SLT is a non-thermal laser treatment that uses short pulses of low energy light (532 nm) to target selectively and irradiate only the pigmented cells in the trabecular meshwork (TM). In contrast to argon laser trabeculoplasty (ALT), there is neither collateral damage to adjacent tissue nor direct damage to the underlying structure of the TM. Macrophage recruitment takes place to remove damaged cells, and TM cells divide to replace the lost cells. Finally, a healthier, more 'porous' TM restores balanced aqueous outflow.

Dr Madhu Nagar, a consultant ophthalmologist and lead clinician, specialising in glaucoma management, is a strong advocate of the treatment: "Selective laser trebeculoplasty embodies the qualities and capabilities that the literature and my clinical experience ascribe to ideal glaucoma treatment. It can be used early enough to enable patients to avoid vision loss, is effective and repeatable and it eliminates or reduces compliance issues because it eliminates or reduces dependence on glaucoma drugs.

"These factors and others were addressed at the annual meeting of the European Society of Cataract and Refractive Surgery (ESCRS) by me," continued Dr Nagar, "and other glaucoma specialists including Prof. Jens Funk, MD, Lawrence F. Jindra, MD, and Karin Hornykewycz, MD. Prof. Funk, of Zurich, moderated the event and shared his preliminary SLT research findings, while Dr Jindra, a U.S. glaucoma specialist and long-time SLT proponent, presented long-term outcomes. Dr Hornykewycz, of Austria, and I reported our SLT findings, as well, adding to a growing body of data substantiating the therapy's efficacy as a primary glaucoma treatment."

Dr Lawrence Jindra, has said that he suspects that SLT's successful clinical implementation will rank among ophthalmology milestones, such as the development of phacoemulsification and the invention of the IOL. Dr Nagar agrees: "It was just a matter of time before phacoemulsification for cataract surgery took root as the gold standard even among its staunchest critics, and now, as Dr Jindra's theory goes, it is just a matter of time until evolution elevates SLT to the head of the glaucoma treatment paradigm."

Efficacy of SLT in patients with insufficient control of IOP under max drug therapy

Professor J. Funk, Dr Cornelia Hirn, Dr Sandrine ZweifelUniversitätsspital Zurich, eye clinic, Switzerland

Figure 1: SLT applied to the eye using the contact lens. (Image courtesy of Ellex GmbH)

Professor Funk's study addresses the efficacy of SLT in patients with insufficient IOP control under maximally tolerated medication. "We are investigating whether additional IOP reduction occurs when SLT is applied and if yes, how long it is maintained. Since our follow-up covers a postoperative period of one year, we are also examining the option and effectiveness of possible retreatment," he said.

Inclusions & exclusions

Patients with primary open-angle glaucoma (including normal tension glaucoma), pseudoexfoliation glaucoma (PEX) and ocular hypertension were enrolled in our open, prospective, non-controlled study. A previous Argon laser trabeculoplasty (ALT) is not considered an exclusion criterion. The standard exclusion criteria apply. Follow-up examinations were performed after 2 hours, 1, 30, 90, 180 and 360 days postoperative.