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Laser trabeculoplasty and micropulse: evolution from trabecular photocoagulation, to trabecular photothermolysis, to trabecular photostimulation

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Laser trabeculoplasty (LT), administered as argon laser trabeculoplasty (ALT), or as selective laser trabeculoplasty (SLT), or as micropulse laser trabeculoplasty (MLT), is arguably one of the most valuable and practiced laser procedures among the clinically utilized laser treatments of ocular diseases. LT is used to lower intraocular pressure (IOP) in patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG). In this chapter, we trace the origins of LT, its evolution during the past four decades and its changing role in the clinical practice. This retrospective will help to fully appreciate the conditions and the rationale for the adoption of the micropulse laser emission as an additional LT treatment option. The clinical refinement and the better understanding of MLT’s mechanism of action has contributed to the gradual paradigm shift from the destructive ALT trabecular photocoagulation to less or nondamaging IOP-lowering laser techniques (i.e. SLT’s trabecular photothermolysis and MLT’s trabecular photostimulation) that can be administered earlier and repeated PRN (pro re nata) as required in a chronic, progressive neurodegenerative disease like glaucoma.
We also outline future directions and new technologies emerging from LT’s seminal lessons on a better understanding of the ways the trabecular meshwork (TM) can regulate the outflow of aqueous humor (AH) and IOP homeostasis.

New Concepts in Glaucoma Surgery Series: Volume 1, pp. 193-209 #14
Edited by: John R. Samples and Iqbal Ike K. Ahmed
© Kugler Publications, Amsterdam, The Netherlands

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