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Patient Selection

Almost all patients with abnormally elevated IOP, whichmay benet from IOP reduction, are suitable candidates forSLT treatment.

Patients with any type of adult glaucoma, and those whoconform to the following criteria, are suitable candidates:

Require lowering of IOP as either primary orsecondary therapy

Unlikely to comply and/or persist with drug therapy

Have difculty administering eye drops

Suffer from drug therapy induced side effects

Complain of reduced quality of life due to the needto administer eye drops daily

Failed drug therapy

Failed ALT treatment, or if ALT ceased to reduce the

IOP sufciently Failed SLT treatment, or if SLT ceased to reduce the

IOP sufciently

Pigmentary or pseudoexfoliation glaucoma(Proceed with caution as there is a risk of post-SLTIOP spike)

Normal tension glaucoma

Ocular hypertension

SLT has not been shown to be suitable for the followingconditions:

Pediatric glaucoma

Juvenile glaucoma

Primary or secondary narrow-angle glaucoma

Inammatory or Uveitic glaucoma

Any disease process or malformation that blocksthe angle

Unclear view of the trabecular meshwork (TM)

Pre-treatment

Pre-operative medications typically include an alphaagonist, such as brimonidine tartrate, and topicalanaesthesia, such as proxymetacaine hydrochloride.

Treatment

The treatment regimen is evolving and protocols varyfrom treatment of 360, 180 or 90 of the TM. It has beenhighlighted that the more aggressive the treatment thehigher the risk of inducing temporary pressure spike, whichdiminishes within 48 hours.

A Latina SLT gonio laser lens, with no magnication to avoidchanges to the spot size, is used to perform treatment.

The treatment spot size is xed at 400m, which is largeenough to irradiate the whole width of the meshwork withsome overspill. This provides a comfortable margin fortreatment as the overspill is of no clinical signicance.

It is important to obtain a clear view of the TM focus mustbe on the target tissue and not on the aiming beam spot.

180 treatment involves treatment of a 180 area pertreatment period. Treatment is undertaken in single shotmode, placing approximately 50 contiguous but notoverlapping energy spots along the meshwork.

SLT Treatment Guidelines

The following treatment guidelines are based on the results of clinical studies and are provided for information

purposes only. It is the operating ophthalmologists responsibility to familiarize themselves with the latestrecommended techniques .

SLT PHOTOREGENERATION

Treatment Steps:

To determine the optimal level of energy for eachpatient, the laser is initially set at 0.8 mJ and theenergy level increased in 0.1 mJ steps until the

threshold energy level for mini-bubble formation(micro cavitations) is observed, or decreased in0.1 mJ steps if bubble formation was noted with0.8 mJ.

After the threshold level is found (when mini-bubble formation occurs) the energy levelis decreased in 0.1 mJs steps as treatmentcontinues until bubble formation ceases. Thisenergy is then used for treatment.

The process should be monitored and adjustedas neccessary as pigment variation alters energyuptake at a lower threshold.

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Need more information?

For further information regarding SLT, please visit slt-ellex.com - the primary online resource for Ellex SLTusers. Alternatively, please contact Ellex at slt@ellex.com. .

Treatment Steps continued

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continued Generally, the TM is more heavilypigmented inferiorly than superiorly. With this inmind, two options are possible:

A Nasal half for rst 180 treatment; repeat/ enhancement treatment will target temporal half.

Post-treatment

Non steroidal anti-inammatory drops such as Ketorolac or Acular drops four times daily for three to ve days.

Note: An increasing number of physicians are electing notto prescribe post-op medications.

Observable Side Effects

There are minimal observable side effects resulting fromSLT treatment; these include mild discomfort duringthe procedure and tender eyes, perhaps with mildphotophobia, for 2-3 days.

The absence of adverse side effects is one of the majorbenets of SLT treatment.

In a small percentage of cases (