Previous Tips:
Dr. Mark Tomalla
Dr. Prateep Vyas
Prof. Jens Funk and
Dr. Frau Cornelia Hirn
Dr. Prashant N. Vasa
Dr. Prin RojanaPongpun
Dr. David Gosiengfiao
Dr. Enping Chen
Dr. Ivan Goldberg
Ms. Madhu Nagar

Clinical Tips by:
Philippe Denis, MD, PhD, University Hospital of Lyon, France
  1. A narrow angle does not necessarily mean that SLT treatment is not indicated. SLT can be performed as long as the trabeculum can be observed during gonioscopy. When the angle is narrow but open, I usually prescribe pilocarpine to open the angle, thereby allowing me to perform SLT treatment more easily.
  2. The choice of the gonioscopy lens is crucial, as the optical magnification helps me to determine the spot size and the energy I need to deliver to the trabecular meshwork.
  3. To perform SLT, I always ensure that my patient is comfortably seated in front of the slit lamp. The gonioscopy lens needs to be positioned perpendicular to the eye axis. In order to visualize the trabecular meshwork in cases of iris bombe, do not move the lens, but instead ask the patient to look towards the lens mirror.
  4. When performing SLT, I recommend treating the trabecular meshwork over 180-degrees, starting from the inferior area of the angle (from 3 to 9 o’clock) or from its temporal area. Place 50 consecutive but not overlapping spots. It is important to note that the Inferior and temporal areas of the TM are usually larger than the superior or nasal areas, which enhances the visibility of the structures and thereby makes the treatment easier. Should an enhancement treatment be required to further reduce IOP, treat the other 180-degrees at least one month following the initial SLT treatment.
  5. SLT is not indicated for congenital and juvenile glaucoma – in these cases, filtrating surgery should be performed.
  6. To avoid any post-laser inflammatory reaction of the anterior chamber, I usually prescribe nonsteroidal anti-in?ammatory drops for a few days. I also usually prescribe an alpha-2 adrenergic agonist before the SLT treatment to avoid post-treatment ocular hypertension.
  7. I always wait for a few weeks before assessing the IOP-lowering efficacy of SLT treatment: not all patients respond immediately, and there may be some “late responders.” During this timeframe, I continue to treat patients with their previous medications.
  8. I strongly believe in the efficacy of repeat treatment with SLT. I usually wait at least six months before performing repeat treatment, always following the same protocol. Repeat treatment is, however, useless for patients who were not responders to initial SLT treatment.
CLINICAL TIPS - PHILIPPE DENIS