Safety and Efficacy of Direct Selective Laser Trabeculoplasty in Patients With Ocular Hypertension or Open Angle Glaucoma

PRECIS: DSLT is a safe and effective modality for IOP reduction in OHT or OAG, performing especially well as first-line therapy in treatment-naive eyes with high baseline IOP. PURPOSE: To evaluate the safety and efficacy of direct selective laser trabeculoplasty (DSLT) in ocular hypertension (OHT) or open angle glaucoma (OAG), including treatment-naive and medically treated eyes. METHODS: A retrospective, single-center study based on electronic medical records of consecutive patients with OHT or OAG who underwent 360-degree DSLT between January 2023 and October 2024 in a tertiary hospital in Jerusalem. Demographic and clinical data were collected. Intraocular pressure (IOP) was measured pretreatment, 30 minutes post-DSLT, and at 2-months. The primary outcome was treatment success, defined as ≥20% or ≥3 mm Hg IOP reduction at 2 months without extra therapy. Secondary outcomes were mean IOP change, adverse events, and best-corrected visual acuity (BCVA) change. RESULTS: The study included 218 eyes from 144 patients. At 2 months, 66.97% of eyes met treatment success criteria. Mean baseline IOP was 19.73±4.52 mm Hg and decreased by 3.42±3.62 mm Hg (15.57%). Treatment-naive eyes showed greater IOP reduction (4.54±2.88 mm Hg, 20.17%) and higher success rates (78.43%) compared with premedicated eyes (3.07±3.11 mm Hg, 14.17%; 63.47% success; P =0.038). Subconjunctival hemorrhages occurred in 54.6% of eyes. IOP spikes were rare (1.8%). BCVA remained stable ( P =0.152). No serious adverse events were observed. CONCLUSIONS: DSLT is a safe and effective method for lowering IOP in OHT or OAG patients, particularly in treatment-naive eyes. Its noncontact, rapid, and standardized approach may offer practical advantages over conventional SLT. Further prospective studies with extended follow-up are needed to confirm these findings.