33
EW GLAUCOMA
May 2018
Contact information
Kammerdiener: lkammerdiener@gmail.com
Sharpe: Sharpera@musc.edu
Editors' note: Dr. Kammerdiener and
Dr. Sharpe have no financial interests
related to their comments.
Reference
1. Sharpe RA, et al. Efficacy of selective laser
trabeculoplasty following incisional glaucoma
surgery. Int J Ophthalmol. 2018;11:71–76.
because these are already difficult
patients who have failed multiple
treatments," he said, adding that to
have more than one-fourth of all of
the patients who had prior incision-
al surgery have a positive result was
encouraging.
Those with higher initial
pressures were attaining closer to
20% pressure drops, Dr. Sharpe said.
"That made us think that this was
an even more powerful tool for
those patients who you would oth-
erwise rush to put on the schedule
for surgery," he said. "Those are the
ones who you can buy more time for
with SLT."
From a clinical perspective, this
could bring important change, Dr.
Sharpe thinks. "Traditionally the
algorithm is to try drops, then at
some point the laser becomes an
option. If that doesn't work, then
you perform an incisional glaucoma
surgery. The traditional thinking is
that SLT at that point has been sur-
passed, and you can't go back and
use it," he said. "What we found is
that SLT now may have an addition-
al role even after glaucoma surgery."
Practitioners can bring it back in as a
treatment option, just as they would
bring in other drops for uncon-
trolled pressure in patients who've
had surgery, he said.
Dr. Kammerdiener likewise
views this as a chance to expand the
role of SLT, which she thinks has
been largely forgotten in post-inci-
sional glaucoma patients. "A lot of
people think that by the time it has
gotten to the level of a trab or tube
that they have given up on the out-
flow system and at that point they're
in the glaucoma surgeon's realm,"
Dr. Kammerdiener said. "I think that
this shows that 25–30% of people
can benefit for an extended period
of time from having an additional
treatment. This should give compre-
hensive doctors confidence that if
they have a patient who has family
issues or something else going on
and they need to temporize, this is
a possibility. It expands the options
for treatment," she concluded. EW
