DIRECT SELECTIVE LASER TRABECULOPLASTY (DSLT)

Selective Laser Trabeculoplasty (SLT) is an effective first-line treatment option for patients with open-angle glaucoma and normal-tension glaucoma.

Alcon has improved the delivery system of SLT machines with the development of the Voyager Direct Selective Laser Trabeculoplasty (DSLT) system.

Voyager™ DSLT is designed to automatically deliver 120 laser pulses directly through the limbus to the trabecular meshwork, thereby improving aqueous outflow and reducing intraocular pressure.

The GLAUrious Study comparing DSLT and SLT did not find inferiority of the DSLT procedure at 6 and 12 months of follow-up.

The study demonstrated that DSLT with the Eagle device is effective in providing a clinically meaningful reduction in IOP at 6 months that is sustained out to 12 months.

The protocol included DSLT: 120 shots, 3 ns, 400 µm spot size, energy 1.4–1.8 mJ delivered at the limbus over 2 s. SLT: approximately 100 shots, 3 ns, 400 µm spot size administered 360 degrees at the limbus using any gonioscopy lens, energy 0.3–2.6 mJ.

According to the authors, a sample size of 164 is sufficient to detect a non- inferiority margin of 1.95 mm Hg for change from baseline IOP.

REFERENCE:

Congdon N, Azuara-Blanco A, Solberg Y, Traverso CE, Iester M, Cutolo CA, Bagnis A, Aung T, Fudemberg SJ, Lindstrom R, Samuelson T, Singh K, Blumenthal EZ, Gazzard G; GLAUrious study group. Direct selective laser trabeculoplasty in open angle glaucoma study design: a multicentre, randomised, controlled, investigator-masked trial (GLAUrious). Br J Ophthalmol. 2023 Jan;107(1):62-65. doi: 10.1136/bjophthalmol-2021-319379. Epub 2021 Aug 25. PMID: 34433548; PMCID: PMC9763163.