Efficacy of Selective Laser Trabeculoplasty After Canaloplasty
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.