Research Article Open Access Volume 2 • Issue 8 • 1000176 J Clinic Experiment Ophthalmol ISSN:2155-9570 JCEO an open access journal Open Access Research Article Francis J Clinic Experiment Ophthalmol 2011, 2:8 DOI: 10.4172/2155-9570.1000176 Keywords: Glaucoma; Laser; Trabeculoplasty; Selective; SLT; Trabeculectomy Introduction Terapeutic options in persons with open angle glaucoma (OAG) include topical and systemic medications, laser trabeculoplasty, and incisional glaucoma surgery. Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are approved for treatment of OAG and have documented efcacy [1-3] and therapeutic equivalency [2,3]. SLT was initially studied as a secondary modality in cases of failure of medical therapy or ALT [4]. It has more recently been shown to be efective as primary treatment in OAG [5,6] and as a replacement for glaucoma medications in medically controlled OAG [7]. Te efcacy of SLT afer failed trabeculectomy has not yet been studied, however. Te goal of the current study was to prospectively determine the 12 month success rate of SLT for uncontrolled OAG in persons with a history of previously failed trabeculectomy who were unwilling or unable to undergo further incisional glaucoma surgery. Methods Participants were recruited from consecutive patient visits to the clinical practice of an academic, tertiary-care glaucoma clinic at the Doheny Eye Institute. Te Institutional Review Board at the University of Southern California approved the study protocol, and all study procedures conformed to Health Insurance Portability and Accountability Act and the Declaration of Helsinki for research involving human participants. All participants provided written consent prior to receiving laser trabeculoplasty treatment. Inclusion criteria were: 1) diagnosis of primary open angle (defned as a historical baseline IOP > 21 mmHg, with glaucomatous optic nerve appearance and characteristic visual feld loss) or exfoliation glaucoma (same as POAG, also with exfoliation material evident on the anterior lens *Corresponding author: Brian A. Francis, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Doheny Eye Institute, 1450 San Pablo Street, DEI 4804, Los Angeles, CA 90033, USA, Tel: (323) 442-6454, Fax: 323-442-6412; E-mail: bfrancis@usc.edu Received May 20, 2011; Accepted August 04, 2011; Published August 10, 2011 Citation: Francis BA, Chopra V, Traudt B, Enright J, Hertzog D, et al. (2011) Selective Laser Trabeculoplasty after Failed Trabeculectomy in Open Angle Glaucoma. J Clinic Experiment Ophthalmol 2:176. doi:10.4172/2155-9570.1000176 Copyright: © 2011 Francis BA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Selective Laser Trabeculoplasty after Failed Trabeculectomy in Open Angle Glaucoma Brian A. Francis 1 *, Vikas Chopra 1 , Brandon Traudt 2 , Julie Enright 3 , Dieter Hertzog 1 , Laurie Dustin 4 and Bryan K. Hong 1 1 Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA 2 UCLA Center for Health Policy Research, Los Angeles, CA, USA 3 Southwestern Medical Center, Department of Ophthalmology, University of Texas, USA 4 Department of Preventative Medicine, Keck School of Medicine, University of Southern California, USA capsule or pupillary margin), 2) evidence of failed trabeculectomy (no functional bleb on clinical exam with fat or immobile, scarred conjunctiva over the scleral fap site) greater than 6 months post operatively afer previous trabeculectomy, 3) poorly controlled IOP on maximum tolerated medical therapy (defned as failure to meet a predetermined target IOP based on optic nerve damage, visual feld loss, baseline IOP, and stability of disease), and 4) the participants were unable or unwilling to undergo further surgery such as repeat trabeculectomy or aqueous tube shunt. Exclusion criteria included aphakia, corneal scarring, edema, or other abnormality that may afect applanation tonometry, topical or systemic corticosteroid use, more than one failed trabeculectomy, prior tube shunt or cycloablation procedure, and/or greater than 90 degrees of peripheral anterior synechiae noted on gonioscopic examination. Te glaucoma medications were initially started by monocular trial in order to determine efcacy. Tere was no attempt to washout medications or reestablish efcacy prior to intervention. In order to reduce diurnal variations, all IOP measurements were made at the same time of day (within 2 hours). Pre-operative IOP was calculated Abstract Objective: To determine the effcacy of selective laser trabeculoplasty (SLT) for uncontrolled open angle glaucoma (OAG) on maximal tolerated medical therapy and with a history of previously failed trabeculectomy. Methods: This was a prospective, non-randomized, interventional case series. Participants included 22 eyes of 20 consecutive glaucoma patients with a previously failed trabeculectomy and medically uncontrolled intraocular pressure, unable or unwilling to undergo further incisional surgery. A single SLT treatment was performed over 270° to 360°, and participants were followed for a minimum of 12 months. Success was defned in two separate analyses as 1) absolute IOP reduction ≥ 3 mm Hg and 2) percentage IOP reduction of 20% or 15% without additional laser or surgical intervention. Results: The mean IOP dropped from 20.8 mm Hg to 16.3 mm Hg 12 months after SLT. The mean reduction in IOP was 19.5% or 4.5 mm Hg (95% confdence interval, 1.06-7.92, p<0.001). The cumulative success rate at 12 months (3 mmHg IOP reduction) was 16%. There was no statistically signifcant change in the number of medications (2.2 ± 0.8 to 2.0 ± 1.1). Conclusions: In the short- and intermediate-term, SLT had mild to moderate success in achieving lower IOP in individuals with medically uncontrolled OAG with previously failed trabeculectomy. Journal of Clinical & Experimental Ophthalmology J o ur n a l o f C l i n ic a l & E x pe r i m e n t a l O p h t h a l m o lo g y ISSN: 2155-9570