360/High SLT protocol outperforms alternatives in glaucoma study

The selective laser trabeculoplasty (SLT) with a high-energy laser applied in a full 360-degree pattern demonstrated superior results in terms of intraocular pressure reduction, success rate, and time to glaucoma treatment escalation compared to other SLT variants, according to a study.

The study involved 2 SLT techniques: one using 50±5 laser spots in a 180-degree pattern and the other using 100±10 spots in a full 360-degree pattern. In addition, the laser power was adjusted to create cavitation bubbles either just below the standard level or at 50-75% of applications, resulting in 4 distinct treatment protocols: 180/standard, 180/high, 360/standard, and 360/high

In the study, which included 400 patients with glaucoma, the 360/high protocol demonstrated a clear superiority across all primary endpoints.

Patients treated with this protocol exhibited a reduction in intraocular pressure (IOP) of 5.4 mmHg, compared to 3.4 mmHg, 3.2 mmHg, and 4.2 mmHg in the other groups (P < 0.001). The success rate after 6 months was significantly higher at 58.3%, as opposed to 30.2%, 29.3%, and 41.7% in the alternative protocols (P < 0.001). The median time to glaucoma treatment escalation was more than doubled at 1323 days, compared to 437 days, 549 days, and 620 days (P < 0.001).

Reference
Dahlgren T, Ayala M, Zetterberg M. Optimal Performance of Selective Laser Trabeculoplasty Results from the Swedish Optimal SLT Multicenter Randomized Controlled Trial. Ophthalmol Glaucoma. 2023;S2589-4196(23)00191-6. doi: 10.1016/j.ogla.2023.10.004. Epub ahead of print. PMID: 37838088.