Abstract / Summary
Introduction: Selective laser trabeculoplasty (SLT) is an established treatment for reducing intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG).However, evidence on the use of VISULAS green SLT in advanced-to-severe POAG remains limited, particularly in real-world clinical settings.This study aimed to evaluate the six-month outcomes of VISULAS green SLT in patients with advanced-tosevere POAG.Methods: This retrospective cohort study included seven patients (10 treated eyes) with advanced-to-severe POAG who underwent SLT at a tertiary ophthalmology center in Malaysia between January and December 2025.IOP and topical IOP-lowering medication burden were assessed at baseline and at one week, one month, three months, and six months after SLT.Changes over time were analyzed using the Friedman test, followed by exploratory Wilcoxon signed-rank tests for paired comparisons.Subsequent glaucoma interventions were also recorded.Results: Of the 10 treated eyes, seven (70%) had advanced POAG and three (30%) had severe POAG.The mean patient age was 65.29 ± 8.88 years, and five patients (71.4%) were female.Overall, mean IOP decreased from 22.40 ± 7.21 mmHg at baseline to 19.29 ± 2.81 mmHg at six months, although the number of eyes with available measurements decreased from 10 to 7.Among the seven eyes with complete six-month data, mean IOP increased from 18.86 mmHg at baseline to 19.29 mmHg at six months, representing a paired mean increase of 0.43 mmHg.No statistically significant overall change in IOP was observed (Friedman test, p = 0.511).The median topical medication burden remained at two medications throughout the follow-up (p = 0.092).None of the seven evaluable eyes (0%) achieved the predefined target IOP at six months.Subsequent glaucoma surgery was documented in three eyes (30%), comprising two trabeculectomies and one iStent implantation.Conclusions: In this small real-world cohort, no statistically significant changes in IOP or topical medication burden were demonstrated over six months following VISULAS green SLT.These findings should be interpreted cautiously given the very small sample size and incomplete follow-up and should be considered exploratory rather than evidence of an absence of treatment effect.SLT may serve as an adjunctive or interim treatment in selected patients who decline or temporarily defer surgery; however, close monitoring and timely escalation of treatment remain essential.