TABLE 4.
SLT Dose-Response at Different Patterns of Application
| References | Methodology | Laser Manufacturer | Sample Size | Glaucoma Type | Energy Range (mJ) | Energy per Spot in mJ (Mean±SD) | Pattern | No. Spots (Mean±SD) | Total Energy in mJ (Mean±SD) | Follow-up (mo) | Medications After SLT | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Nagar et al66 | Prospective | Lumenis, Coherent, Inc, Palo Alto, CA | 167 | OHT, OAG | — | — | 90, 180, and 360 degrees | 25–30 (90 deg), 48–53 (180 deg), 93–102 (360 deg), no SD reported | — | 12 | Dexamethasone 0.1% eye drops 4 times/d for 5 d or ketorolac eye drops 4 times/d for 5 d | |
| Shibata et al50 | Retrospective | Lumenis, Coherent, Inc, Palo Alto, CA | 54 | POAG, PE | 0.8–1.4 | — | 180 and 360 degrees | 75±22 and 121±19 in 180 and 360 degrees, respectively | 73±29 and 125±30 in 180 and 360 degrees, respectively | 36 | Apraclonidine 1% once, fluorometholone 0.1% eye drops 4 times/d for 7 d | |
| Ozen et al67 | Prospective | Lightmed SeLecTor Deux | 26 | POAG | 0.7–0.9 | — | 180 degrees in group 1 and 360 degrees in group 2 | 50 in group 1 and 100 in group 2 (no SD reported) | — | 6 | None | |
| Tawfique et al68 | Prospective | Ellex, Adelaide, Australia | 67 | POAG, PE, OHT, pigmentary | — | — | 90 and 360 degrees | 25 in the 90-degree group and 100 in the 360-degree group | — | 24 | — | |
| Tufan et al69 | Prospective | Lumenis, Coherent, Inc., Palo Alto, CA | 40 | POAG | — | — | 180 and 360 degrees | 56.0±6.5 in the 180-degree group and 97.5±11.5 in the 360-degree group | 65.6±17.2 in the 180-degree group and 116.0±31.7 in the 360-degree group | 6 | Apraclonidine 1% once postlaser | |
| George et al70 | Retrospective | Lumenis, Coherent Inc, Palo Alto, CA | 284 | POAG, PE | 05–1.6 in the overlapping SLT group and 0.7–1.1 in the nonoverlapping SLT group | 1.03±0.17 in the overlapping SLT group and 0.89±0.1 in the nonoverlapping SLT group | 180 degrees in the overlapping SLT group and 360 degrees in the non-overlapping SLT group | 104±18.67 in the overlapping SLT group and 105±12.83 in the nonoverlapping SLT group | — | 14 | Diclofenac sodium 0.1% drops 4 times daily for 5 d | |
| Wong et al71 | Retrospective | Ellex, Adelaide Australia | 199 | POAG, PACG, OHT, NTG, PE, | 0.8–1.2 | — | 360 degrees | 119.39±4.23 and 159.56±3.56 | — | 12 | Brimonidine tartrate 0.15%/ apraclonidine hydrochloride 0.5% postlaser for 4 d | |
| Pukl et al72 | Prospective | OptoSLT M DPSS, Optotek d.o.o, Slovenia | 30 | POAG, OHT, NTG | — | 0.82 in the 1 ns group and 0.74 in the 3–5 ns group (no SD reported) | 360 degrees | 64.9 in the 1 ns group and 61.8 in the 3–5 ns group (no SD reported) | 53.0 in the 1 ns group and 45.7 in the 3–5 ns group (no SD reported) | 6 | Dexamethasone 1 mg/ml 3 times daily for 5 d, oral Acetazolamide 125 mg immediately post-laser, with an additional 125 mg given 6–8 h postoperatively | |
| No. Glaucoma Medications | IOP (mm Hg) | |||||||||||
| References | Pre-SLT (Mean±SD) | Post-SLT (Mean±SD) | Pre-SLT (Mean±SD) | Post-SLT (Mean±SD) | Reduction (Mean±SD) | Adverse Events | Definition of Success | Main Results | ||||
| Nagar et al66 | — | — | 29.3 (SD not reported) | 17–25 in all groups, at 12 mo (SD not reported) | — | Pain/discomfort, uveitis, IOP spikes | Both as a 20% or more reduction in IOP from baseline measurements and also as a 30% or greater IOP reduction from baseline with no additional antiglaucomatous interventions | Mean IOP was significantly lower with 360-degree SLT than 90-degree SLT and 180-degree SLT. Success rates were greater with 180-degree and 360-degree than with 90-degree SLT. With 360-degree SLT, 82% of eyes achieved a 20% IOP reduction and 59% a 30% reduction from baseline. Although success rates were better with 360-degree than with 180-degree SLT treatments, differences were not significant. There were no differences with regard to laser power settings or total laser energy delivered between eyes that responded, in terms of a 20% and a 30% IOP reduction, and those that did not respond with 180-degree and 360-degree SLT treatments. | ||||
| Shibata et al50 | 3.0±1.0 and 2.8±0.7 in 180 and 360 degrees, respectively | — | 19.5±4.3 and 21.0±4.1 in 180 and 360 degrees, respectively | — | 2.6±4.0 and 5.6±4.3 and in 180 and 360degrees at 6 mo, respectively | IOP spikes | IOP reduction by ≥20% of pretreatment IOP without additional medications, laser or surgery | IOP reduction was significantly greater in the 360-degree group than in the 180-degree group. Response rate between groups was similar. Success rate was higher in the 360-degree group at 1 and 2 y than in the 180-degree group. Total energy was not associated with IOP reduction. | ||||
| Ozen et al67 | 2.2±0.7 in group 1 and 2.25±0.7 in group 2 | — | 27.4±2.1 in group 1 and 27.7±2.4 in group 2 | 18.3±2.0 in group 1 and 17.4±1.9 in group 2, at 6 mo | — | — | Reduction of 20% or more in IOP at 6 mo | There was 33.0% reduction in IOP in group 1 and 37.1% reduction in IOP in group 2. At 6 mo, success rate was 73.1% in group 1 and 76.9% in group 2 (differences were not significant). No significant difference was determined between the 2 groups in terms of antiglaucoma drug numbers. | ||||
| Tawfique et al68 | — | — | 24.9±3.6 in the 90-degree group and 24.8±4.2 in the 360-degree group | — | — | — | — | Distributions of survival times for the 2 treatment extents were not significantly different. The mean survival of the treatment effect was similar in the 90-degree and 360-degree SLT groups. | ||||
| Tufan et al69 | 2.2±0.4 in the 180-degree group and 2.4±0.5 in the 360-degree group | — | 17.3±2.3 in the 180-degree group and 17.0±2.9 in the 360-degree group | 16.8±2.4 in the 180-degree group and 17.6±3.1 in the 360-degree group, at 6 mo | — | Mild anterior chamber inflammation | — | There were no significant differences in IOP reductions between the groups | ||||
| George et al70 | 2.51 in the 180-degree overlapping SLT group and 2.48 in the 360-degree nonoverlapping SLT group (no SD reported) | 2.0 in the 360- degree nonoverlapping SLT group at 14 mo, no SD reported (change was not observed in the other groups) | 18.44 in the 180-degree overlapping SLT group and 19.35 in the 360-degree nonoverlapping SLT group, no SD reported | — | — | — | — | The percentage of responders was ~20% greater for nonoverlapping SLT than for overlapping SLT (50% vs. 30%, respectively | ||||
| No. Glaucoma Medications | IOP (mm Hg) | |||||||||||
| References | Pre-SLT (Mean±SD) | Post-SLT (Mean±SD) | Pre-SLT (Mean±SD) | Post-SLT (Mean±SD) | Reduction (Mean±SD) | Adverse Events | Definition of Success | Main Results | ||||
| Wong et al71 | 1.11±1.26 (120 spots), 0.55±0.95 (160 spots) | — | 18.81±3.72 (120 spots), 19.21±4.43 (160 spots) | — | 2.88±4.34 (120 spots) 4.11±3.92 (160 spots) at 1 y | — | ≥20% IOP reduction as defined by the World Glaucoma Association with no need for further SLT or trabeculectomy; or a decrease in glaucoma medications without an increase in IOP when compared to baseline | IOP reduction was greater in the 160-spot group in univariate analysis. There was no difference in success rates between the groups. | ||||
| Pukl et al72 | None | None | 24.1±3.72 in the 1 ns group and 24.3±3.71 in the 3–5 ns group | 18.28±3.32 in the 1 ns group and 18.41±3.53 in the 3–5 ns group, at 6 mo | 5.8 in the 1 ns group and 5.9 in the 3–5 ns group (no SD reported) | — | ≥20% drop in IOP from baseline | There was no significant difference in mean IOP between groups at any follow-up visit. Success rate was 76% in the 1 ns group and 72% in the 3–5 ns group at 6 mo | ||||
IOP indicates intraocular pressure; NTG, normal tension glaucoma; OAG, open angle glaucoma; OHT, ocular hypertension; PACG, primary angle closure glaucoma; PE, pseudo-exfoliation; POAG, primary open angle glaucoma; SLT, selective laser trabeculoplasty.