Eyeworld

SEPTEMBER 2019 | EYEWORLD | 79 G Newer techniques MLT delivers energy in repetitive microsecond pulses followed by a rest period, thereby reduc- ing any buildup of thermal energy. There is no observable coagulative damage to the trabecular meshwork, and it seems to have a similar ef- ficacy as SLT over a 52-week follow-up peri- od, with less discomfort during and after the procedure, a recent study showed. An investi- gation in a small group of exfoliative glaucoma patients insufficiently controlled on a prosta- glandin revealed a significant IOP reduction up to 12 months after MLT, with 52% of patients demonstrating at least a 20% IOP reduction. "The reasonably good efficacy and supe- rior safety profile it displays have made SLT increasingly popular in glaucoma practices worldwide. Expanding indications could include PACG (when some angle is visible). Although promising, today there is insufficient controlled evidence for the success of MLT," Prof. Kons- tas said. primary ALT showed the probability of success (no additional therapy) in exfoliation patients was 80% after 2 years, 54% after 5 years, and 36% after 8 years." SLT Prof. Konstas thinks that SLT may prove to be a cost-effective and successful strategy as initial or stepwise therapy, specifically in eyes with exfoliative glaucoma, as this treatment targets pigment, which is abundant in this form of glaucoma. Evidence suggests that SLT was effective in reducing IOP by almost 30% when used as initial therapy in open angle glaucoma patients and by roughly 31% when used as ad- junctive therapy in exfoliation patients. In a review of the clinical usefulness of SLT in eyes with exfoliative glaucoma, Prof. Konstas and his colleagues noted a greater IOP reduction and decreased burden of multiple medical therapies. 1 "The pigment-laden trabecu- lar meshwork enhances the absorption of laser energy and thus augments the biological effect induced by this treatment," he explained. Reference 1. Katsanos A, et al. A review of the clinical usefulness of selective laser trabeculoplasty in exfoliative glaucoma. Adv Ther. 2018;35:619–630. Relevant financial interests Konstas: None Sheybani said physicians need to pay attention to what medications are doing. Patients in the study used significantly fewer glaucoma medi- cations over a 12-month period (68% reduction in medication at 1 year). Fifty-eight percent of patients were medication free at 1 year. Overall, Dr. Sheybani said he thinks this study is "more real world than what the typical studies show." From a quality of life standpoint, IOP has almost no bearing, Dr. Radcliffe, said while medication has a "massive financial, com- fort, and general quality of life impact." A 2-year pooled analysis of the MicroShunt in patients with primary open-angle glaucoma Juan Batlle, MD, Henny Beckers, MD, Isabelle Riss, MD This research, Dr. Sheybani said, helps get at the questions: Should we be doing trabe- culectomies and can devices start slowly re- placing this procedure? It included multicenter, prospective, non-randomized single-arm studies that evaluated the InnFocus MicroShunt (Sant- en Pharmaceutical) in a more advanced glauco- ma population than what Dr. Sheybani said is usually seen in MIGS studies. Dr. Sheybani said that while these devices are not enhancing physiology, they have safety, control, and significant pressure lowering. The study showed a reduction from a mean baseline IOP of 22.4±4.2 mm Hg to 13.8±4.0 mm Hg at 2 years postop. Patients ended up on fewer medications years out as well. Editors' note: The session is available on demand at ascrs.org/clinical-education/2019ondemand for those who attended the 2019 ASCRS ASOA Annual Meeting. continued from page 76

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