Can Laser Trabeculoplasty Be Repeated?

Feb 4, 2015

That depends upon the type of laser used. Only one full (360 degree) or two partial (180 degree) treatments of Argon Laser Trabeculoplasty (ALT) can be performed on an eye. Once a portion of the trabecular meshwork has been treated with the Argon laser, additional treatments with ALT typically result in either minimal IOP lowering[1] or a rapid decline in effect.[2]Selective Laser Trabeculoplasty (SLT), however, can be effective after failed ALT.[3]

Selective Laser Trabeculoplasty (SLT) may be repeated multiple times so long as there is an initial IOP-lowering response to the first treatment.[4]  When SLT is repeated after the first SLT treatment has worn off the IOP may be further reduced by about 20% in 43-67% of treated eyes.[5] Eventually, however, re-treatments lose their effect at which time medical or non-laser surgical options must be considered if the IOP is too high.

There are currently no published studies looking at the effect of repeated Micropulse Laser Trabeculoplasty (MLT). It is believed that thermal damage is what limits the benefit of repeated treatments. At least in theory, as MLT does not result in thermal damage to the trabecular meshwork it should be repeatable.

[On Photo: NEW MicroPulse™ Laser Trabeculoplasty (MLT) Lens via www.iridex.com]

Can Laser Trabeculoplasty Be Repeated?
References

1) Starita RJ, Fellman RL, Spaeth GL, et al. The effect of repeating full-circumference argon laser trabeculoplasty. Ophthalmic Surg. 1984;15(1):41-43.

Brown SV, Thomas JV, Simmons RJ. Laser trabeculoplasty re-treatment. Am J Ophthalmol. 1985;99(1):8-10.

Messner D, Siegel LI, Kass MA, et al. Repeat argon laser trabeculoplasty. Am J Ophthalmol. 1987;103(1):113-115.

Richter CU, Shingleton BJ, Bellows AR, et al. Retreatment with argon laser trabeculoplasty. Ophthalmology. 1987;94(9):1085-1089.

Grayson DK, Camras CB, Podos SM, et al. Long-term reduction of intraocular pressure after repeat argon laser trabeculoplasty. Am J Ophthalmol. 1988;106(3):312-321.

Weber PA, Burton GD, Epitropoulos AT. Laser trabeculoplasty retreatment. Ophthalmic Surg. 1989;20(10):702-706.

Feldman RM, Katz LJ, Spaeth GL, et al. Long-term efficacy of repeat argon laser trabeculooplasty. Ophthalmology. 1991;98(7):1061-1065.

Spiegel D, Wegscheider E, Lund OE. Argon laser trabeculoplasty: long-term follow-up of at least 5 years. Ger J Ophthalmol. 1992;1(3-4):156-158.

2) Feldman RM, Katz LJ, Spaeth GL, et al. Long-term efficacy of repeat argon laser trabeculoplasty. Ophthalmology. 1991;98(7):1061-1065

3) Damji KF, Shah KC, Rock WJ, et al. Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial. Br J Ophthalmol. 1999;83(6):718-722.

4) Hong BK, Winer JC, Martone JF, et al. Repeat selective laser trabeculoplasty. J Glaucoma. 2009;18(3):180-183.

5) Avery N, Ang GS, Nicholas S, et al. Repeatability of primary selective laser trabeculoplasty in patients with primary open-angle glaucoma. Int Ophthalmol. 2013;33:501-6.

Hong BK, Winer JC, Martone JF, et al. Repeat selective laser trabeculoplasty. J Glaucoma. 2009;18:180-3.

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