Selective laser trabeculoplasty (SLT) is a very effective way to control eye pressures in patients who cannot tolerate pressure-lowering eye drops or in whom such drops do not lower the eye pressure adequately. SLT makes microscopic holes in the trabecular meshwork (ie the drain in the eye) which allows the fluid in the eye to drain more easily and thus decrease the eye pressure. SLT is known for causing less tissue scar than Argon Laser Trabeculoplasty (ALT), and it can be repeated multiple times.

Complications are very rare and include: not lowering the eye pressure enough; rarely will the eye pressure go up after the procedure but that can happen.

We always give a non-steroidal or steroid after the procedure to keep the inflammation down to prevent the holes we make in the trabecular meshwork from clogging. Steroids have the potential to increase eye pressure, usually if used for more than 10-14 days.

This is a good paper to show both nonsteroidal drops & steroids drops help keep the eye pressure low after SLT.

NSAID drops for 4 days are a great alternative it appears to help with the mild inflammation that can happen after SLT.

SLC

Steroids After Laser Trabeculoplasty (SALT) Trial: Impact of Short-term Anti-Inflammatory Treatment on SLT Efficacy

Sylvia L. Groth1

Eiyass Albeiruti2,ˆ

Mariana Nunez1,3,4

Roman Fajardo4

Lucie Sharpsten4

Nils Loewen2

Joel S. Schuman2,&

Jeffrey L. Goldberg1,3,4,∗

Correspondence information about the author Jeffrey L. Goldberg

DOI: https://doi.org/10.1016/j.ophtha.2019.05.032

Article Info

Abstract

Abstract

Objective

In this study we examined whether short-term use of topical NSAID or steroid therapy affected the efficacy of selective laser trabeculoplasty (SLT).

Design

Double-masked, randomized, placebo-controlled, dual-center, multi-surgeon trial

Subjects

and controls: Patients over 18 years with IOP >18 mm Hg for whom the clinician decided SLT would be appropriately indicated therapy were randomized to one of three groups in a ratio of 1:1:1 as follows: ketorolac 0.5%, prednisolone 1%, or saline tears.

Methods

After SLT was performed, patients randomized into each group were instructed to use an unmarked drop 4 times per day starting the day of the SLT and continuing for 4 additional days. Kruskal Wallis test and Wilcoxon Rank Sum test were used for continuous variables when comparing two or three treatment groups, respectively. Fisher’s Exact test was used for categorical variables.

Main outcome measures

The primary outcome of this study was intraocular pressure (IOP) at 12 weeks. Secondary outcome measures included IOP at 1 and 6 weeks, patient-reported pain, and detectable anterior chamber inflammation.

Results

96 eyes of 85 patients fit inclusion criteria and were enrolled between the two sites. The NSAID, steroid, and placebo groups were similar in baseline demographics and baseline IOP (mean 23.3± 3.9 mm Hg, p=0.57). There was no statistically significant difference in IOP decrease among groups at week 6. Both the NSAID and steroid groups had a statistically significantly greater decrease in IOP at week 12 compared to placebo (-6.2±3.1, -5.2±2.7 and -3±4.3 mmHg, respectively; ANOVA p-value 0.02; t-test p=0.002 for NSAID vs. placebo; p=0.02 for steroid vs. placebo).

Conclusions

Significantly better IOP reduction at 12 weeks was measured in eyes treated with steroid or NSAID drops following SLT. Short-term postoperative use of NSAID or steroid drops may improve IOP reduction after SLT. Longer-term follow-up studies are indicated.