Indications and Contraindications

LTP is indicated to lower IOP in patients with open-angle glaucoma or ocular hypertension. Historically, LTP was reserved for patients failing maximally tolerated medical therapy. However, it has been shown to be more effective when done earlier and is cost-effective compared with medical therapy. Accordingly, many surgeons now use LTP as a first-line treatment option. Patients who have difficulty applying topical medications, who have poor adherence to treatment, or who have significant ocular surface disease are all good candidates for trabeculoplasty.

LTP should be performed only in patients with an open angle. In a patient with advanced glaucoma and significantly elevated IOP, other treatment options should be considered. Although it has not been well studied, LTP should generally be avoided in eyes with anterior uveitis because of the risk of increased inflammation and formation of peripheral anterior synechiae (PAS); however, the technique has been shown to have potential benefit when the inflammation is very well controlled and the etiology of the IOP elevation is thought to be steroid induced. LTP is not effective in eyes with iridocorneal endothelial (ICE) syndrome, angle neovascularization, or extensive PAS.

Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.