Beginner’s Technique with Beginner’s Technique with SLTSLT

Sungjun Hwang MDSungjun Hwang MD

Amy Zhang MDAmy Zhang MD

Financial Disclosure: Hwang Gonio Lens (Ocular Instruments)

PurposePurpose

Selective Laser Trabeculoplasty (SLT) Selective Laser Trabeculoplasty (SLT) difficult for the novice given lack of burn difficult for the novice given lack of burn marksmarks

Alternative method using a modified Latina Alternative method using a modified Latina SLT Gonio Laser Lens (Ocular SLT Gonio Laser Lens (Ocular Instruments)Instruments)

MethodsMethods

161 SLT procedures 161 SLT procedures Private Private comprehensive comprehensive practicepractice

Modified Latina SLT Modified Latina SLT Gonio Laser lensGonio Laser lens

4 months follow-up4 months follow-up

ReflectedIndicatorReflectedIndicator

45o Indicator45o Indicator

MethodsMethods

Latina SLT Gonio Latina SLT Gonio Laser Lens Laser Lens

-modified to indicate a -modified to indicate a 4545oo arc on the arc on the trabecular meshworktrabecular meshwork

Laser applied to a 90Laser applied to a 90oo arc using 45arc using 45oo indicator indicator as a guideas a guide

90o Arc90o Arc

45o Indicator45o Indicator

MethodsMethods

Successively Successively positioned to treat 4 positioned to treat 4 quadrants of each quadrants of each eyeeye

Superior, Temporal Superior, Temporal inferior and nasal inferior and nasal quadrants of quadrants of trabecular meshwork trabecular meshwork

Superior Lateral

Inferior Lateral

ResultsResults

Average Pressure Difference -2.38 Average Pressure Difference -2.38 ±4.77±4.77

131 out of 161 eyes (81.4%) had reduction in 131 out of 161 eyes (81.4%) had reduction in intraocular pressure (IOP) intraocular pressure (IOP)

43 eyes (26.7%) were able to reduce the usage of 43 eyes (26.7%) were able to reduce the usage of IOP lowering medicationsIOP lowering medications

30 eyes (18.6%) did not experience any IOP 30 eyes (18.6%) did not experience any IOP reductionreduction

No adverse outcomes were notedNo adverse outcomes were noted

ConclusionConclusion

Argon Laser Trabeculoplasty (ALT) and Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT) are Selective Laser Trabeculoplasty (SLT) are common modalities for treatment of glaucoma common modalities for treatment of glaucoma with similar efficacies.with similar efficacies.1,2,31,2,3

ALT allows for visualization of the burn marks ALT allows for visualization of the burn marks thus facilitating placement of the next burn mark thus facilitating placement of the next burn mark especially for the novice.especially for the novice.4,54,5

New technique with the modified lens allows New technique with the modified lens allows similar visualization on the SLT laser and yields similar visualization on the SLT laser and yields good results.good results.

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Long-term efficacy of argon laser trabeculoplasty.Ophthalmolog1987 Dec;94(12):1513-8.

2.McIlraith I, Strasfeld M, Colev G, Hutnik CM Selective laser trabeculoplasty as initial

and adjunctive treatmentfor open-angle glaucoma. J Glaucoma. 2006 Apr;15(2):124-30.

3. Stein JD, Challa P.Mechanisms of action and efficacy of argon laser trabeculoplasty

and selective laser trabeculoplasty. Curr Opin Ophthalmol. 2007 Mar;18(2):140-5.

4. Pham H, Mansberger S, Brandt JD, Damji K, Ramulu PY, Parrish RK. Argon

Laser trabeculoplasty versus selective laser trabeculoplasty. Surv Ophthalmol. 2008 Nov

Dec;53(6):641-6.

5. Mahar PS, Jamali KK. Argon laser trabeculoplasty as primary therapy in open angle

glaucoma. J Coll Physicians Surg Pak. 2008 Feb;18(2):102-4.