Is There a Role for SLT After MIGS?

Is There a Role for SLT After MIGS? A practical framework for patient selection and clinical decision-making when intraocular pressure rises after minimally invasive glaucoma surgery.

By
Shivani S. Kamat, MD
September 1, 2026
13 min

Glaucoma Physician

Background

The management of glaucoma has evolved significantly with the introduction of MIGS, which offers a safer and less invasive option for patients with mild to moderate primary open-angle glaucoma (POAG). However, as MIGS is not curative, IOP may rise over time, necessitating further treatment options. Understanding the role of SLT in this context is important.

Data Highlights

No numerical data available in the source material.

Key Findings

SLT is noninferior to first-line topical therapy for untreated open-angle glaucoma, as demonstrated in the LiGHT trial.
At 6 years, SLT was superior to topical therapy, with 70% of eyes requiring no additional treatment.
SLT can be an effective bridging intervention when MIGS efficacy wanes, particularly in cases where trabecular meshwork (TM) tissue is preserved.
Studies indicate that SLT can reduce IOP by approximately 2 mmHg to 3 mmHg after MIGS procedures like iStent implantation.
Excisional goniotomy may leave sufficient TM tissue for SLT to remain effective in untreated regions.
Gonioscopy-assisted transluminal trabeculotomy (GATT) may limit the rationale for SLT due to the removal of TM tissue, although distal outflow pathways may still be targeted.

Clinical Implications

Clinicians should consider SLT as a viable option for managing elevated IOP following MIGS, especially when TM tissue remains functional. The complementary mechanisms of SLT and MIGS procedures may enhance overall treatment efficacy.