Laser Trabeculoplasty: ALT vs SLT - EyeWiki

Argon laser trabeculoplasty (ALT) was introduced by Wise and Witter in 1979 for the treatment of medically uncontrolled glaucoma. Createaccount Login MainPageArticlesGettingStartedHelpRecentchangesMyPortal Page Discussion Viewform Viewsource History LaserTrabeculoplasty:ALTvsSLT FromEyeWikiJumpto:navigation,search EnrollintheResidentsandFellowscontest EnrollintheInternationalOphthalmologistscontest ResidentsandFellowscontestrules|InternationalOphthalmologistscontestrules Originalarticlecontributedby: JoAnnA.Giaconi,MD Allcontributors: SarwatSalimMD,FACS, AhmadA.Aref,MD,MBA, OscarD.Albis-Donado,MD, DanielB.Moore,MD, TiagoMorais-Sarmento,M.D., JoAnnA.Giaconi,MD, LeonardK.Seibold,MD Assignededitor: AhmadA.Aref,MD,MBA Review: AssignedstatusUpdatePending  byAhmadA.Aref,MD,MBAonNovember2,2021. add ContributingEditors: add Contents 1Summary 2DiseaseEntity 2.1Disease 2.2GeneralPathology 2.3Pathophysiology 2.4History 2.5Physicalexamination 2.6Diagnosticprocedures 2.7Generaltreatment 2.8Surgery 2.9Surgicalfollowup 2.10Complications 2.11EfficacyofALTandSLT 2.11.1SelectedStudiesALT 2.11.2SelectedStudiesSLT 2.11.3SelectedStudiesComparingALTandSLT 2.12Prognosis 3References Summary Argonlasertrabeculoplasty(ALT)wasintroducedbyWiseandWitterin1979forthetreatmentofmedicallyuncontrolledglaucoma.Soonafteritsintroduction,theefficacyandsafetyofthisnewtechniquewasstudiedinalargemulticenterprospectiveclinicaltrialfundedbyNEI,GlaucomaLaserTrial(GLT),inwhicheyesreceivingALT360degrees werecomparedwithtimololmonotherapy.From2.5to5.5yearsoffollow-up,GLTdemonstratedthattrabeculoplastywasasefficaciousasmedicaltherapyintreatingearlyPOAG.Despitethesefavorableresults,lasertherapydidnotreplacemedicationsasprimarytherapyinpatientswithPOAG.Thiswaspartlyduetoattritionseeninefficacyovertimeandintroductionofmoreeffectiveglaucomamedications,namelyprostaglandinanalogues.Theroleoflasertrabeculoplastywaslimitedanditwasusedeitherasanadjunctivetherapyorasanintermediatestepbetweenfailedmedicaltherapyandsurgicalintervention.Interestinlasertrabeculoplastyhasbeenre-ignitedinthepastfewyearswiththeintroductionofselectivelasertrabeculoplasty(SLT).AnumberofstudiescomparingALTandSLThaveshownsimilarIOPreductionwiththetwolasers.BecauseSLTappearstobelessdestructivehistopathologically,apotentialbenefitofrepeatabilityhasbeenadvocated. DiseaseEntity Lasertrabeculoplasty,bothargonlasertrabeculoplasty(ALT)andselectivelasertrabeculoplasty(SLT)types,isusedtoincreaseaqueousoutflowfacilitythroughthetrabecularmeshwork(TM) inordertolowerintraocularpressure(IOP)incasesofocularhypertensionandglaucoma.[1] Disease BothALTandSLTareindicatedforthetreatmentofocularhypertension,primaryopenangleandsecondaryopenangleglaucomas,suchaspseudoexfoliationandpigmentdispersionglaucoma.Steroidinducedglaucomaisanotherpossiblecandidatefortheprocedure.Narrowangleglaucoma,wherethetrabecularmeshworkisnotobstructedbyirisappositionorsynechiae,mayalsobenefit.Ifthereissynechialclosure,trabeculoplastyisnotadvised.Contraindicationsareinflammatory,iridocornealendothelial(ICE)syndrome,developmental,andneovascularglaucoma.LasertrabeculoplastyisalsonoteffectiveinanglerecessionglaucomaduetodistortionoftheangleanatomyandTMscarring.Ifthereisalackofeffectinoneeye,thenitisrelativelycontraindicatedinthefelloweye. GeneralPathology ElevatedintraocularpressureiscausedbyresistancetoaqueousoutflowatthetrabecularmeshworkandSchlemm’scanal(SC)junction.ThepurposeofbothALTandSLTistoincreaseoutflowfacilitythroughthetrabecularmeshworkinordertolowerIOP. Pathophysiology Theexactmechanismofactionof lasertrabeculoplasty isnotwellestablished.Various theorieshavebeen proposedasexplanationsfortheincreasedaqueousoutflowfacilityseenfollowingsuccessfultrabeculoplasty,[2][3]includingmechanical,cellular,andbiochemicaltheories. ThemechanicaltheoryforALTsuggeststhatthelaserelectromagneticenergyisconvertedtothermalenergywhenitcontractstheTM.Tissuecontractionandscarformationresultinmechanicalstretchingofthesurroundinguntreatedregionsofthemeshwork,facilitatingflowintoSCwithsubsequentreductioninIOP.[4]However,thereissomeevidencethat themechanicaltheory maybeflawed[5] The celluartheoryforALT isbasedon stimulationandincreasedcelldivisionandrepopulationofthetrabecularmeshwork.[6]AnincreaseinDNAreplicationandcelldivisionfollowingargonlasertreatmenthavebeendemonstrated.[7][8] The biochemicaltheoryforbothALTandSLT suggestsareleaseofchemicalmediatorsafterlasertreatmentthatincreaseaqueousoutflowfacility.ALThasbeenshowntoincreasemacrophagerecruitmentatthesiteoftreatment,resultinginremodelingoftheextracellularmatrixandincreasedoutflowfacility.[9][10]ALThasalsobeenshowntoincreasethereleaseofinterleukin-1andtumornecrosisfactorgeneexpression,whichupregulatematrixmetalloproteinaseexpressionandremodelingoftheextracellularmatrix.[11][12]IthasbeendemonstratedthatinculturedhumantrabecularmeshworkirradiatedwiththeSLTlaser,interleukins8,1-alpha,1-beta,andtumornecrosisfactoralphaareupregulated.WhenthetrabecularmeshworkmediumwasaddedtoSchlemm’scanalendothelialcells,theSchlemm’scanalendotheliumunderwenta4-foldincreaseinfluidpermeability.[13] StudiesconductedbyKramerandNoeckerineyestreated byALT orSLT usingscanningandtransmissionelectronmicroscopy haveshowncoagulativedamage,trabecularbeamdisruption,endothelialmembraneformationonTM collapsedSClumen,andintertrabeculardebrisinALT-treatedeyes,incontrasttoeyestreatedwithSLT,inwhich minimalchangewasapparentonimaging.[14] InpostSLTeyes,generalstructureofTMwasintactwithnoendothelialmembraneformationandSClumenwasnotcollapsed.LesshistopathologicaldestructionobservedwithSLT haspromotedrepeatabilityofSLToverALT. Itisimportantto notethatsome earlierstudiesofALTdidnotshowthesamecrater-likedamageseeninthepreviouslymentionedstudy,butonlymildcoagulativedamage.[15][5]LessdestructionseenwithSLTlasersystemissecondarytoitsabilitytoselectivelyphotolysepigmentedTMcellswithoutinducingphotocoagulationandcollateraldamagetonon-pigmentedcellsorstructuressinceitspulsedurationisshorter(3nsec)thanthethermalrelaxationtimeofmelanin(1msec). History Adetailedmedicalandocularhistoryisrecommendedpriortoeitherformoftrabeculoplasty. Physicalexamination Thepreoperativeexaminationmustincludegonioscopicevaluationoftheangle.ThisisroutinelydoneattheslitlampwithaZeiss,Posner,orSussmanlens,orwithastandardsingleortriplemirrorGoldmanntypelens.Takenoteofwhetherornotthetrabecularmeshworkisvisiblewithoutindentationsincethisisthestructurethatmustbetreatedbytrabeculoplasty.Iftheirisapproachissomewhatsteep,butthetrabecularmeshworkisrevealedbyrotatingtheeyetowardsthemirror,thenthereisprobably sufficient anglearea fortreatment.Thepresenceorabsenceofsynechiaeshouldbelookedfor,assynechiaemaybeacontraindicationtotheprocedure.Thedegreeoftrabecularmeshworkpigmentationshouldbenoted,asthismayinfluencetheinitialenergylevelchosenfortrabeculoplasty. Diagnosticprocedures Completeglaucomaevaluationshouldbedonepriortorecommendingtrabeculoplasty.Thisevaluationshouldincludegonioscopy,intraocularpressuremeasurement,centralcornealpachymetry,opticnerveexaminationandevaluation,andvisualfieldtesting. Generaltreatment Lasertrabeculoplastycanbeusedasaprimarytreatmentorasanadjunctivetreatmenttomedications.IntheU.S.,ALTisseldomchosenasthefirst-linetreatmentforIOPreduction,whileSLT isincreasinglygaining popularityasafirst-linetreatment. Surgery Approximately30-60minutespriortoeitherALTorSLT,theeyeshouldreceivealphaadrenergicagonist,eitherapraclonidineorbrimonidine,todecreasetheriskofanimmediateIOPspike.Topicalanestheticisusedimmediatelypriortotheproceduretoanesthetizetheeyeforthelasercontactlens. InALT,theargongreenlaseristypicallysetata50-micronspotsize,0.1-secondduration,whilethepowersettingcanvarybetween300-1000mW,dependingonresponse.Thedesiredendpointisblanchingofthetrabecularmeshworkorproductionofatinybubble.Ifalargebubbleappears,theenergyshouldbetitrateddownward.Thelaserbeamisfocusedthroughagoniolensatthejunctionoftheanteriornon-pigmentedandtheposteriorpigmentededgeoftrabecularmeshwork.Veryposteriorapplicationofthelaserbeamtendstoproducemoreinflammation,pigmentdispersion,prolongedelevationofIOPandperipheralanteriorsynechiae(PAS).ManypatientshavesatisfactoryIOPreductionswithtreatmentof180ºofthetrabecularmeshwork(approximately40-50applications).Treating360ºisassociatedwithahigherincidenceofpressurespikes,butadditional180degreesoftreatmentcanbeperformedlateriftreatmentresponseisappreciatedwithinitialtreatment.TheALTprocedurecanalsobeperformedwithadiodelaser.Inthiscase,typicalsettingsare75-micronspotsize,0.1-secondduration,and600-1000mWpower. InSLT,thelaserisafrequency-doubled(532-nm)Q-switchedNd:YAGlaser(Selecta7000,CoherentMedicalGroup,SantaClara,CA).Thelasersettingsarefixedexceptforthepower.Spotsizeis400-micronsandpulsedurationis3ns.Thelargespotsizeresultsinlowfluences(mJ/cm2).Inmorelightlypigmentedangles,initialenergycanbesetat0.8-1.0mJ.Inmoreheavilypigmentedangles,theinitialpowercanstartofflowerat0.3-0.6mJ.TheaimingbeamiscenteredoverthetrabecularmeshworkandstraddlestheentireTM.BecausepreciseplacementofthelaserbeamisnotnecessaryasitisinALT,SLTisconsideredtechnicallyeasiertodo.Theaimingbeamwillnotbeinsharpfocuswhenthesurgeonfocusesonthetrabecularmeshworktodelivertreatment.ThetreatmentendpointistheappearanceofsmallcavitationbubblesadjacenttotheTM.Generally,180or360degrees aretreatedinasession.Laserspotscanbeplacedcontiguouslyorseveralspotsizesapart. Surgicalfollowup Similartootherlaserprocedures,itisroutinetoplaceadropofapraclonidineorbrimonidineintheeyeafterALTorSLTtodecreasetheriskofa IOPspike. Approximately1hourafterbothALTandSLT,anintraocularpressurecheckisrecommended.IftheIOPiselevatedbeyondwhatisreasonablefortheeyeatonehour,theIOPmustbetreatedandthepatientshouldbeseenthenextday.Thetreatmentrequiredmaybemild(i.e.—onehypotensiveeyedrop)oraggressive(i.e.—systemiccarbonicanhydraseinhibitors)dependingontheeye’scircumstances.Thefollow-upintervalwillalsodependontheseverityof IOPspike.Ifthe1-hourpostoperativeIOPcheckisnotelevated,thepatientcanbeseenbackin1-2weeks.Thefollow-upthereafterwilldependonthepatientanddoctor,butacommonlyfollowedroutineis4-6weekslaterandthenevery3-4months. AfterALT,atopicalsteroidisprescribedfourtosixtimesperdayfor4-7days,astheprocedureisinflammatory.InSLT,itismorecommonnottoprescribeanyanti-inflammatorymedicationspostoperatively,asitisfeltthattheseagentsmaybluntthebiologicaleffectsofthelaser.Manysurgeonswillgiveascriptforanon-steroidalanti-inflammatorytobeusedasneededifpatientsuffers ocular discomfort.Ofnote,asmallprospectiveobserver-maskedstudyfoundthata1-weekcourseoftopicalprednisoloneacetate1%didnotaffecttheIOP-loweringeffectofSLTat3months.[16] Patientsareinstructedtoresumetheirusualantihypotensivedropsimmediatelyafterthelaser.AdecisiontodiscontinuedropscanbemadebasedonIOPresponseafter 6-8weeks.  In2018,theSteroidsafterLaserTrabeculoplasty(SALT)trialintendedtoassesstheimpactoftopicalanti-inflammatorydrugsafteraSLTprocedureininflammation,painandIOPreductionin96eyes.Three subgroupofpatientssubmittedtoSLTwerestudied:afirstsubgroupwithonlyartificial tears,asecondsubgroupsubmittedtosteroidtherapy(prednisolone4id5days) andathirdsubgroupsubmittedtoNSAIDtherapy(ketorolac0.5%4id5days).[17] RegardingIOP reductionandinflammatoryoutcomes,therewasnosignificantdifferencebetween subgroupsat1weekpost-SLT.At6weekspost-SLT,therewasatrendfor greaterreductioninNSAID(-6.37mmHg)andsteroid(-5.85mmHg)subgroupsthan insalinetears(-4.26mmHg),albeitstatisticallynon-significant(p=0.14). However,at12weekspost-SLT,therewasastatisticallysignificantgreater reductioninIOPintheNSAID(-6.22vs.-2.96mmHg,p=0.002)andsteroid (-5.21vs.-2.96mmHg,p=0.02)subgroupsthaninthesalinetearssubgroup. WhencomparingNSAIDandsteroidsubgroup,therewasatrendforgreater reductionofIOPintheNSAID,althoughstatisticallynon-significant(p=0.18).[17] Then,theSALTtrialdispelsthetheoryofan“inflammatory” mechanismofactioninSLTwithunderlyingreductionofefficacywhen prescribingtopicalanti-inflammatoriesafterSLTprocedures.Furthermore,the SALTtrialsuggeststheuseofNSAIDsorsteroidspost-SLTproceduresasauxiliary agentsinSLTshort-termefficacy.[17] Complications Atransientrisein IOPafterlasertrabeculoplastyisthecomplicationofgreatestsignificancetoglaucomapatientsundergoingthistreatment.With180°ofALTintheGlaucomaLaserTreatmentTrial,ariseof>5mmHgwasreportedin34%andarise>10mmHgwasseenin12%ofpatients.Ofnote,therewasnoperioperativealpha-adrenergicprophylaxisusedinthistrial.[18]Thefrequencyof IOPspikes isreducedbytwo-thirdswiththeuseofprophylacticalpha-adrenergics.[19]PostoperativeIOPriseismoresevereandfrequentwithhigherenergylevels,360°treatments,posteriorplacement,heavyanglepigmentation,andalowpreoperativeoutflowfacility.[20]Spikesareusuallytransient,occurwithinthefirsthouralthoughtheymaybedelayed,[21]andmostresolvewithmedicaltreatmentbythenextday. InSLTprophylacticallytreatedforapressurespike,thereportedrateofanIOPrise>5mmHgisaround10%orlessandtherate ofanIOP rise>10mmHgisaround3%.[22]TherearerarecasesrequiringtrabeculectomyforsustainedIOPincreasesafterbothSLTandALT,[23]andthispossibilityshouldbeincludedintheinformedconsentprocessforeitherprocedure. Othercomplicationsseenwitheitherformoftrabeculoplasty,butwhicharepopularlybelievedtooccurmoreoftenwithALTalthoughtheliteraturedoesnotshowthistobetrue,[24]arelow-gradeiritisandtheformationofPAS.CornealedemaattributabletoHSVreactivationhasbeenreportedfollowingSLT.Thethoughtisthattheinflammatorycascadefollowinglasercontributestovirusreactivation.[25]Hyphemashavealsobeenreported.[26][27] Thereisonlyonerandomized,clinicaltrialcomparingSLT(n=89eyes)andALT(n=87eyes)withoneyearoffollow-up.Seetableforcomparativeresults.[24] Complication ALT SLT IOPSpike 3.4% 4.5% PASFormation 1.2% 1.1% ALTtreatmentwithin1year 5.7% 3.4% SLTtreatmentwithin1year 4.6% 6.7% Trabeculectomywithin1year 8.0% 9.0% EfficacyofALTandSLT SelectedStudiesALT Author NumberofEyes/Dx FollowUp(Years) IOPReduction(%) Amonetal.1990 Ophthalmologica 61POAG 4.4 32 Lottietal.1995 OphthalmicSurg 237POAG 11 19 Sharmaetal.1997 IndianJOphthal. 36POAG 2 29 Odbergetal.1999 ActaOph.Scand. 168POAGandPXF 8 32 Agarwaletal.2002 40POAG 5 30 BJO 39POAG(onglaucomamedications) 5 13 SelectedStudiesSLT Author NumberofEyes FollowUp MeanIOPReduction %IOPReduction (mmHg) Gracner2001 50OAG 6months 5.1 22.5 Ophthalmologica Melamedetal.2003 45OAG 6-18months 7.7 30  ArchOph. Laietal.2004 58OAG/OHT 5years 8.7 32 ClinExpOph.   Cvenkel2004 44OAG 1year 7.1 27.6 Ophthalmologica McIlraithetal.2006 74OAG/OHT 1year 8.3 31 JGlaucoma Weinandetal.2006 52OAG 1year 6 24.3  EurJGlauc. 4years 6.3 29.3 SelectedStudiesComparingALTandSLT Author NumberofEyes MeanFollowUp MeanIOPReduction PValue (mmHg) SLT     ALT Damjietal.1999 36 6Months 4.8      4.7 0.97  BJO Damjietal.2006 176 12Months 5.9     6.04 0.84 BJO Popielaetal.2000  27 3Months 2.85    2.63 0.84  KlinOczna Juzychetal.2004 154  ALT 5Years  %IOPReduction ___ Ophthalmology 41    SLT 32%    31% Prognosis Theeffectofeitherformoflasertrabeculoplastydiminishesovertime.InaretrospectiveanalysisoflongertermoutcomesofSLT(n=41)comparedtoALT(n=154),successwasdefinedasanIOPdecreaseofatleast3mmHgwithoutadditionalmedicationorsurgery.SuccessrateintheSLTgroupat1,3,and5yearfollow-uptimepointswas68%,46%,and32%,respectively,whileintheALTgroupitwas54%,30%,and31%.Therewasnostatisticallysignificantdifferenceatanytimepoint.[28] Aprospectivestudythatrandomizedpatientsto180°ofSLTversusALT,foundnostatisticallysignificantdifferenceinIOP reductionbetweenthetwoprocedures.At6months,IOPdecreasedby4.8±3.4mmHgintheSLTgroup,and 4.7±3.3mmHgintheALTgroup.[29]Anextensionofthepreviouslymentionedstudyto12monthsshowednodifferencebetweenIOPresults,andthisextensionallowedadditionalmedications,laserandsurgery,aswouldoccurinclinicalpractice.[24] ALThasbeenstudiedinaNEI-sponsoredrandomizedmulti-centertrial,calledtheGlaucomaLaserTrial(GLT),whichwaspublishedinthe1990s.Thestudycompared360°ALTtomedicaltherapywithtimolol0.5%innewlydiagnosedpatientswithprimaryopenangleglaucoma.TheGLTfoundthatALTloweredIOPby9mmHgcomparedto7mmHgwithtimololalone.Attwoyears,nofurtherinterventionwasrequiredin44%ofALTeyesandin30%ofmedicationeyes.Aftersevenyearsoffollow-up,theALTeyeshadlowerIOPsandlesssubjectivefieldlossthanmedicationeyes.[30][31][32] AstudyofprospectivelyenrolledSLTtreatedeyes(n=29)hasbeenreportedinastudyfromHongKongthathadasimilardesigntotheGLTinthatoneeyewasrandomizedto360°SLTwhiletheothereyewasgiventopicalmedication.Thepatientswererecently diagnosedwithPOAGorOHTN withnoprevioustreatmentandwerefollowedfor5yearsaftertreatmentintervention.After5years,27.6%oftheSLTeyesrequiredadditionaltreatment.NodifferenceinIOPreductionwasfoundbetweentreatments.MeanIOPreductionwas32.1%inSLTeyesand33.2%inmedicallytreatedeyes.[33]BoththisstudyandtheGLTcanbecriticizedforoverestimatingtheeffectoftrabeculoplastyasaresultofcross-overeffectofthemedicationsinthecontralateraleye.Inanotherstudycomparing180°degreesof SLTtreatmenttolatanoprostasinitialtreatmentfornewlydiagnosedOAGandOHTN,inwhichthetreatmentwaschosenbythepatient,IOPpercentdecrease(~30%)wassimilarbetweengroupswithaveragestartingpressuresinthemid-20s. [34] TheLiGHTtrialcomparedSLTtoeyedropsasfirst-linetreatmentforocularhypertensionandglaucomaandenrolled718patients.At36months,eyesrandomizedtoSLTwerewithintargetIOPatahigherpercentageofvisitscomparedtotheeyedropsgroup(93%vs.91.3%,respectively)andwerelesslikelytorequireglaucomasurgery.SLTwasfoundtobemorecost-effectivethananeye-dropfirstapproach.[35]Follow-upanalysesfromtheLiGHTtrialfoundthatpatientstreatedwithmedicationsfirstweremorelikelytoexperiencerapidvisualfielddeterioration.[36] After360°ofangleistreatedbyALT,itisrecommendedthatnofurtherALTisperformed.RepeatALT1-yearsuccessratesvaryfrom21%to73%.[37][38][39][40]WithSLTithasbeensuggestedthatsincethereisminimaltissuealterationthattheprocedurecanberepeatedwithgoodefficacy.Inastudyof360°SLTafterprior360°SLTthatwassuccessfulforatleast6months(n=44eyes),IOPreductionwasseenwiththesecondSLTtreatmentalthoughthemagnitudeofIOPdecreasewassmaller,averagedecrease5mmHgafterfirstSLTand2.9mmHgaftersecondSLT.[41] SLTperformedineyeswithpreviousALTiscomparativelyeffective.[24][42][43][44]Inonestudy,IOPwasreducedby5mmHgormorein40%ofeyeswithoutpriorALTandin57%ofeyeswithpriorALT.[45] Theeffectoftrabeculoplastyondiurnalcurvehasbeenstudied.BothALTandSLThavebeenshowntodecreasediurnalIOPfluctuation.[46][47][48] Indifferentsubgroupsofpatients,bothALTandSLThavebeenfoundefficaciouswhencomparedtotreatmentforPOAG.Inpseudoexfoliation[49][50][51]SLThasnotbeenfoundtobelessefficaciousinpseudophakiceyescomparedtophakicones.[52]WhereasitisgenerallythoughtthatALTisbetterperformedwhileaneyeisphakic.[53] Onestudycomparedthecost-effectivenessofgenerictopicalprostaglandinanalogues(PGAs)versuslasertrabeculoplastyinpatientswithnewlydiagnosedmildPOAGandfoundthatPGAsprovidemarginallybettervaluecomparedtolasertrabeculoplastywhenutilizinga25yeartimehorizon.However,whenassumingmorerealisticlevelsofmedicationadherence(25%lesseffective),lasertrabeculoplastybecameamorecosteffectivealternative.[54] References ↑GoyalS,Beltran-AgulloL,RashidS,etal.Effectofprimaryselectivelasertrabeculoplastyontonographicoutflowfacility:arandomizedclinicaltrial.BrJOphthalmolMay2010. ↑ThomasJV,SimmonsRJ,BelcherCD.Argonlasertrabeculoplastyinthepresurgicalglaucomapatient.Ophthalmol1982;89:187-97. ↑BrubakerRF,LiesegangTJ.Effectoftrabecularphotocoagulationontheaqueoushumordynamicsofthehumaneye.AmJOphthalmol1983;96:139-47. ↑vanderZypenE,BebieH,FrankhauserF.Morphologicstudiesabouttheefficiencyoflaserbeamsuponthestructureoftheangleoftheanteriorchamber.Factsandconceptsrelatedtothetreatmentofthechronicsimpleglaucoma.IntOphthalmol1979;1:109-22. ↑5.05.1vanBuskirkEM,PondV,RosenquistRC.Argonlasertrabeculoplasty.Studiesofmechanismofaction.Ophthalmol1984;91:1005-1010. ↑AcottTS,SamplesJR,BradleyJM,etal.Trabecularrepopulationbyanteriortrabecularmeshworkcellsafterlasertrabeculoplasty.AmJOphthalmol1989;107:1-6. ↑BylsmaSS,SamplesJR,AcottTS,VanBuskirkEM.Trabecularcelldivisionafterargonlasertrabeculoplasty.ArchOphthalmol1988;106:544-547. ↑BylsmaSS,SamplesJR,AcottTSetal.DNAreplicationinthecattrabecularmeshworkafterargonlasertrabeculoplastyinvivo.JGlaucoma1994;3:36-43. ↑ParshleyDE,BradleyJM,SamplesJR,etal.Earlychangesinmatrixmetalloproteinasesandinhibitorsafterinvitrolasertreatmenttothetrabecularmeshwork.CurrEyeRes1995;14:537-544. ↑ParshleyDE,BradleyJM,FiskA,etal.Lasertrabeculoplastyinducesstomyelsinexpressionbytrabecularjuxtacanalicularcells.InvestOphthalmolVisSci1996;37:795-804. ↑MelamedS,PeiJ,EpsteinDL.Shorttermeffectofargonlasertrabeculoplastyinmonkeys.ArchOphthalmol1985;103:1546-1552. ↑BradleyJM,AnderssonAM,ColvisCM,etal.Mediationoflasertrabeculoplasty-inducedmatrixmetalloproteinaseexpressionbyIl-1betaandTNF-alpha.InvestOphthalmolVisSci2000;41:422-430. ↑AlvaradoJA,AlvaradoRG,YehRFetal.Anewinsightintothecellularregulationofaqueousoutflow:howtrabecularmeshworkendothelialcellsdriveamechanismthatregulatesthepermeabilityofSchlemm’scanalendothelialcells.BrJOphthalmol2005;89:1500-1505. ↑KramerTR,NoeckerRJ.Comparisonofthemorphologicchangesafterselectivelasertrabeculoplastyandargonlasertrabeculoplastyinhumaneyebankeyes.Ophthalmol2001;108:773-79. ↑vanBuskirkEM.Pathophysiologyoflasertrabeculoplasty.SurvOphthlamol1989;33:264-272. ↑RealiniT,CharltonJ,HettlingerM.Theimpactofanti-inflammatorytherapyonintraocularpressurereductionfollowingselectivelasertrabeculoplasty.OphthalmicSurgLasersImaging2010;41:100-3. ↑17.017.117.2GrothSL,AlbeirutiE,NunezM,FajardoR,SharpstenL,LoewenN,SchumanJS,GoldbergJL.SALTTrial:SteroidsafterLaserTrabeculoplasty:ImpactofShort-TermAnti-inflammatoryTreatmentonSelectiveLaserTrabeculoplastyEfficacy.Ophthalmology.2019Jun6.pii:S0161-6420(18)32934-8.doi:10.1016/j.ophtha.2019.05.032. ↑GlaucomaLaserTrialResearchGroup.TheGlaucomaLaserTrial1.Acuteeffectsofargonlasertrabeculoplastyonintraocularpressure.ArchOphthalmol1989;107:1135-42. ↑RobinAL,PollackIP,HouseB,EnberC.EffectsofALO2145onintraocularpressurefollowingargonlasertrabeculoplasty.Arch1987;105:646-50. ↑KeightleySJ,KhawPT,ElkingtonAR.ThepredictionofIOPrisefollowingargonlasertrabeculoplasty.Eye1987;1:577-80. ↑WeinrebRN,RudermanJ,JusterR,ZweigK.ImmediateIOPresponsetoargonlasertrabeculoplasty.AmJOphthalmol1983;95:279-86. ↑BarkanaY,BelkinM.SelectiveLaserTrabeculoplasty.SurvOphthalmol2007;52:634-654. ↑HarasymowyczPJ,PapamatheakisDG,LatinaM,etal.SelectiveLaserTrabeculoplastycomplicatedbyIOPelevationineyeswithheavilypigmentedtrabecularmeshworks.AmJOphthalmol2005;139:1110-3. ↑24.024.124.224.3DamjiKF,BovellAM,HodgeWG,RockW,ShahK,BuhrmannR,PanYI.Selectivelasertrabeculoplastyversusargonlasertrabeculoplasty:resultsfroma1-yearrandomizedclinicaltrial.BrJOphthalmol2006;90:1490-1494 ↑MoubayedSP,HamidM,ChoremisJ,LiG.Anunusualfindingofcornealedemacomplicatingselectivelasertrabeculoplasty.CanJOphthalmol2009;44:337-38. ↑RheeDJ,KradO,PasqualeLR.Hyphemafollowingselectivelasertrabeculoplasty.OphSurgLasersImaging2009;40:493-4. ↑ShihadehWA,RitchR,LiebmannJM.Hyphemaoccurringduringselectivelasertrabeculoplasty.OphthalmicSurgLasersImaging2006;37(5):432-3. ↑JuzychMS,ChopraV,BanittMR,etal.Comparisonoflong-termoutcomesofselectivelasertrabeculoplastyversusargonlasertrabeculoplastyinopenangleglaucoma.Ophthalmol2004;111:1853-1859. ↑DamjiKF,ShahKC,RockWJ,etal.Selectivelasertrabeculoplastyversusargonlasertrabeculoplasty:aprospectiverandomizedclinicaltrial.BrJOphthalmol1999;83:718-22. ↑TheGlaucomaLaserTrial(GLT)2Resultsofargonlasertrabeculoplastyversustopicalmedicines.TheGlaucomaLaserTrialGroup.Ophthalmol1990;97:1403-13. ↑TheGlaucomaLaserTrial(GLT)andglaucomalasertrialfollow-upstudy:7Results.GlaucomaLaserTrialGroup.AmJOphthalmol1995;120:718-31. ↑TheGlaucomaLaserTrial(GLT)3Designandmethods.GlaucomaLaserTrialGroup.ControlClinTrials1991;12:504-24. ↑LaiJS,ChuaJK,ThamCC,LamDS.Five-yearfollowupofselectivelasertrabeculoplastyinChineseeyes.ClinExperimentOphthalmol2004;91:361-5. ↑McIlraithI,StrasfeldM,ColevG,HutnikCM.Selectivelasertrabeculoplastyasinitialandadjunctivetreatmentforopen-angleglaucoma.JGlaucoma2006;15:124-30. ↑GazzardG,KonstantakopoulouE,Garway-HeathD,etal.SelectiveLaserTrabeculoplastyversusEyeDropsforFirst-LineTreatmentofOcularHypertensionandGlaucoma(LiGHT):aMulticentreRandomisedControlledTrial.Lancet2019;393:1505-16. ↑WrightDM,KonstantakopoulouE,MontesanoG,etal.VisualFieldOutcomesfromtheMulticenter,RandomizedControlledLaserinGlaucomaandOcularHypertensionTrial(LiGHT).Ophthalmology2020;127:1313-1321. ↑FeldmanRM,KatzLJ,SpaethGL,etal.Long-termefficacyofrepeatargonlasertrabeculoplasty.Ophthalmol1991;98:1061-5. ↑RichterCU,ShingletonBJ,BellowsAR,etal.Retreatmentwithargonlasertrabeculoplasty.Ophthalmol1987;94:1085-9. 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