Real World Comparison of Direct Selective Laser Trabeculoplasty Versus Selective Laser Trabeculoplasty: 12-Month Retrospective Study of a Tertiary Center in the UK

<b>Background:</b> Direct selective laser trabeculoplasty (DSLT) is a novel option for intraocular pressure (IOP) control in patients with glaucoma or ocular hypertension. The automated and touchless translimbal delivery of laser energy to 360 degrees of the trabecular meshwork (TM) improves aqueous outflow and lowers IOP. DSLT is faster, simpler, and less invasive than routinely performed SLT. Few studies have compared the two techniques. <b>Objective:</b> To retrospectively compare the safety and efficacy of DSLT and SLT over a 1-year follow-up period. <b>Methods:</b> In total, 16 eyes that underwent DSLT and 16 eyes that underwent SLT were included. The primary outcome measures were mean absolute and percent IOP reduction, number of medications, and BCVA at 1, 3, 6, and 12 months. Survival analysis on 1-year data was performed based on the presence of one or more of the following failure criteria: (1) IOP > 21 mmHg or less than 20% reduction in IOP from baseline at two consecutive visits; (2) increase in the number of IOP-lowering drops from baseline at two consecutive visits; (3) further procedures. <b>Results:</b> The survival rates in the DSLT vs. SLT group were 81% vs. 78%, 44% vs. 62%, and 37% vs. 43% at 3, 6, and 12 months, respectively. No statistically significant differences were reported. DSLT does not seem inferior to conventional SLT in terms of safety and efficacy in reducing IOP. <b>Conclusions:</b> The advantages of an automated, rapid, contactless technique may enlarge the cohort of patients eligible for a drop-free first-line IOP control procedure.