Purpose To evaluate clinical outcomes of two selective laser trabeculoplasty (SLT) approaches in the management of primary open-angle glaucoma (POAG): a single-session 180° SLT versus a staggered 360° SLT approach, where a second 180° treatment was added to the superior trabecular meshwork 1–2 months after the initial inferior treatment. Methods A retrospective chart review was conducted on 134 eyes of 134 patients with POAG treated at a single center. Sixty-seven eyes received only 180° SLT, while 67 underwent staggered 360° SLT. The decision to proceed with the second session was based on clinician judgment and was not standardized. Intraocular pressure (IOP) and the number of topical IOP-lowering medications were assessed at baseline, and at 3, 6, and 12 months post-treatment. Results Both groups showed significant IOP reduction at all follow-up visits (p < 0.001). At 12 months, the mean IOP change was −5.1 ± 3.3 mmHg (180° SLT) and −4.9 ± 3.5 mmHg (360° SLT). Higher baseline IOP was associated with greater IOP reduction (p < 0.001). No statistically significant difference in IOP-lowering efficacy was observed between groups. However, the 360° SLT group showed a greater within-group reduction in medication burden (p < 0.01) compared to the 180° group (p < 0.05). Conclusions Both 180° and staggered 360° SLT were effective in lowering IOP in POAG patients. While limited by its retrospective design and selection bias, this study supports staggered SLT as a viable strategy to reduce medication dependency in clinical practice.
Assaf et al. (2025) studied this question.