Automated Direct Selective Laser Trabeculoplasty: First Prospective Clinical Trial

First results of direct selective laser trabeculoplasty for the treatment of glaucoma

AIM

To evaluate the efficacy and safety of direct selective laser trabeculoplasty (DSLT) on eyes with primary open-angle glaucoma (POAG) and on primary angle closure glaucoma (PACG) eyes at 1 year follow-up.

METHODS

In this study, 54 patients affected by POAG (76) or PACG (28) undergoing DSLT were enrolled, for a total of 104 eyes. Before each treatment and at each follow-up visit, all subjects underwent a complete eye visit, including the collection of data regarding the number and type of topical medications prescribed for glaucoma. The patients treated underwent 30-2 standardised automated perimetries prior to DSLT, at 6 months and 12 months post DSLT procedure. Each patient was checked at 1 week and subsequently at 1, 3, 6 and 12 months.

RESULTS

At 1 month follow-up, both the eyes affected by POAG and those affected by PACG showed significantly (p<0.01) lower mean intraocular pressure (IOP) (-3.67±2.95 mm Hg and -3.93±2.36 mm Hg, respectively) and lower mean number of IOP-lowering topical drugs taken (-0.62±0.57 and -0.78±0.64, respectively) after DSLT. These reductions remained significant until the 1 year follow-up, both for IOP (-3.76±2.84 mm Hg and 3.67±2.46 mm Hg, respectively) and for drugs assumed (-0.79±0.53 and 0.96±0.47, respectively). The mean deviation mean values showed perimetry stability both in POAG and in PACG eyes at 1 year follow-up. No major complications were observed in the eyes included in this study.

CONCLUSIONS

Although this study has some limitations such as the retrospective design, the lack of comparison with standard selective laser trabeculoplasty (SLT) and the relatively short follow-up, the results observed require confirmation through further studies, with extended follow-up and larger cohorts. This study suggests that DSLT would be a useful tool for the management of patients with glaucoma.

Direct selective laser trabeculoplasty: A retrospective study

PURPOSE

To investigate the effectiveness and safety profiles of Direct Selective Laser Trabeculoplasty (DSLT).

MATERIALS AND METHODS

Retrospective study of 15 eyes of 10 patients diagnosed with open angle glaucoma (OAG) or ocular hypertension (OHT) who underwent DSLT in June 2023 at University Hospitals of Leicester, UK. We defined success as IOP reduced ≥20% from baseline with no additional medications needed or as a decrease in the number of anti-glaucoma medications while maintaining target IOP. We also considered secondary outcomes such as final BCVA and final number of anti-glaucoma medications.

RESULTS

At the fourth month visit, success was reached in 11 eyes (73.3%). We registered 4 failures (26.7%). Mean IOP at baseline was 22.7 ± 4.4 mmHg and was reduced to 18.7 ± 4.2 mmHg (p = 0.008). The absolute mean reduction of IOP in the group of eyes that maintained unchanged the number of medications was 5.4 ± 2.7 mmHg, as baseline IOP was 21.4 ± 4.3 mmHg, and final IOP was 15.9 ± 2.3 mmHg, with a 25.7% reduction (p = 0.003). Mean BCVA remained unchanged (0.1 ± 0.1 logMAR, p = 1.00). No significant adverse events requiring surgical or clinical intervention were observed.

CONCLUSION

DSLT showed profiles of effectiveness and safety comparable with those of SLT in the literature and consistent with the results obtained in previous studies on DSLT itself. DSLT may represent a valid alternative to traditional SLT.

Selective laser trabeculoplasty: An updated narrative review

Selective laser trabeculoplasty (SLT) has experienced a resurgence in interest, primarily driven by promising findings from the Laser in Glaucoma and Ocular Hypertension Trial. By offering SLT as an initial drug-free treatment option, we may be able to thwart issues such as adherence and persistence that plague our current medical management protocols. In this comprehensive narrative review, we delve into the current body of literature that explores the utility of SLT across a wide spectrum of scenarios and glaucoma subtypes. We present evidence that provides valuable insight into the efficacy and benefits of SLT, positioning it as a viable option in the management of glaucoma. Careful consideration of the associated risks and challenges is also necessary for successful adoption into clinical practice. Despite the ample evidence supporting SLT's efficacy, some questions remain regarding its long-term effects and the potential need for retreatment. This review aims to shed light on these aspects to guide clinicians in making informed decisions and tailoring treatment plans to individual patient needs. This review also provides the readers with a bird's eye view of the potential impact of SLT and adds clarity to the various therapeutic protocols that one can follow to ensure optimal clinical outcomes for our patients.

A Review of Selective Laser Trabeculoplasty: "The Hype Is Real"

Presently, there is no efficacious treatment for glaucomatous optic neuropathy; the current treatment is focused on lowering intraocular pressure (IOP). Studies have demonstrated the safety and efficacy of selective laser trabeculoplasty (SLT) in reducing the IOP in eyes with open-angle (OAG) glaucoma or ocular hypertension (OH). Moreover, the European Glaucoma Society has instated SLT as the first-line or adjunctive treatment in OAG or OH, reiterating its clinical significance. In this review, we outline the old and the new roles of SLT, with an emphasis on clinical practice, and look further into its renewed appeal and future developments.