Transscleral Selective Laser Trabeculoplasty Without a Gonioscopy Lens

Purpose of the Study:The purpose of the study was to investigate results of selective laser trabeculoplasty (SLT) performed directly on the sclera without a gonioscopy lens.Design:Interventional case series, prospective, randomized, masked, controlled clinical trial.Methods:Setting: Meir Medical Center, Kfar-Saba, Israel. Study population: Adults with uncontrolled primary open angle or pseudoexfoliation glaucoma randomized into 2 groups. Intervention: The controls underwent conventional SLT with 100 spots delivered using a gonioscopy lens for 360 degrees of the trabecular meshwork. The study group underwent irradiation using the same parameters with the laser applications administered on the perilimbal sclera. Study visits: 1 hour, 1, 7, 30, 60, 180, and 365 days postprocedure. Main Outcome Measures: Intraocular pressure (IOP) and side effects.Results:Thirty adults were randomized into 2 groups. The mean (SD) pretreatment IOP was 20.21 +/- 3.19 mm Hg for the study group (n=14) and 21.14 +/- 2.98 mm Hg for the controls (n=14; P =0.43), dropping to 15.50 +/- 3.77 and 15.00 +/- 4.08 mm Hg (P =0.74) after 6 months and to 16.00 +/- 3.31 and 14.00 +/- 2.45 mm Hg (P =0.22) after 12 months. The average IOP reduction after 6 and 12 months was 23.4% and 20.83% for the study group and 27.1% and 33.77% for the controls (P=0.528). Success (a decrease of 15% at 6 months with no additional medications, laser, or glaucoma surgery) was achieved in 12 (85.7%) study patients and 9 (69.2%) controls (P=0.385). Complications were mild and transient (n=30), although significantly higher in the controls (n=15; P <0.0001).Conclusions:SLT applied directly to the perilimbal sclera may be as efficacious as the conventional procedure for 1 year.