Real-Life Effectiveness and Safety of Selective Laser Trabeculoplasty as Primary, Adjunctive, and Substitutive Therapy.

Objectives: To assess real-world outcomes of selective laser trabeculoplasty (SLT) in naive patients compared to SLT as adjunctive treatment (AT), investigating SLT's intraocular pressure (IOP) reduction and its potential to decrease topical medication. Materials and Methods: Patients undergoing SLT with no prior glaucoma surgery or laser treatment were grouped based on the intended objective: SLT as primary treatment (PT), SLT as AT, and SLT as substitutive treatment (ST). Survival in the PT and AT groups was defined as ≥20% IOP reduction from baseline and IOP ≤21 on two consecutive visits with the same or fewer medications and no additional glaucoma procedure, including repeat SLT. Survival in the ST group was defined as decreasing topical medication while maintaining or reducing IOP. Results: The study included 120 eyes of 120 patients with a mean follow-up of 32.7 months. The PT group showed superior IOP reduction than the AT group at 24-36 months (22.1% vs. 14.5%, p=0.039). Non-responders comprised 28.6% of the PT group and 37.0% of the AT group. The PT group demonstrated better survival rates than the AT group at 12, 24, and 36 months (69.0% vs. 47.1%, 38.8% vs. 31.4%, and 31.1% vs. 23.5%, respectively). In the ST group, 34.2% of patients were successful at 12 months, increasing to 38.3% at 24 months. At 24 months, 50.0% of patients had reduced at least one medication. Conclusion: SLT showed two-thirds effectiveness, with one-third being non-responders. It was more effective as PT, with higher IOP reduction and success rates. SLT reduced topical medication in half of patients.