DEC 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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mm Hg, they found that mean IOP was reduced by 3.3 mm Hg (18%) at three months and 3.6 mm Hg (19%) at 24 months after SLT. No significant safety issues were identified. "We found no evidence that resident-performed SLT efficacy differs from the IOP reductions reported in the literature for attending-performed SLT in patients with similar pre-SLT IOP," he said. Similarly, Wanda Hu, MD, Jules Stein Eye Institute, Los Angeles, and colleagues directly compared SLT outcomes between residents and attendings. Their study included 43 eyes of 43 patients treated by residents and 68 eyes of 68 patients treated by attendings. Through up to 36 months of follow-up, there were no statistically significant differences in mean IOP of eyes treated by residents versus attendings, she said. Likewise, both groups had similar rates of IOP spikes, failures requiring additional IOP-lowering interventions, and time to such failures, she said. Following MMT Many clinicians offer SLT as primary or early adjunct therapy, but many others still save it for those patients who have failed maximal medical therapy and are facing glaucoma surgery. Eman Elhawy, MD, Wills Eye Institute, Philadelphia, and colleagues reported on SLT's efficacy when used in this role. The group analyzed 90 eyes of 81 patients, who were using an average of about 3.5 medications at the time of SLT. Of these, 15 had little response and went on to surgery shortly after SLT. The remaining 75 were followed for up to five years with mean IOP reductions of 1.9 mm Hg, 1.8 mm Hg, and 2.6 mm Hg at one, three, and five years; commensurately, medications were reduced at the same time points by about 0.4, 0.75, and 1.5, respectively. Because relatively fewer eyes were followed for the three- and five-year intervals, IOP reduction was only significant at one year, and medication reduction at one and three years. Importantly, only eight of the 40 eyes followed for three years required surgery. In other words, SLT allowed 32 of those 40 eyes to avoid incisional surgery. Additive to a prostaglandin? It has been theorized that the mechanisms by which SLT and prostaglandin analogues (PGAs) lower IOP may not be completely complementary. Reports on the efficacy of SLT in eyes treated with PGAs are conflicting. Babak Eliassi-Rad, MD, Boston University, and colleagues retrospectively analyzed SLT outcomes in 18 patients not using a PGA and seven patients using a PGA. In this small study, there were no significant differences in IOP reductions seen between the two groups with followup as long as 30 months. .EW 2HEINĀ® 2ESPOSABLE +NIVES Front View Clinical impact SLT is safe and effective. While the optimal positioning of SLT is currently not established, compelling data support its use as primary, adjunctive and rescue therapy. As SLT technology becomes more available nationwide, these data facilitate further individualization of clinical management, allowing clinicians to confidently offer SLT at different stages in the treatment cascade for different patients. EW s s s s s s s Editors' note: Drs. Eliassi-Rad and Mr. Lowry have no financial interests related to the article. +ERATOMES 3IDEPORTS 4RAPAZOIDS 3POONS #RESCENTS 3TABS 2ESTRICTED 3TABS Contact information Eliassi-Rad: babak.eliassi-rad@bmc.org Hu: w.hu@jsei.ucla.edu Lowry: gene.lowry@ucsf.edu s 0 ATENTE D $ "L ADE S $ E S IG NE D 4O # RE ATE ! 3UPERIOR 3ELF 3EALING )NCISION 5NIQUE ! S Y M MET R IC A L $ " EVEL S 0 U SH 3T ROMA ) N 4 H RE E $ I RE C T ION S # RE AT I NG ! - ORE 4OR T U ROU S 0 AT H &OR &LU ID % G RE S S ION EyeWorld factoid s 3PECIAL (ANDLES !RE !UTOCLAVEABLE !ND 2 E U S A B L E ! L L O W I N G - U L T I P L E 5 S E S 4O " R I N G 4HE #OST 0ER #ASE $OWN Selective laser trabeculoplasty (SLT) lowers IOP by about 30% when used as initial therapy. s !V A I L A B L E 3 T E R I L E 0 E R " O X ) N ! 6A R I E T Y / F 3IZES ,ABELED &OR 2EUSE Source: Glaucoma Research Foundation s 2 E U S A B L E !UTOCLAVEABLE -ADE )N 4HE 53! ! N D !V A I L A B L E & O R ! 3 U R G I C A L % V A L U A T I O N 7IT HOUT / BLIGAT I O N Call 727-209-2244 For More Information. 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 s 4EL s &AX %MAIL )NFO 2HEIN-EDICALCOM s 7EBSITE WWW2HEIN-EDICALCOM *Patent Number RE 37,304 3TYLIZED %YE 2HEIN -EDICAL 1345 Rev.A BABC

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