Short-term outcomes of selective laser trabeculoplasty in pseudophakic primary angle-closure glaucoma after iridotomy: a retrospective pilot comparison with primary open-angle glaucoma

BACKGROUND: Selective laser trabeculoplasty (SLT) is a widely accepted treatment for primary open-angle glaucoma (POAG), but its role in primary angle-closure glaucoma (PACG) remains less defined. This study aimed to evaluate the short-term outcomes of SLT in pseudophakic PACG patients who had undergone prior laser peripheral iridotomy (LPI), and to compare outcomes with those in POAG patients. METHODS: This retrospective study included pseudophakic patients diagnosed with PACG after LPI or POAG who underwent SLT. Intraocular pressure (IOP) and topical antiglaucoma medication use were assessed at baseline and at 1, 2, and 3 months after SLT. Changes in IOP over time were analyzed, and multivariable linear regression was performed to evaluate factors associated with IOP reduction at 1 month. RESULTS: A total of 123 patients were included, comprising 89 with POAG and 34 with PACG. The PACG group was older and had a higher proportion of female patients. The mean IOP reduction was numerically comparable between groups at each follow-up visit. At 1 month, a statistically significant reduction in IOP was observed in the POAG group. The PACG group also demonstrated a numerical reduction in IOP, although this did not reach statistical significance. However, the between-group comparison at 1 month should be interpreted cautiously given the limited sample size and multiple comparisons. The number of glaucoma medications remained unchanged during the follow-up period in both groups. In multivariable analysis, baseline IOP was associated with greater IOP reduction at 1 month, whereas SLT energy parameters were not significantly associated with treatment response. No major complications were recorded during the study period. CONCLUSIONS: SLT demonstrated a short-term IOP-lowering effect in pseudophakic PACG after LPI, with outcomes numerically similar to those in pseudophakic POAG. These findings should be considered preliminary and warrant confirmation in larger prospective studies with longer follow-up.