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.