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.