Selective Laser Trabeculoplasty – The First-line Treatment For Open-Aangle Glaucoma?!

Abstract

The purpose of this nonrandomized study conducted at the Eye Clinic "Akhali Mzera" between October 2011 and November 2022 was to evaluate the intraocular pressure (IOP) reduction and side effects following selective laser trabeculoplasty (SLT). A total of 867 eyes of 558 patients with early to moderate primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PXG) phakic and pseudophakic were included in the study. The patients were treated with laser as primary therapy or adjunct laser with medication. The mean age of the study participants was 54.3 ± 5.2 years (range, 40 to 78 years) and 362 (64.9%) were males. The glaucoma diagnosis was POAG in 726 (83.7%) eyes and PXG in 141 (16.3%) eyes. Diabetes mellitus in 8% and systemic hypertension in 30% were noted. 736 eyes (84.9%) were on medications, and 130 (14.9%) eyes were treated with laser as primary therapy. Overall, the mean IOP after SLT was 17.8 ± 3.2mmHg, 18.8 ± 2.3 mmHg, and 23.4 ± 2.5 mmHg in the 12th month, 24th month, and 36th month respectively. About 20% of patients with POAG lost efficacy in 18 months post-treatment and in these eyes, the second SLT procedure was more effective than the first one. The number of drugs reduced from an average of 1.3 to an average of 1.0 was statistically significant with the inter-eye correlation. Those patients who were treated with laser as primary therapy with a baseline IOP of 25.4 mmHg ±2.9 mmHg had IOP reduction of 7.5 ± 3.1 mmHg at the last visit, and those who were on antiglaucoma medication with baseline IOP 23.9 ± 2.2 mmHg had IOP reduction of 4.8 ± 2.8 mmHg. IOP reduction at the last visit between POAG, and PXG was 6.5 mmHg and 7.9 mmHg, respectively. It was concluded that SLT is a safe and innovative technology that uses lasers to target only certain cells of the trabecular meshwork of the eye.