Selective laser trabeculoplasty vs micropulse laser trabeculoplasty in open-angle glaucoma

Benjamin Abramowitz,1 Nisha Chadha,2 Amr Kouchouk,3 Rashed Alhabshan,4 David A Belyea,4 Tania Lamba4 1Glaucoma Department, Eye Consultants of Northern Virginia, Springfield, VA, USA; 2Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA; 3Cornea Department, Atlantis Eyecare, Torrance, CA, USA; 4Department of Ophthalmology, The George Washington University, Washington, DC, USA Aim: The aim of this study was to prospectively compare the efficacy, safety, and tolerability of selective laser trabeculoplasty (SLT) vs micropulse laser trabeculoplasty (MLT) in reducing intraocular pressure (IOP) in open-angle glaucoma patients. Patients and methods: In all, 38 patients were randomized to 360° MLT and 31 patients were randomized to 360° SLT. IOP was measured at intervals of 1hour and 1, 1–6, 6–12, 6–24, 24–36, and 36–52weeks. Patients completed a survey 1week after the procedure. Patients with end-stage, neovascular, uveitic, or angle-closure glaucoma were excluded. Treatment response was defined as an IOP reduction of ≥20.0% or ≥3mmHg from baseline. Results: IOP was lowered to ≥3mmHg from baseline among 37.0% of the micropulse patients and 36.0% of patients in the selective laser group at 24–52weeks. Similarly, 29.6% of the micropulse patients and 36.0% of the selective laser patients experienced a 20.0% IOP decrease from baseline during the 24–52-week interval (P=0.77). Both groups revealed similar reductions in IOP as absolute values and percentage decreases from baseline at all intervals up to 52weeks post treatment. There were more treatment failures in the micropulse group up to 52weeks post laser treatment; however, this was not statistically significant. The micropulse group reported less pain both during and after the procedure (P=0.005). Conclusion: Micropulse trabeculoplasty has demonstrated similar efficacy to SLT over a 52-week follow-up period with less discomfort experienced both during and after the procedure. Keywords: randomized controlled trial, selective laser trabeculoplasty, micropulse, glaucoma, intraocular pressure