ESCRS - FP28.05 - A Prospective Study On Direct Selective Laser Trabeculoplasty In Effective Intraocular Pressure Reduction In Patients With Primary Angle Closure Disease From A Tertiary Centre In Singapore

A Prospective Study On Direct Selective Laser Trabeculoplasty In Effective Intraocular Pressure Reduction In Patients With Primary Angle Closure Disease From A Tertiary Centre In Singapore

Published 2026 - 44th Congress of the ESCRS

Reference: FP28.05 | Type: Free paper | DOI: 10.82333/45rf-y674

Authors: Dr Joycelin Foong* 1 , Dr Arun Narayanaswamy 2 , Dr Shana Sood 2 , Yamon Thant Syn 2 , Dr Phey Feng Lo 2 , Prof. Tin Aung 2 , Prof. Shamira Perera 2

1Singapore National Eye Centre,Singapore,Singapore, 2Glaucoma,Singapore National Eye Centre,Singapore,Singapore

Purpose

Trans-limbal direct selective laser trabeculoplasty (DSLT) (Alcon, Fort Worth, Texas, USA) is a novel laser delivery method that targets the trabecular meshwork outflow pathway through the perilimbal sclera, thereby overcoming some limitations of SLT, including the need for a goniolens, and anatomical obstacles such as narrow angles. This study aims to measure the 6-month efficacy of DSLT in reducing intraocular pressure (IOP) in eyes with primary angle closure (PAC) or primary angle closure glaucoma (PACG).

Setting

All patients were recruited from Singapore National Eye Centre, a tertiary care hospital in Singapore.

Methods

Patients with a baseline diagnosis of PAC and PACG who had received prior laser iridotomy or cataract surgery were recruited in this prospective single-arm pilot trial. Post-washout, they had to achieve an IOP ≥ 22mmHg but ≤ 35mmHg. One eye per subject received DSLT: 120 shots delivered over 2 seconds at an energy setting of 2.2mJ, circumferentially over 360 degrees. Patients were followed up at regular intervals of 1 week, 2 months, 4 months and 6 months. All patients were prescribed nepafenac four times a day for a week after laser treatment.

Results

The mean age was 63.7±9.3 years. 9 eyes had PAC, 12 had PACG. 19 eyes were on eye drops prior to DSLT treatment. 2 were treatment naïve whilst the rest were on either 1 or 2 eye drops. 4 eyes had prior cataract surgery.

Mean baseline IOP was 24.0±2.7mmHg. Post-treatment mean IOP was 18.1±3.4mmHg (-24.6%, p<0.001), 17.1±3.3mmHg (-28.8%; p<0.001) and 15.3±2.5mmHg (-36.3%, p<0.001) at two, four and six months respectively.

At month 6, 16 patients (76%) achieved complete success (no medications required) with an average IOP lowering of 8.3mmHg from baseline. 8 patients (38%) required re-treatment with DSLT by month 4, of which 4 did not require further treatment or medications; 4 were re-started on 1 eye drop. No adverse events were observed.

Conclusions

Automated DSLT is an effective and safe non-contact modality for reducing IOP in patients with PAC and PACG, with a significant proportion of eyes achieving good medication-free IOP at 6 months with no reported adverse events.