Objective:

To evaluate the role of selective laser trabeculoplasty (SLT) in managing intraocular pressure (IOP) after minimally invasive glaucoma surgery (MIGS).

Approach:

• Overview of MIGS: MIGS procedures target the trabecular meshwork (TM) and Schlemm’s canal to lower IOP, but are not curative, leading to potential IOP rise post-surgery.
• SLT Mechanism: SLT lowers IOP by stimulating remodeling of the TM extracellular matrix, enhancing aqueous outflow without causing trabecular scarring.
• Clinical Evidence: Retrospective studies indicate SLT can effectively reduce IOP after MIGS, particularly in cases with preserved TM.

Key Findings:

• SLT has been shown to be noninferior to first-line topical therapy for untreated open-angle glaucoma, as demonstrated in the LiGHT trial.
• At 6 years follow-up, SLT was superior to topical therapy, with a lower rate of disease progression and reduced need for surgical intervention, according to the LiGHT trial.
• The effectiveness of SLT post-MIGS depends on the preservation of TM tissue, which varies by MIGS procedure type, as noted in the studies by Sieminski et al and Dorairaj et al.

Limitations:

• Prospective data on SLT after MIGS are limited.
• Clinical evidence supporting SLT after 360° trabeculotomy is sparse.

Sources:

• LiGHT Trial
• Sieminski et al Study
• Dorairaj et al Study