Selective Laser Trabeculoplasty can be considered lifesaving treatment for the cornea when severe ocular disease co-exists with glaucoma

The Science behind the Tip

Elevated intraocular pressure (IOP) and glaucoma are not uncommon in cases of cicatricial conjunctivitis (CC) such as graE-versus-host disease (GVHD), Stevens-Johnson syndrome, or Cicatricial Pemphigoid, with glaucoma's prevalence at approximately 26%.1-2 In cases of severe ocular surface diseases (OSDs), the use of IOP-lowering medications may pose challenges as they can disrupt the delicate equilibrium of the ocular surface, exacerbating tear film instability, leading to epithelial impairment, and inflammation, thereby worsening the underlying conjunctivitis.3 Despite preservative-free medications having fewer adverse effects compared to preserved medications4, an&-glaucoma drugs contribute to 28.3% of CC induced by topical drug.2 The severity of OSD rises with glaucoma severity, leading to reduced quality of life and worsened symptoms, possibly resulting in reduced treatment adherence.5 In this scenario, selecting an effective management strategy becomes highly relevant. Selective Laser Trabeculoplasty (SLT) is a recommended first-choice treatment for managing ocular hypertension or open-angle glaucoma6, providing drop-free target IOP at 3 years in 74.2% of patients.7 When the cornea is clear enough, initiating SLT as a primary treatment may help preserve the ocular surface by avoiding the potentially harmful effects of topical IOP-lowering medications. Alternatively, SLT can be used to reduce the medication burden leading to beneficial outcomes for the ocular surface and potentially avert the need for surgery, particularly challenging in severe OSD.

Contributor: *Chiara Bonzano MD, PhD, FEBO, Università degli Studi di Genova

References

1 Saboo US, Amparo F, Shikari H, Dana R. Prevalence of ocular hypertension and glaucoma in paAents with chronic ocular graC-versushost disease. Graefes Arch Clin Exp Ophthalmol. 2016 May;254(5):923-8. doi: 10.1007/s00417-016-3312-3. Epub 2016 Mar 12. PMID: 26968719; PMCID: PMC4842331.
2 SwaA Singh, Pragnya Rao Donthineni, Swapna S. Shanbhag. Drug induced cicatrizing conjuncAviAs: A case series with review of eAopathogenesis, diagnosis and management, The Ocular Surface, 2022, ISSN 1542-0124, h_ps://doi.org/10.1016/j.jtos.2022.02.004.
3 Zhang X, Vadoothker S, Munir WM, Saeedi O. Ocular Surface Disease and Glaucoma MedicaAons: A Clinical Approach. Eye Contact Lens. 2019 Jan;45(1):11-18. doi: 10.1097/ICL.0000000000000544. PMID: 30199425; PMCID: PMC6298827.
4 Iester M, Telani S, Frezzof P, Motolese I, Figus M, Fogagnolo P, Perdicchi A; Beta-Blocker Study Group. Ocular surface changes in glaucomatous paAents treated with and without preservaAves beta-blockers. J Ocul Pharmacol Ther. 2014 Aug;30(6):476-81. doi: 10.1089/jop.2013.0216. Epub 2014 Apr 30. PMID: 24787056.
5 Li G, Akpek EK, Ahmad S. Glaucoma and Ocular Surface Disease: More than Meets the Eye. Clin Ophthalmol. 2022 Nov 4;16:3641- 3649. doi: 10.2147/OPTH.S388886. PMID: 36389640; PMCID: PMC9642795.
6 Gazzard G, Konstantakopoulou E, Garway-Heath D, Adeleke M, Vickerstaff V, Ambler G, Hunter R, Bunce C, Nathwani N, Barton K; LiGHT Trial Study Group. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-Year Results of Primary SelecAve Laser Trabeculoplasty versus Eye Drops for the Treatment of Glaucoma and Ocular Hypertension. Ophthalmology. 2023 Feb;130(2):139- 151. doi: 10.1016/j.ophtha.2022.09.009. Epub 2022 Sep 17. PMID: 36122660.
7 SelecAve laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT

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