Clinical Outcomes of Selective Laser Trabeculoplasty in Thai Glaucoma Patients Across Initial, Adjunctive, and...

To evaluate the outcomes of selective laser trabeculoplasty (SLT) in Thai glaucoma patients across three treatment groups-initial, adjunctive, and replacement therapy-and to identify predictors of treatment response and durability.

This retrospective study included glaucoma patients who underwent SLT and were classified into initial, adjunctive, and replacement therapy groups. Treatment durability was analyzed using Kaplan-Meier survival methods. Predictors of non-response and shortened effects were identified using multivariable logistic regression and Cox proportional hazards models.

A total of 254 eyes from 123 patients were included: 76 eyes in the initial group, 117 in adjunctive therapy, and 61 in replacement therapy. Overall, 61.1% of eyes achieved a laser response, with significant variation among groups (initial 78.9%, replacement 68.9%, adjunctive 45.3%; p < 0.001). The mean effective duration of SLT was 1.5 years, with cumulative success of 67.2% at 1 year and 14.7% at 3 years, without significant intergroup differences (p = 0.448). Retreatment with SLT was associated with a reduced risk of non-response (adjusted OR = 0.328, p= 0.023). Independent predictors of non-response included higher baseline IOP (adjusted OR = 1.118, p = 0.004), greater number of medications (adjusted OR = 1.371, p = 0.013), and acetazolamide use (adjusted OR = 5.531, p = 0.033). Shortened treatment effect within 1 year was predicted by older age (adjusted HR = 1.029, p = 0.002), higher baseline IOP (adjusted HR = 1.070; p = 0.001), and greater number of medications (adjusted HR = 1.179, p= 0.036).

SLT is effective and repeatable in Thai patients, particularly as initial or replacement therapy. While adjunctive therapy provides some benefit, patients with higher baseline IOP, heavier medication burden are more likely to experience non-response or shortened efficacy. Individualized selection and timely retreatment may optimize outcomes.