A Prospective Study On Direct Selective Laser Trabeculoplasty In Effective Intraocular Pressure Reduction In Patients With Primary Open-Angle Glaucoma And Ocular Hypertension From A Tertiary Centre In Singapore

Direct Selective Laser Trabeculoplasty (DSLT) is a non-contact transscleral procedure performed through the limbus without gonioscopy to lower intraocular pressure (IOP). This prospective study evaluates the safety and effectiveness of DSLT in ethnic Chinese patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT).

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

Thirty patients with mild to moderate POAG, OHT or normal tension glaucoma (NTG) with mean screening IOP of 17.7 mmHg were recruited from Singapore National Eye Centre. They were on up to three topical hypotensive medications. Following a washout period, baseline IOP was taken and patients underwent DSLT.

The mean age was 63.0±11.8 years. Of the 40 eyes (22 mild POAG, 2 moderate POAG, 13 OHT, 3 NTG), five were treatment naïve. Mean baseline IOP was 22 mmHg (n=40). Post-treatment mean IOP was 18.0 (n=30), 18.8 (n=16), 17.6 (n=19) and 17.3 (n=12) at two, four, six and twelve months. Mean IOP reduction at four and twelve months were 18.2% (n=16) and 25.3% (n=12). Five eyes (16.7%) were retreated at month 2 (n=30). One adverse event was observed: in one eye, there was an IOP rise (24 to 28 mmHg) post-DSLT with spontaneous resolution (week 1 IOP: 16 mmHg) without treatment. By month 12, 11 eyes (91.7%) achieved target IOP. 84.2% remained medication-free by month 6 (n=19) and 75% by month 12 (n=12).

The interim data suggests that DSLT is safe and effective in reducing IOP in patients with mild to moderate POAG and OHT, given few adverse events and the substantial proportion of patients achieving target IOP while remaining medication-free.