The following treatment guidelines are based on the results of clinical studies and are provided for information purposes only. It is the operating ophthalmologist’s responsibility to familiarize themselves with the latest recommended techniques.
Almost all patients with abnormally elevated IOP, which
The treatment regimen is evolving and protocols vary
may benefit from IOP reduction, are suitable candidates for
from treatment of 360º, 180º or 90º of the TM. It has been
highlighted that the more aggressive the treatment the higher the risk of inducing temporary pressure spike, which
Patients with any type of adult glaucoma, and those who
conform to the following criteria, are suitable candidates:
• Require lowering of IOP as either primary or
A Latina SLT gonio laser lens, with no magnification to avoid
changes to the spot size, is used to perform treatment.
• Unlikely to comply and/or persist with drug therapy
The treatment spot size is fixed at 400μm, which is large
• Have difficulty administering eye drops
enough to irradiate the whole width of the meshwork with
• Suffer from drug therapy induced side effects
some overspill. This provides a comfortable margin for
• Complain of reduced quality of life due to the need
treatment as the overspill is of no clinical significance.
It is important to obtain a clear view of the TM – focus must
• Failed ALT treatment, or if ALT ceased to reduce the
be on the target tissue and not on the aiming beam spot.
180° treatment involves treatment of a 180° area per
• Failed SLT treatment, or if SLT ceased to reduce the
treatment period. Treatment is undertaken in single shot
mode, placing approximately 50 contiguous but not
• Pigmentary or pseudoexfoliation glaucoma
overlapping energy spots along the meshwork.
(Proceed with caution as there is a risk of post-SLT IOP spike)
To determine the optimal level of energy for each
SLT has not been shown to be suitable for the following
patient, the laser is initially set at 0.8 mJ (for
heavily pigmented TM, set the energy at 0.4 mJ) and the energy level increased in 0.1 mJ steps
until the threshold energy level for mini-bubble
formation (micro cavitations) is observed, or
• Primary or secondary narrow-angle glaucoma
decreased in 0.1 mJ steps if bubble formation
• Any disease process or malformation that blocks
After the threshold level is found (when mini-
• Unclear view of the trabecular meshwork (TM)
bubble formation occurs) the energy level is decreased in 0.1 mJs steps as treatment continues until bubble formation ceases. This
energy is then used for treatment. Note that
Pre-operative medications typically include an alpha
some users aim to treat with minimal fine bubble
agonist, such as brimonidine tartrate, and topical
anaesthesia, such as proxymetacaine hydrochloride.
Non steroidal anti-inflammatory drops such as Ketorolac or
The process should be monitored and adjusted as neccessary as pigment variation alters energy
Acular drops four times daily for three to five days.
uptake at a lower threshold. Generally, the TM is
Note: An increasing number of physicians are electing not
more heavily pigmented inferiorly than superiorly.
With this in mind, two options are possible:
enhancement treatment will target temporal half.
There are minimal observable side effects resulting from SLT treatment; these include mild discomfort during the procedure and tender eyes, perhaps with mild photophobia, for 2-3 days.
The absence of adverse side effects is one of the major benefits of SLT treatment.
B Inferior half for first 180° treatment; enhancement treatment will target superior half.
In a small percentage of cases (<10%) some postoperative increase in IOP has been observed, usually appearing within the first 24 hours and disappearing within a further 24 hours. However, a few cases of sustained IOP increase requiring follow-up treatments have been reported.
Pigmentation varies significantly between the superior and inferior half, and it is necessary to titrate power levels according to pigmentation moreso if treating the nasal half and temporal half, compared to the inferior half and superior half.
4 Follow-up visits should be scheduled according
to the perceived risk of a post-SLT pressure spike and patient access to the treating ophthalmologist. In practice, for patients who do not present a specific risk of pressure spikes, follow-up visits can be scheduled at one week, one month, three months and six months after the treatment, and every six months thereafter to measure IOP.
For further information regarding SLT, please visit slt-ellex.com - the primary online resource for Ellex SLT users. Alternatively, please contact Ellex at [email protected]
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