Efficacy and Safety of Selective Trabeculoplasty in the Treatment of Exfoliative Glaucoma

Research Article

Austin J Clin Ophthalmol. 2020; 7(1): 1106.

Efficacy and Safety of Selective Trabeculoplasty in the Treatment of Exfoliative Glaucoma

Bouzouba T*, Tamym B, Chabbar I, Karmoun S, Elmarzouqi B and Berraho A

Ophtalmologie B, Hôpital des Spécialités de Rabat, Morocco

*Corresponding author: Tarik Bouzouba, Ophtalmologie B, Hôpital des Spécialités de Rabat, Morocco

Received: January 24, 2020; Accepted: March 06, 2020; Published: March 13, 2020


Exfoliative glaucoma is the leading cause of identifiable glaucoma in the world. Due to its favorable safety profile and its repeatability potential, SLT offers a therapeutic option for the eyes with XFG, POAG or with ocular hypertension. The main goal of this work was to demonstrate the efficacy of TLS to reduce intraocular pressure, confirm its immediate and long-term safety and to prove its usefulness as a 1st and 2nd line treatment for exfoliative glaucoma.

Keywords: Exfoliative glaucoma; Selective Laser Trabeculoplasty SLT


Exfoliative glaucoma is the leading cause of identifiable glaucoma in the world [1]. Laser treatment is mainly indicated when medical treatment proves to be insufficient or sometimes as a first line, especially when there is a doubt about therapeutic compliance. Selective laser trabeculoplasty has been shown to decrease pressure in exfoliative glaucoma [2,3]. The aim of our study is to report the efficacy and safety of selective laser trabeculoplasty in the treatment of exfoliative glaucoma.


This is a prospective, non-comparative, non-randomized study conducted in the ophthalmology department B at hospital des spécialités de Rabat, based on the study of the efficacy and tolerance of selective trabeculoplasty in 10 patients. 16 eyes were examined, of which 8 are newly diagnosed (group A) and 8 were followed for poorly balanced exfoliative glaucoma under well-managed hypotonic treatment (group B). The exclusion criteria were a history of SLT, ALT or filtering surgery before laser treatment, the existence of any other ocular pathology, in particular inflammatory, and a history of ocular trauma. All patients underwent an ophthalmological examination with measurement of the best corrected visual acuity, slit lamp examination (LAF), measurement of eye tone, and fundus examination. All patient had a visual field and papillary OCT. Treatment with SLT was carried out 15 minutes after instillation of a drop of 0.5% apraclonidine in the eye. The procedure was performed under topical anesthesia using the Latina SLT lens (Ocular Instruments, Bellevue, WA, USA) to visualize the angle. The laser used was an Nd: Yag Coherent Selecta 7000 (Coherent Inc, Palo Alto, CA). The laser beam was focused on the pigmented trabeculum. The initial energy setting was 0.7mJ, which was increased or decreased by 0.1mJ to the maximum power giving no thermal effect “in champagne bubbles”. The lower 180° were treated with 50 non-confluent impacts, all patients received topical treatment with non-steroidal anti-inflammatory drugs 3 times a day for a week. The patients were examined at 1 hour, 1 day, 1 week, 1 month, 3, 6, 9 and 12 months after the laser treatment. At each visit, an ophthalmological examination was performed, which included measurement of visual acuity, slit lamp biomicroscopy, Goldmann aplanation tonometry and the fundus. All IOP measurements were taken between 8:00a.m. and 11:00a.m. Success of SLT was defined by a drop in IOP greater than 20% compared to the base IOP and / or reduction in the number of drugs used by at least 1. Patients had to have a follow-up of 12 months in relation to achieving SLT to be included in the study.


The average age of the patients at the start of treatment was 62.2 years (between 48 and 75 years of age) for a total of 10 patients, we had 4 men and 6 women. 6 patients had bilateral glaucoma. 16 treated eyes of which 8 were on hypotonizing treatment and 8 are newly diagnosed. A central corneal thickness analysis was performed using the IOL master. The average pachymetry is 535.5 microns with extremes ranging from 507 to 584 μm. The cup / disc ratio was evaluated by the papillary OCT with an average of 0.65 (Figure 1). For group B, 1 eye was on quaditherapy (3 molecules topically and diamox per os), 2 eyes were on triple therapy and 5 on dual therapy. The average drug used was 2.5. The energy used per impact varied from 0.4 to 0.9 mj with an average of 0.65mj. The mean initial intraocular pressure of the 16 eyes was 25.66mmhg (Figure 2). It decreased to 17.93mmhg, a percentage of 30.12%. The initial IOP was 27.20mmhg in group A, and 24.12mmhg in group B. All patients received topical non steroid anti inflammatory therapy at the rate of 3 drops per day for one week after SLT. One patient complained of minimal eye pain in the 2nd day after SLT, however we did not observe any inflammatory reaction or hypertensive peak or significant pain in the hours and days following the laser. At 12 months, the success rate reached 75% in group A and 87.5% in group B. In group A, at the end of the study, the number of hypotonizing agents used was reduced in 4 eyes and the average medication went from 2.5 before SLT to 1.87 (Figure 3-5).