Twelve-Month Outcomes of Direct Selective Laser Trabeculoplasty According to Treatment Indication

Précis: Direct selective laser trabeculoplasty achieves clinically meaningful and sustained intraocular pressure reduction across a wide spectrum of patients, supporting its use as first-line treatment, medication-sparing strategy, and in eyes with uncontrolled IOP despite medication. Purpose: To report twelve-month outcomes of direct selective laser trabeculoplasty (DSLT) across three groups defined by treatment indication in clinical practise. Methods: Retrospective study of 97 eyes of 97 patients treated with DSLT (VOYAGER®, Alcon) between December 2023 and March 2025, with ≥12 months of follow-up. Eyes were grouped by treatment indication: Group 1 (23 eyes), treatment-naïve; Group 2 (23 eyes), treatment-burden reduction with controlled intraocular pressure (IOP); Group 3 (51 eyes), additional IOP lowering in eyes uncontrolled despite medication. Success was ≥20% IOP reduction from baseline without additional treatment, or fewer hypotensive drugs with an IOP change from baseline of less than 20% in either direction. Results: At 12 months, Group 1 IOP fell from 26.83±3.72 to 19.82±3.49 mmHg (−24.8%; P <0.001; success 47.8%). In Group 2, IOP remained stable (16.87±5.21 to 16.10±2.91 mmHg) while medications fell from 1.65±0.77 to 0.67±1.02 ( P <0.001; success 60.9%). In Group 3, IOP fell from 22.29±3.94 to 18.64±5.08 mmHg (−15.7%; P <0.001; success 35.3%). Composite success did not differ between groups ( P =0.11), whereas the proportion achieving ≥20% IOP reduction did (60.9%, 8.7% and 33.3%; P <0.001). The only notable adverse events were two IOP spikes and three transient anterior chamber reactions. Conclusions: Direct selective laser trabeculoplasty was associated with IOP reduction in treatment-naïve and medically uncontrolled eyes. In eyes treated for medication reduction, DSLT reduced medication burden while maintaining IOP control. These findings suggest that DSLT may serve different treatment objectives in glaucoma management. Larger prospective studies are needed to establish its long-term effectiveness and safety.