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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

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Clinical Scorecard: Is There a Role for SLT After MIGS?

At a Glance

CategoryDetail
ConditionPrimary Open-Angle Glaucoma (POAG)
Key MechanismsSelective laser trabeculoplasty (SLT) stimulates cytokine-mediated remodeling of the trabecular meshwork (TM) extracellular matrix to enhance aqueous outflow.
Target PopulationPatients with mild to moderate POAG, particularly those who have undergone minimally invasive glaucoma surgery (MIGS).
Care SettingClinical decision-making framework for managing intraocular pressure post-MIGS.

Key Highlights

  • MIGS procedures lower intraocular pressure (IOP) but are not curative; IOP may rise after surgery.
  • SLT is noninferior to first-line topical therapy and can be a viable option when MIGS efficacy wanes.
  • The effectiveness of SLT depends on the preservation of functional TM tissue after MIGS.
  • Retrospective studies indicate significant IOP reduction with SLT following certain MIGS procedures.
  • Canaloplasty may be the most favorable MIGS category for preserving SLT target tissue.

Guideline-Based Recommendations

Diagnosis

  • Monitor IOP in patients post-MIGS to identify rising pressure.

Management

  • Consider SLT as a bridging intervention when IOP rises after MIGS.

Monitoring & Follow-up

  • Evaluate the functional status of TM to determine SLT viability.

Risks

  • Potential for progressive TM dysfunction and inadequate IOP control post-MIGS.

Patient & Prescribing Data

Patients with inadequately controlled POAG after MIGS.

SLT may reduce IOP by 2-3 mmHg and decrease the need for additional medical or surgical treatment.

Clinical Best Practices

  • Assess TM preservation after MIGS to guide SLT candidacy.
  • Utilize SLT in cases where IOP control is suboptimal following MIGS.

Related Resources & Content

Original Source(s)

Is There a Role for SLT After MIGS?

  • by Shivani S. Kamat, MD

  • September 1, 2026

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