Laser trabeculoplasty

Laser trabeculoplasty may be used as an adjunct to or replacement for medical therapy (oftentimes with reduction in the need for adjunctive therapy) or as the primary therapy in patients with difficulty complying with medical treatment because of side effects, allergies, difficulty instilling drops, forgetfulness, etc. Head-to-head comparison studies of argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) demonstrate fairly similar efficacy of the two laser procedures; however, SLT offers the advantage of selectively targeting trabecular pigmented cells and sparing adjacent nonpigmented cells from thermal damage (e.g., no visible scarring). SLT is also much easier to perform because the spot size is larger than ALT. Micropulse laser trabeculoplasty (MLT) is thought to be even lower impact than SLT because it delivers short microbursts of energy followed by a rest period. Recent data suggests that MLT lowers intraocular pressure (IOP) as well as or may be slightly less than SLT. MLT typically does not result in postoperative pressure spikes, and as a result postoperative drops are often unnecessary. MLT is performed with the IQ 532-nm (Iridex), which is this author's preference but can also be performed with the IQ 577-nm (Iridex) and even less commonly with the IQ 810-nm (Iridex) using a slit-lamp adaptor piece.