Types Of Laser Trabeculoplasty

Jan 26, 2015

Types Of Laser Trabeculoplasty

Types Of Laser Trabeculoplasty

There are three types of lasers currently used for trabeculoplasty glaucoma surgery: Argon, “Selective”, and Micropulse.

Argon Laser Trabeculoplasty (ALT)

This type of laser has been around the longest. It is generally performed in one or two sessions. However, it can result in microscopic scars called “peripheral anterior synechiae”[1] that can limit the effectiveness of the treatment as well as future surgeries (such as canaloplasty).

Selective Laser Trabeculoplasty (SLT)

Selective Laser Trabeculoplasty (SLT) was first reported in 1995.[2] It uses a “Q-switched, frequency-doubled Nd:YAG laser”. This laser energy is preferentially absorbed by the pigment-containing cells in the trabecular meshwork while cells without pigment are left undamaged.[3] Because SLT does not “coagulate” (or melt) tissue this results in a less traumatic laser treatment compared to ALT.[4]

SLT appears to cause less damage to the eye tissue and uses less than 1% of the energy required for ALT.[5] It is rapidly becoming the preferred method of laser surgery (over ALT) for treating primary open angle glaucoma. It can also be performed on patients who have already had received a full treatment of ALT.[6]  

Micropulse Laser Trabeculoplasty (MLT)

MLT from http://www.iridex.com/

Micropulse Laser Trabeculoplasty (MLT) via www.iridex.com

Micropulse Diode Laser Trabeculoplasty (MDLT or MLT) is the latest addition to the Laser Trabeculoplasty party. MLT works by using very short bursts of the laser (called “micro-pulses) to heat up the trabecular meshwork cells without destroying them. This avoids the damage and scarring associated with ALT while minimizing the inflammation and post-operative IOP elevations seen with both ALT and SLT.[7]


1) Rouhianinen HJ, Teravirta ME, Tuovinen EJ. Peripheral anterior synechiae formation after trabeculoplasty. Arch Ophthalmol. 1988;106(2):189-191.

2) Latina MA, Park C. Selective targeting of trabecular meshwork cells: in vitro studi es of pulsed and CW la ser interactions. Exp Eye Res. 1995; 60:359-71.

3) Latina MA, park C. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and CW laser interactions. Exp Eye Res. 1995;60(4):359-371.

Latina MA, Sibayan SA, Shin DH, et al. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998;105(11):2082-2088; discussion 2089-2090.

4) KramerTR, Noecker RJ. Comparison of the morphologic changes after selective laser trabeculoplasty and argon laser trabeculoplasty in human eye bank eyes. Ophthalmology. 2001;108:773-9.

5) Samples JR, Singh K, Lin SC, et al. Laser trabeculoplasty for open-angle glaucoma: a report by the American Academy of Ophthalmology.Ophthalmology. 2011;118:2296-302.

6) 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.

7) Fudemberg, SJ, Myers, JS, Katz, LJ: Trabecular Meshwork Tissue Examination with Scanning Electron Microscopy: A Comparison of Micropulse Diode Laser (MLT), Selective Laser (SLT), and Argon Laser (ALT) Trabeculoplasty in Human Cadaver Tissue. Invest. Ophthalmol. Vis. Sci. 2008;49(5):1236.

Don’t delay getting checked for glaucoma. Make an appointment with an eye doctor in your area now. If you live in the greater Los Angeles area and would like Dr. Richardson to evaluate your eyes for glaucoma call 626-289-7856 now. Same day or next day appointments are available Tuesday through Saturday.

SLT: The Gentler Glaucoma Laser Surgery

Dr. David Richardson offers Selective Laser Trabeculoplasty (SLT) as an outpatient procedure in his San Marino Eye office. SLT can be performed on the same day as most examinations and the whole procedure takes 5 minutes of less. SLT is a gentler glaucoma laser surgery. Contact Dr. David Richardson immediately to see if SLT is for you.  Call today to schedule an appointment with Dr. Richardson at 626.289.7856.

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