Selective Laser Trabeculoplasty Versus MIGS: Forgotten Art or First-Step Procedure in Selected Patients with...

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Interventions

Background:

• Primary open-angle glaucoma (POAG) management requires effective long-term intraocular pressure (IOP) control.
• Evaluating selective laser trabeculoplasty (SLT) against minimally invasive glaucoma surgery (MIGS) is crucial for clinical practice.

Purpose of the Study:

• To compare the long-term efficacy of SLT versus MIGS (Trabectome®, iStent inject®) in reducing IOP and medication needs in POAG patients.
• To assess the clinical utility and survival rates of SLT and MIGS procedures.

Main Methods:

• A comparative study of 342 POAG patients undergoing stand-alone SLT (n=105), Trabectome® (n=107), or iStent inject® (n=130).
• Long-term IOP and glaucoma medication data were collected over 3 years postoperatively.
• Statistical analysis included regression modeling, propensity score matching, and Kaplan-Meier survival analysis using predefined success criteria.

Main Results:

• All procedures significantly reduced IOP by approximately 30% at 3 years (SLT: 31.2%, Trabectome®: 31.4%, iStent inject®: 29.9%).
• SLT demonstrated a significant reduction in glaucoma medication (p=0.046), unlike Trabectome® (p=0.138) and iStent inject® (p=0.612).
• SLT showed higher survival rates under qualified success criteria A (93.3%) and B (74.5%) compared to MIGS procedures.

Conclusions:

• Selective laser trabeculoplasty (SLT) is a safe and effective initial treatment for mild to moderate POAG, offering significant IOP reduction and medication decrease.
• Minimally invasive glaucoma surgery (MIGS) is a viable option for follow-up treatment in mild to moderate glaucoma, particularly after topical therapy.
• Both SLT and MIGS demonstrate good to moderate long-term efficacy, with SLT showing an advantage in medication reduction and initial success rates.