Eyeworld

78 | EYEWORLD | SEPTEMBER 2019 G UCOMA PRESENTATION SPOTLIGHT Contact information Konstas: konstas@med.auth.gr by Stefanie Petrou Binder, MD EyeWorld Contributing Writer that laser burns induce contracture and stretch- ing of the adjacent tissues, thereby widening the trabecular pores. Another theory proposes a cellular mechanism action, in which LT induc- es cell division with subsequent renewal of cellularity. A biochemical mechanism of action suggests the renewal of MMPs on the beams and stimulation of macrophages as the means by which LT ultimately reduces IOP. These mechanisms of action are thought to work together and are not mutually exclusive. ALT ALT is the most tried and tested NIGP. It treats the trabecular meshwork aiming to enhance the outflow facility. IOP reduction with ALT was 24–30% a year after treatment in one investigation, however, all researchers have documented a gradual decline in efficacy over time, as with lasers overall. Evidence suggests that primary ALT low- ered IOP more than initial therapy with tim- olol and was at least as effective in preserving visual field and optic disc status over a period of more than 5 years. Other data shows that primary SLT had similar IOP-lowering effects as latanoprost over 12 months of follow-up. More recently, SLT employed as sole therapy was shown to be very effective, reducing IOP between 29% and 39%, with patients achieving and maintaining target IOP after 12 months and demonstrating a success rate of almost 80%. "LT could be a very interesting choice for therapy particularly in patients with exfoliative glaucoma," Prof. Konstas said. "We know that laser has a better safety profile than medical or surgical therapy, and it is cost effective. Evidence shows that LT in some elderly pa- tients eliminated any further need for medical therapy. Another study on long-term efficacy of I n glaucoma surgery, the less invasive, the better. Fortunately, laser and ultrasound technologies employed as primary or ad- junctive therapies seem to offer viable, less invasive options. According to Anastasios Konstas, MD, PhD, in a presentation at the 23rd European Society of Cataract and Re- fractive Surgeons Win- ter Meeting, non-in- vasive procedures can be reasonably effective in lowering IOP while offering improved safety over more inva- sive surgeries. "Today, non-in- vasive glaucoma procedures (NIGP) do not require eye penetration, differ- entiating them from MIGS, which requires small incisions and instruments entering the eye," Prof. Konstas said. "Evidence sug- gests that the success of laser trabeculoplasty is greater when employed as initial therapy or early in stepwise medical therapy. The perception of limited success of this treatment in the past was influenced by the use of laser as a 'last resort' before filtering surgery." Current and emerging NIGP NIGPs include the established argon laser trabeculoplasty (ALT) as well as more recent additions, such as selective laser trabeculoplas- ty (SLT) and micropulse laser trabeculoplasty (MLT). Some of the newest innovations com- prise procedures such as deep wave trabecu- loplasty, therapeutic ultrasound, and ultrasonic circular cyclocoagulation. Laser trabeculoplasty (LT) was shown to be successful in lowering IOP for OAG patients. The mechanisms of LT action are not fully un- derstood, and evidence is lacking to support the superiority of any particular form of laser. One theory on the mechanism of action of LT says Non-invasive, laser trabeculoplasty for IOP reduction About the doctor Anastasios Konstas, MD, PhD Professor of ophthalmology Aristotle University of Thessaloniki Thessaloniki, Greece "We know that laser has a better safety profile than medical or surgical therapy, and it is cost effective. Evidence shows that LT in some elderly patients eliminated any further need for medical therapy." —Anastasios Konstas, MD

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