Real world outcomes of Selective Laser Trabeculoplasty as Primary Treatment for glaucoma in Enugu Nigeria: A Retrospective study

Abstract Background Selective Laser Trabeculoplasty (SLT) is a non-invasive procedure for managing open-angle glaucoma by reducing intraocular pressure (IOP). While effective as a primary treatment in various populations, data on its efficacy in sub-Saharan Africa, particularly Nigeria, are limited. This study evaluates SLT as a primary treatment for open-angle glaucoma in Enugu, Nigeria, addressing a regional gap in real-world outcomes. Methods A retrospective chart review was conducted on 116 eyes of 64 patients who underwent SLT as primary treatment at The Eye Specialists Hospital, Enugu, Nigeria, between 2019 and 2021. Patients with open-angle glaucoma (primary, juvenile, or normal-tension) and a minimum 3-month follow-up were included. SLT success was defined as an IOP reduction of ≥ 3 mmHg without additional intervention or ≥ 20% from baseline IOP. Data were analyzed using SPSS version 26, with statistical significance set at p < 0.05. Results Mean baseline IOP was 17.0 ± 5.0 mmHg. Post-SLT, mean IOP decreased to 13.1 ± 4.5 mmHg (23.1% reduction) at 3 months, 12.5 ± 3.4 mmHg (26.3%) at 6 months, 12.2 ± 3.2 mmHg (28.2%) at 12 months, 12.8 ± 3.0 mmHg (25.0%) at 24 months, and 15.3 ± 6.4 mmHg (20.3%) at 36 months (all p < 0.05). Eyes with higher baseline IOP showed greater reductions up to 24 months. The number of antiglaucoma medications increased from 0 at baseline to 0.74 ± 1.13 at 12 months and 1.25 ± 1.34 at 36 months (p < 0.001). Cumulative success rates were 82.8% at 3 months, 75.9% at 6 months, 64.2% at 12 months, 53.5% at 24 months, and 43.8% at 36 months. Conclusion SLT is an effective primary treatment for reducing IOP in Nigerian patients with open-angle glaucoma, particularly those with higher baseline IOP, with minimal need for additional medications or surgery over 36 months. These findings support SLT's role in resource-limited settings, though prospective studies are needed to confirm long-term outcomes.