Efficacy of Selective Laser Trabeculoplasty After Canaloplasty

Friday, April 17, 2015
KIOSKS (San Diego Convention Center)
Ilya Sluch, MD
Steven R. Sarkisian Jr., MD

Purpose
The purpose of the study is to investigate the role of SLT in glaucoma patients who had previously undergone a canaloplasty.

Methods
A retrospective systematic review of outcomes of SLT in patients with a prior canaloplasty was performed using the Dean McGee Eye Institute database. Of the 54 patients identified from 2010 to August 2014, 37 were excluded because SLT was performed on a different eye, before the canaloplasty, or a major glaucoma surgery was done prior to SLT. A total of 17 patients and 19 eyes were analyzed. Failure of therapy was defined as a less than 20% reduction in IOP with no decrease in IOP medications after 2-4 weeks, increase in IOP medications, or need for future IOP-lowering surgery.

Results
11 of the 19 underwent YAG goniopuncture prior to SLT. Of the 19 eyes, 5 had SLT done prior to canaloplasty. Average time between Canaloplasty and SLT was 17 months (range 7-30). IOP was decreased to 21 or less in 10 patients (53%), 18 or below in 7 patients (37%), 15 or below in 3 paients (16%).  IOP was lowered by 20% in 3 patients (16%) and was sustained over 2.5 year follow up. Of the remainder 16 eyes, 8 required further surgical intervention, 2 required increase in medications, and 6 were continued to be monitored.

Conclusion
Based on this study, a greater than 20% reduction of IOP 2-4 weeks after SLT in canaloplasty creates a sustainable and beneficial effect on IOP. Future studies with a larger, less refractory treatment group would be beneficial.