EyeWorld Asia-Pacific June 2011 Issue

41 June 2011 EW GLAUCOMA Now available www.EyeWorld.org/ascrsamolivesurgery2011 High Definition Live Surgery from the 2011 ASCRS•ASOA Symposium and Congress Innovating Refractive Cataract Surgery with the Micro-Implantation Cataract Suite Program Moderator: Richard L. Lindstrom, MD Operating Surgeon: Kerry K. Assil, MD Faculty: David F. Chang, MD Randall J. Olson, MD Mark Packer, MD Roger R. Steinert, MD 2011.05.19-CT3456 treatment have not been completely characterized. Currently, most clinicians titrate the energy setting until they see a tiny burst of so-called champagne bubbles emerge from the angle after each laser application. Albert Khouri, MD, New Jersey Medical School, Newark, NJ, USA, examined the effect of high versus low energy settings on the magnitude of IOP reduction seen after SLT. “We compared the IOP outcomes in two groups of patients,” Dr. Khouri said. “One group underwent SLT at the traditional energy settings, in which energy was titrated to the appearance of champagne bubbles. The mean energy level per treatment spot was 0.8 mJ. The other group underwent SLT at uniformly higher energy levels, generally around 1.5 mJ per spot.” This was a retrospective chart review, Dr. Khouri said. He explained that the data came from the patients of two clinicians, one who consistently used traditional settings on all patients and one who consistently used high energy settings on all patients. “At one month, four months, and eight months following SLT, the mean IOP reduction was consistently and statistically significantly lower in the eyes undergoing high-energy SLT compared to conventional SLT,” he said. Mean IOP reductions at one, four, and eight months were 3.6 mmHg, 3.2 mmHg, and 3.0 mmHg, respectively, in the conventional group, versus 4.9 mmHg, 4.6 mmHg, and 5.8 mmHg, respectively, in the high-energy group. At each follow-up time point, the p-value for the difference was below 0.05, he said. New questions While the results of this study are encouraging, Dr. Khouri cautioned against widespread adoption of high energy SLT at this time. “These data raise some interesting questions,” Dr. Khouri said. “Higher energy may provide greater IOP reduction, but is it as safe as SLT at conventional energy settings?” He also mentioned that at least one published report has demonstrated that SLT can be safely and effectively repeated once its effect wears off. “We also have to ask whether high energy SLT is as repeatable as SLT performed at conventional energy levels.” EW Contact information Khouri: albertkhouri@hotmail.com Rhee: dougrhee@aol.com