Beginners Technique with SLT Sungjun Hwang MD Amy

Beginner’s Technique with SLT Sungjun Hwang MD Amy Zhang MD Financial Disclosure: Hwang Gonio Lens (Ocular Instruments)

Purpose Selective Laser Trabeculoplasty (SLT) difficult for the novice given lack of burn marks Alternative method using a modified Latina SLT Gonio Laser Lens (Ocular Instruments)

Methods 161 SLT procedures Private comprehensive practice Reflected Indicator Modified Latina SLT Gonio Laser lens 4 months follow-up 45 o Indicator

Methods Latina SLT Gonio Laser Lens -modified to indicate a 45 o arc on the trabecular meshwork Laser applied to a 90 o arc using 45 o indicator as a guide 90 o Arc 45 o Indicator

Methods Superior Successively positioned to treat 4 quadrants of each eye Superior, Temporal inferior and nasal quadrants of trabecular meshwork Inferior Lateral

Results Average Pressure Difference -2. 38 ± 4. 77 131 out of 161 eyes (81. 4%) had reduction in intraocular pressure (IOP) 43 eyes (26. 7%) were able to reduce the usage of IOP lowering medications 30 eyes (18. 6%) did not experience any IOP reduction No adverse outcomes were noted

Conclusion Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT) are common modalities for treatment of glaucoma with similar efficacies. 1, 2, 3 ALT allows for visualization of the burn marks thus facilitating placement of the next burn mark especially for the novice. 4, 5 New technique with the modified lens allows similar visualization on the SLT laser and yields good results.

References 1. Shingleton BJ, Richter CU, Bellows AR, Hutchinson BT, Glynn RJ Long-term efficacy of argon laser trabeculoplasty. Ophthalmolog 1987 Dec; 94(12): 1513 -8. 2. Mc. Ilraith I, Strasfeld M, Colev G, Hutnik CM Selective laser trabeculoplasty as initial and adjunctive treatmentfor open-angle glaucoma. J Glaucoma. 2006 Apr; 15(2): 124 -30. 3. Stein JD, Challa P. Mechanisms of action and efficacy of argon laser trabeculoplasty and selective laser trabeculoplasty. Curr Opin Ophthalmol. 2007 Mar; 18(2): 140 -5. 4. Pham H, Mansberger S, Brandt JD, Damji K, Ramulu PY, Parrish RK. Argon Laser trabeculoplasty versus selective laser trabeculoplasty. Surv Ophthalmol. 2008 Nov Dec; 53(6): 641 -6. 5. Mahar PS, Jamali KK. Argon laser trabeculoplasty as primary therapy in open angle glaucoma. J Coll Physicians Surg Pak. 2008 Feb; 18(2): 102 -4.