Open-angle glaucoma can be operated on with an argon laser or more recently with a SLT (Selective) laser. It consists of making impacts in the angle between the iris and the cornea, more precisely on the trabecular meshwork. It has the effect of widening the meshwork of the trabecular meshwork, allowing it to be more permeable to aqueous humor and therefore reducing eye pressure.
The operation is performed without hospitalization, it is technically simple and can be done at the ophthalmologist's office. Anesthetic eye drops are instilled on the eye and a contact lens is placed on the eye in order to practice the laser.
The after-effects of Glaucoma laser treatment surgery are simple. At most, there is irritation of the eye that lasts a few hours. An anti-inflammatory treatment is then prescribed for about a week. This treatment is effective because it reduces eye pressure by almost 30%, which allows you to stop taking eye drops or reduce the number prescribed.
But its effectiveness is transitory. Eye pressure can rise again after a few years in nearly 40% of cases.
The main advantage of the Selective laser compared to Argon is the possibility, due to its absence of thermal effects and its safety, of re-treating the patient with laser after a few years.
Medical treatment can also be reinstated after a few years.
Angle-closure glaucoma can be treated with laser. It consists of opening the iris to prevent it from blocking the trabecular meshwork when it relaxes. Angle-closure glaucoma surgery is performed without hospitalization with the same after-effects and procedures as in laser surgery for open-angle glaucoma but with another laser: YAG laser.
The SLT Laser
Developed in 1995 and approved by the FDA (Food and Drugs Administration USA) in 2001, SLT is a new type of laser that can treat glaucoma by regenerating the trabecular meshwork of the iridocorneal angle.
More than 3,000 centers are equipped with it worldwide, including 1,700 in the USA and around a hundred in France, including the Paris Ouest Vision Laser Center.
The SLT laser, which has proven its efficacy and safety, is a new standard treatment for open-angle glaucoma.
A hundred international scientific publications have confirmed its effectiveness and its place in this glaucoma operation.
The data for our study come from these publications and from the summary presented by Professor Philippe Denis of the Hospices Civils de Lyon.
How it works
The trabeculum is one of the structures of the iridocorneal angle allowing the filtration of aqueous humor.
The SLT laser allows regeneration of the trabecular meshwork without creating tissue burns as is the case with the Argon laser.
It provides a blood pressure reduction identical to that obtained with Argon trabeculectomy without having the undesirable thermal effects or fibrosis.
The blood pressure reduction is nearly 30% of the initial pressure which, in terms of effectiveness, places it favorably compared to eye drops used in monotherapy.
It is a low-energy treatment (nearly 100 times less than with Argon laser) and therefore non-invasive and safe, which allows reprocessing (which further differentiates it from Argon thermal lasers).
Results: decreased eye pressure
The SLT Laser allows a reduction in ocular pressure of 20 to 30% of the initial pressure, which places it favorably compared to medical monotherapy.
The higher the initial pressure, the more effective the laser will be.
The effect will be judged after 1 month.
It remains effective in the long term since according to studies the pressure drop would still be 20% after 5 years.
A therapeutic escape is nevertheless often observed but it will then be wise to do it again because it retains the same effectiveness in the event of reprocessing.
SLT retreatments are harmless because it is a non-invasive method.
Possible side effects
Sometimes, pain or rather transient ocular discomfort may be observed after treatment, sometimes moderate post-operative ocular inflammation prevented if necessary by anti-inflammatory eye drops.
Immediate and short-lived postoperative pressure spike is rare.
No long term side effects.
Contraindications
Congenital glaucoma,
juvenile,
post uveitic,
neovascular,
and closed or very narrow angle.
Conducting glaucoma surgery during an SLT laser session
The session takes place in a clinic or medical office.
The patient is awake, a few drops of anesthetic eye drops are instilled into the eye just before the session.
Depending on the case, preparatory eye drops are prescribed one hour before and after the session.
The patient sits in front of the laser with the eye held open by a contact lens.
The session lasts approximately 1 minute and is painless, the patient being able to work and resume their activities 1/2 hour after the session.
It is usual to offer a 2nd session 2 to 4 weeks after the first.
The final effect on blood pressure is seen after one month.
It will therefore be necessary to continue the previous medical treatment and reduce it after a month depending on the reduction in blood pressure achieved.
Argon Laser Trabeculectomy or SLT is reimbursed by Social Security (and Mutual Insurance Companies) as part of this glaucoma operation.
Place of laser in the treatment of glaucoma
It is usual to start with medical treatment, except in certain indications where Laser may be offered straight away.
Laser is indicated in cases of poor compliance or poor tolerance to treatment with eye drops.
It is also indicated to reduce the number of eye drops prescribed.
It also helps to avoid or delay the need for surgery or in case of a disappointing surgical result.
Please note that the use of the SLT Laser does not reduce the chances of success of the surgery or the effectiveness of any eye drop treatment that may be prescribed subsequently.
Conclusions
The effectiveness of SLT Laser in lowering eye pressure in the long term has been proven in over a hundred international studies.
It is equivalent to Argon in the treatment of open-angle glaucoma.
It is equivalent or even more effective than antiglaucomatous eye drops used as monotherapy.
Studies confirm the absence of thermal effects and validate this non-invasive method with an excellent safety profile.
Retreatments are possible without risk of altering the chances of future surgery.
The SLT Laser is therefore the new reference solution for glaucoma surgery.