Direct Selective Laser Trabeculoplasty for Primary Angle-Closure Glaucoma: A Retrospective Case Series

This retrospective single-center case series evaluated the outcomes of direct selective laser trabeculoplasty (DSLT) in patients with primary angle-closure glaucoma (PACG). Twelve eyes of eight phakic patients with PACG and patent laser peripheral iridotomy (LPI) underwent DSLT. The primary outcome was the percentage reduction in intraocular pressure (IOP). Secondary outcomes included treatment success, defined as an IOP reduction of ≥20% from baseline or a reduction in glaucoma medications while maintaining baseline IOP and safety parameters. The mean patient age was 71.0±9.3 years. Baseline IOP was 17.0±2.3 mmHg and decreased significantly to 13.6±3.0 mmHg at the 2-month follow-up (P=0.0024), representing an overall mean IOP reduction of 20.3%±11.6%. Treatment success was achieved in seven eyes (58.3%), with a mean IOP reduction of 27.6%±7.3%. The mean number of glaucoma medications decreased from 3.17±1.47 to 2.75±1.70 (P=0.0369), and the medications were completely discontinued in three eyes. Corrected distance visual acuity remained stable. The most common transient findings were mild anterior chamber reaction and subconjunctival hemorrhage, and no IOP spikes or other complications occurred. These preliminary results suggest that DSLT is a safe, well-tolerated, and potentially effective non-contact laser therapy for phakic patients with PACG and patent LPI. Larger prospective studies with longer follow-up periods are warranted to confirm these findings.