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The efficacy of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in post-laser iridotomy (post LI) angle-closure glaucoma patients off medication but not adequately controlled in Indian eyes

Poster Details

First Author: S.Raj INDIA

Co Author(s):    B. Tigri   S. Pandav   S. Kaushik        

Abstract Details



Purpose:

To study the efficacy of Selective Laser Trabeculoplasty in lowering intraocular pressure in post laser iridotomy Angle Closure Glaucoma patients without medication, with high intraocular pressure.

Setting:

This prospective Interventional study included 14 eyes of 9 patients of post laser iridotomy (LI) Angle Closure Glaucoma, treated with SLT for high IOP (between >21 and < 29 mmHg) without medication between July 2013 to February 2014 at a tertiary eye institute of North India.

Methods:

This was a prospective Interventional study which included 14 eyes of 9 patients of post L.I Angle Closure Glaucoma patients treated with Selective Laser Trabeculoplasty for high IOP control between July 2013 to February 2014 at a tertiary institute in North India. There were 7 females and 2 males with mean age of 52.92 ±4.37 years. Primary angle closure glaucoma (PACG) were 7 in number and primary angle closure (PAC) were 2. All patients underwent complete ophthalmic evaluation before and at intervals after treatment. This evaluation included visual acuity, detailed slit lamp ocular examination, Goldmann applanation tonometry, gonioscopy, indirect ophthalmoscopy . The IOP was measured preoperatively and on first postoperative day, 1 week postoperative, 1 and 3 months postoperative.

Results:

Main outcome measures were lowering of IOP on Goldmann Applanation Tonometry. Primary Angle Closure Glaucoma (PACG) was seen in 7 patients and Primary Angle Closure (PAC) in 2 patients. The age of presentation was 52.92 ±4.37 years (range 45-69 years). There was no change in visual acuity pre and post laser. Mean prelaser visual acuity was 0.2 and post laser visual acuity was also 0.2 in logmar unit. The mean IOP Pre SLT was 23.71 ± 1.89, IOP reduced to Mean 15.14 ± 2.90 mmHg on day 1 (36.14%), Mean 18.0 ± 3.50 mmHg reduction on day 7 (24.82%), Mean 19.42 ± 1.65 mmHg reduction at 4 weeks (18.09%), Mean 19.42 ± 1.22 mmHg reduction at 3 months (18.09%). Mean energy used was 0.57 mj. Mean number of spots applied were 110.42. In 12 patients, SLT was done in all four quadrants and in two patients, in three quadrants only. Minimum follow up of patients was 3 months. No antiglaucoma medication was used. No post laser IOP spike was noticed. No peripheral anterior synechiae or anyother complication were noticed at end of three months. At the end of 3 months, 18.09% IOP reduction was maintained.

Conclusions:

SLT is effective in reducing IOP by almost 20% in post LI angle closure glaucoma patients with high IOP without medication as primary/adjuvant measure in Indian eyes. It helps to avoid medication post LI in patients with high IOP. Mean energy delivered was much less than white population ( 0.57 mj only). It reduces cost of treatment and is independent of compliance. No complication like post laser IOP spike, peripheral anterior synechae was noticed. However , SLT is effective in post LI inadequately controlled angle closure glaucoma patients at least on short term basis. It can be recommended for patients waiting for surgery. not willing or unfit for surgery. Limitations of the study were short follow up and less number of patients FINANCIAL INTEREST: NONE

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