Real world outcomes of selective laser trabeculoplasty as primary treatment for glaucoma in Enugu Nigeria: a retrospective study

Abstract

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. A retrospective chart review was conducted on 93 eyes of 50 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. Kaplan Meier analysis was used to assess survival rates of SLT alone and SLT with additional treatment therapy overtime. 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. Mean baseline IOP was 17.0 ± 5.1 mmHg. Post-SLT, mean IOP decreased to 12.6 ± 3.3 mmHg (25% reduction) at 3 months, 12.3 ± 3.0 mmHg (25%) at 6 months, 11.9 ± 3.1 mmHg (25%) at 12 months, 12.3 ± 2.9 mmHg (22%) at 24 months, and 13.9 ± 3.3 mmHg (21%) 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 0.6 ± 1.0 at 12 months and 1.5 ± 0.9 at 36 months (p < 0.001). Success rates for SLT alone (without additional therapy) were 86% at 3 months, 83% at 6 months, 67% at 12 months, 54% at 24 months, and 43% at 36 months. Success rates for SLT with additional therapy were 87% at 3 months, 84% at 6 months, 80% at 12 months, and 64% at 36 months. 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.