)
Journal full text Metrics

cited by count
Clinical Trial

2019 Garg et.al. (LIGHT)

Article link | Metrics cited by count

2019
Clinical Trial

Primary SLT achieved comparable early absolute IOP-lowering in Ocular Hypertension versus Open Angle Glaucoma eyes. Drop-free disease-control was achieved in approximately 75% eyes at 36 months after 1 or 2 SLTs (majority of these single SLT).{Garg A, Vickerstaff V, Nathwani N, Garway-Heath D, Konstantakopoulou E, Ambler G, Bunce C, Wormald R, Barton K, Gazzard G; Laser in Glaucoma and Ocular Hypertension Trial Study Group. Primary Selective Laser Trabeculoplasty for Open-Angle Glaucoma and Ocular Hypertension: Clinical Outcomes, Predictors of Success, and Safety from the Laser in Glaucoma and Ocular Hypertension Trial. Ophthalmology. 2019 Sep;126(9):1238-1248.}

  • Randomized controlled trial of Selective laser trabeculoplasty vs eyedrops as first-line treatment in open angle glaucoma or ocular hypertension (718 patients)
  • Findings (3-years)
    • 74·2% of patients in the SLT group required no drops to maintain intraocular pressure at target
      • 76·6% of these required only one treatment
    • There was no difference in health-related QOL between groups

Garg et.al. (LIGHT)
Journal full text Metrics

cited by count
Clinical Trial

2019 Gazzard et.al. (LIGHT)

Article link | Archive link | Metrics cited by count

2019
Clinical Trial

Selective laser trabeculoplasty is an effective first-line treatment for open angle glaucoma and ocular hypertension.{Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, Ambler G, Bunce C, Wormald R, Nathwani N, Barton K, Rubin G, Buszewicz M; LiGHT Trial Study Group. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019 Apr 13;393(10180):1505-1516.}

  • Randomized controlled trial of Selective laser trabeculoplasty vs eyedrops as first-line treatment in open angle glaucoma or ocular hypertension (718 patients)
  • Findings (3-years)
    • 74·2% of patients in the SLT group required no drops to maintain intraocular pressure at target
      • 76·6% of these required only one treatment
    • There was no difference in health-related QOL between groups

Gazzard et.al. (LIGHT)
Journal full text Archive Metrics

cited by count

2.3 Repeat treatment

Clinical Trial

2020 Garg et.al. (LIGHT)

Article link | Metrics cited by count

2020
Clinical Trial

Repeat SLT can maintain IOP at or below target IOP in medication-naive OAG and OHT eyes requiring retreatment with at least an equivalent duration of effect to initial laser.{Garg A, Vickerstaff V, Nathwani N, Garway-Heath D, Konstantakopoulou E, Ambler G, Bunce C, Wormald R, Barton K, Gazzard G; Laser in Glaucoma and Ocular Hypertension Trial Study Group. Efficacy of Repeat Selective Laser Trabeculoplasty in Medication-Naive Open-Angle Glaucoma and Ocular Hypertension during the LiGHT Trial. Ophthalmology. 2020 Apr;127(4):467-476.}

  • Post hoc analysis of patients in SLT treatment arm of LIGHT study requiring repeat SLT within 18 months (115 eyes of 90 patients).
  • Findings (18-months):
    • Absolute IOP reduction at 2 months was greater after initial SLT compared with repeat SLT (mean difference, 1.0 mmHg)
    • Repeat SLT maintained drop-free IOP control in 67% of 115 eyes at 18 months

Garg et.al. (LIGHT)
Journal full text Metrics

cited by count

2.4 SLT vs ALT

Meta-analysis

2013 Chi et.al.

Article link | Metrics cited by count

2013
Meta-analysis

SLT has equivalent efficacy to ALT with a similar constellation of side effects.{Wang W, He M, Zhou M, Zhang X. Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with open-angle glaucoma: a systematic review and meta-analysis. PLoS One. 2013 Dec 19;8(12):e84270.}

  • Analysis of 482 eyes from 6 RCTs treated with laser trabeculoplasty.
  • Findings:
    • There was no significant difference of reduction in IOP comparing SLT with ALT at any time point (up to 5-years)

Chi et.al.
Journal full text Metrics

cited by count

3. Technique

3.1 Anti-inflammatory treatment

Clinical Trial

2019 Gazzard et.al.

Article link | Archive link | Metrics cited by count

2019
Clinical Trial

Short-term postoperative use of NSAID or steroid drops may improve IOP reduction after SLT.{Groth SL, Albeiruti E, Nunez M, Fajardo R, Sharpsten L, Loewen N, Schuman JS, Goldberg JL. SALT Trial: Steroids after Laser Trabeculoplasty: Impact of Short-Term Anti-inflammatory Treatment on Selective Laser Trabeculoplasty Efficacy. Ophthalmology. 2019 Nov;126(11):1511-1516.}

  • Randomized controlled trial of ketorolac vs prednisolone acetate vs saline tears QID for 5 days starting day 0 post SLT in OAG/OHT. (96 patients)
  • Findings (12-weeks)
    • There was no statistically significant difference in IOP decrease among groups at week 6
    • NSAID and steroid groups showed significantly greater decrease in IOP compared with the placebo group at 12 weeks.
ketorolac 0.5% prednisolone 1% saline tears
Mean decrease in IOP (at 12 weeks) (mmHg) -6.2 -5.2 -3

Gazzard et.al.
Journal full text Archive Metrics

cited by count

References

Comments

Subscribe
Notify of
guest
0 Comments
Inline Feedbacks
View all comments

© 2024 - sourceshed