SLT IN PACG Dr Susheel Deshmukh

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Presentation transcript:

SLT IN PACG Dr Susheel Deshmukh SUDRISHTI EYE CARE & GOREGAON GLAUCOMA CENTER, MUMBAI GLAUCOMA INCHARGE- LOTUS EYE HOSPITAL,MUMBAI

Outline Why SLT? What is SLT? (How different is SLT?) Available literature evidence on SLT Points to ponder while performing SLT IN PACG

Cellular photo-activation SLT Cellular photo-activation Cytokines Interleukins Macrophages Act as growth factors Clear TM debris TM tissue remodeling

ALT-Fluorescent cytotoxicity/viiability Assay

TREATMENT PROTOCOL 1drop of Brimonidine 0.15 % instilled just before the procedure Treatment parameters Applications = (90-110) adjacent spots Extent of angle= 360 degree Spot size: 400microns Duration: 3ns Starting power-0.6mj , titrated based on the appearance of cavitation (energy is reduced by 0.1mJ from threshold- energy setting - may vary from one quadrant to other)

Post procedure care 1 hour post laser - SLE and IOP measurement is done. In case of increase in IOP of more than 5 mm Hg – diamox 250mg stat. Post laser medication- No medications. Topical ketorolac TID for 3days if AC reaction/pain. In case of increased anterior chamber reaction, topical dexamethasone QID for 3day on day3.

Indications Primary treatment of glaucoma Financial constraints for medication use Non-compliance and quality of life issues with medications. Drug side effects like OSD. Drug allergy & tachyphylaxis Additional IOP reduction

Glaucoma profile All POAG Ocular Hypertensives requiring IOP Lowering. Pseudoexfoliative glaucoma Chronic ACG(PACG) after Peripheral Iridectomy/Post cataract surgery with open angles.

Avoid in…. NVG Angle recession (Young Pts) NTG/LTG – poor response Secondary /Imflamatory glaucomas- post keratoplasty/VR surgery- Sub-optimal response.

IOP Spike Seen in 10% of patients Expect in Hyper-pigmented TM Young patients Over-treatment Have patience ! ! ! IOP will drop

Major clinical studies on SLT *SLT used as primary initial treatment % IOP reduction n=53; 6 mos ff up n=18; 6 mos ff up n=101; 6 mos ff up n=460; 24 mos ff up n=50; 6 mos ff up n=44; 12 mos ff up n=45; 18 mos ff up

Tips for SLT IN PACG Can be considered in post-iridectomy/post cataract surgery PACG patients Need >180 degrees of visible Posterior Trabecular Meshwork Skip areas of PAS during SLT Avoid overlapping the 400nm spot of SLT on iris root Frequent re-titration of the energy requirement in various sectors/quadrants

Summary for Clinician SLT is effective as initial, replacement and adjunctive therapy in OAG & PACG- post Iridectomy/cataract surgery. Useful in addressing compliance issues with medications Effective in flattening diurnal IOP curve and decreases nocturnal IOP spikes Decreases the cost and side effects of medications for patients.

Tips to avoid disappointment Do not over-promise the patient Choose elderly patients Primary treatment works best Choose re-treatments in responsive patients Treat 360˚at first seating. Avoid areas of synechiae & ostium.

Thank You !