1. SLT IN PACG Dr Susheel Deshmukh
SUDRISHTI EYE CARE & GOREGAON GLAUCOMA CENTER, MUMBAI
GLAUCOMA INCHARGE- LOTUS EYE HOSPITAL,MUMBAI

2. Outline Why SLT? What is SLT? (How different is SLT?)
Available literature evidence on SLT
Points to ponder while performing SLT IN PACG

13. Cellular photo-activation
SLT
Cellular photo-activation
Cytokines
Interleukins
Macrophages
Act as growth factors
Clear TM debris
TM tissue remodeling

14. ALT-Fluorescent cytotoxicity/viiability Assay

18. Indications Primary treatment of glaucoma
Financial constraints for medication use
Non-compliance and quality of life issues with medications.
Drug side effects like OSD.
Drug allergy & tachyphylaxis
Additional IOP reduction

19. Glaucoma profile All POAG Ocular Hypertensives requiring IOP Lowering.
Pseudoexfoliative glaucoma
Chronic ACG(PACG) after Peripheral Iridectomy/Post cataract surgery with open angles.

20. Avoid in…. NVG Angle recession (Young Pts) NTG/LTG – poor response
Secondary /Imflamatory glaucomas- post keratoplasty/VR surgery- Sub-optimal response.

21. TREATMENT PROTOCOL
1drop of Brimonidine 0.15 % instilled just before the procedure
Treatment parameters
Applications = (90-110) adjacent spots
Extent of angle= 360 degree
Spot size: 400microns
Duration: 3ns
Starting power-0.6mj , titrated based on the appearance of cavitation (energy is reduced by 0.1mJ from threshold- energy setting - may vary from one quadrant to other)

22. Post procedure care
1 hour post laser - SLE and IOP measurement is done. In case of increase in IOP of more than 5 mm Hg – diamox 250mg stat.
Post laser medication- No medications. Topical ketorolac TID for 3days if AC reaction/pain.
In case of increased anterior chamber reaction, topical dexamethasone QID for 3day on day3.

23. IOP Spike Seen in 10% of patients Expect in Hyper-pigmented TM
Young patients
Over-treatment
Have patience ! ! ! IOP will drop

24. Summary for Clinician
SLT is effective as initial, replacement and adjunctive therapy in OAG & PACG- post Iridectomy/cataract surgery.
Useful in addressing compliance issues with medications
Effective in flattening diurnal IOP curve and decreases nocturnal IOP spikes
Decreases the cost and side effects of medications for patients.
May help reduce societal costs of treating glaucoma.

25. Major clinical studies on SLT
*SLT used as primary initial treatment
% IOP reduction
n=53; 6 mos ff up
n=18; 6 mos ff up
n=101; 6 mos ff up
n=460; 24 mos ff up
n=50; 6 mos ff up
n=44; 12 mos ff up
n=45; 18 mos ff up

33. Tips for SLT IN PACG
Can be considered in post-iridectomy/post cataract surgery PACG patients
Need >180 degrees of visible Posterior Trabecular Meshwork
Skip areas of PAS during SLT
Avoid overlapping the 400nm spot of SLT on iris root
Frequent re-titration of the energy requirement in various sectors/quadrants

34. Tips to avoid disappointment
Do not over-promise the patient
Choose elderly patients
Primary treatment works best
Choose re-treatments in responsive patients
Treat 360˚at first seating. Avoid areas of synechiae & ostium.

35. Patient education before SLT
‘Realistic’ patient education
Extent of IOP reduction
Possibility of re-treatment
Possibility of medication use in most
‘Kick-in’ period

36. Thank You !