Selective Laser Trabeculoplasty (SLT) is a laser procedure that relieves increased eye pressure by changing the fluid outflow through the trabecular meshwork.
When the fluid that normally flows out of the eye cannot drain through the trabecular meshwork, pressure inside the eye may rise. This rise in pressure could damage the optic nerve and lead to vision loss (glaucoma). The reason for the blockage in the meshwork is unclear, but may be likened to leaves blocking a downpipe or gully trap.
The laser works by releasing local body chemicals that alter the ‘leakiness’ of the meshwork, allowing more fluid out of the eye and thereby decreasing the pressure. The particular benefit of SLT is that it may be repeated many times as there is no appreciable tissue damage.
Laser trabeculoplasty does not work in all patients, but likely benefit can often be predicted beforehand and appropriate patients selected. Patients with heavy pigmentation in the meshwork do best. The duration of effect of the laser is variable, with an average benefit of around 5 years. It may be necessary to supplement the laser with ongoing glaucoma medication, and it is generally unusual for pre-existing treatment to be able to be ceased, except in an exceptionally good response.
A laser trabeculoplasty is usually performed as an outpatient procedure. You will be given eyedrops to prepare the eye (one of which may cause a mild forehead ache). A contact lens is placed on your eye (after local anaesthetic drops) to precisely focus the laser. A laser trabeculoplasty takes only a few minutes. You may see a bright red light that is an aiming beam; the laser beam itself is invisible. You may feel a mild tingling sensation with each laser burn – there are 50-60 fine burns in a treatment, which is given over a half or sometimes a full circumference of the inside of the eye.
You will be asked to return after 30 minutes so that your pressure can be re-checked. Assuming it is normal, you will then be allowed home. There are usually no activity restrictions following the laser treatment, although you should have someone drive you home after the procedure. You will need to continue your usual glaucoma medication. The pressure is checked within a fortnight or so after the procedure, and then again at 5-6 weeks. It is not until this last visit that the success of the treatment is judged.
Loss of vision after laser trabeculoplasty is rare. The main risks of the laser procedure are:
Selective laser trabeculoplasty is a safe and effective procedure with few risks. While glaucoma treatments cannot restore vision already lost from glaucoma, early detection and treatment of glaucoma offers the best chance of preserving your vision.
- The pressure may rise after the treatment, sometimes requiring additional treatment.
- Significant inflammation is rare, but can occur.
- A second procedure or another type of surgery may be required.
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