Abstract:AIM: To assess the effectiveness and safety of VISULAS® green laser selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with pseudoexfoliative syndrome glaucoma (PEXG) and pseudoexfoliative syndrome ocular hypertension (PEXS-OHT). METHODS: This prospective, single-center, interventional study included 20 eyes from 20 patients diagnosed with PEXG or PEXS-OHT. Patients underwent 180° SLT using the VISULAS® green laser, a diode-pumped, frequency-doubled Nd:YVO4 laser with a 532 nm wavelength. IOP was measured at baseline and post-treatment at 1, 3, and 6mo. Medications regimen was stable through the study. Primary outcomes included mean IOP reduction, while secondary outcomes assessed visual and structural parameters, and safety. RESULTS: The mean age of participants was 72.2±6.6y, with 65% of the eyes being left eyes and 35% right eyes. At baseline, the mean IOP was 22.9±2.9 mm Hg. A significant reduction in IOP was observed at all follow-up intervals: 18.5±3.1 mm Hg at 1mo (18.8% reduction, P=0.001), 19.0±4.2 mm Hg at 3mo (16.7% reduction, P=0.002), and 18.2±4.5 mm Hg at 6mo (19.8% reduction, P=0.001). Subgroup analysis showed greater IOP reduction in patients with Shaffer grade 4 angles, phakic eyes, and those with PEXS-OHT compared to PEXG. No significant changes were detected in visual acuity, visual field index, mean deviation, or retinal nerve fiber layer thickness. At 1h post-procedure, 20% of eyes showed an IOP spike >5 mm Hg that resolved without intervention except for one patient. CONCLUSION: SLT with the VISULAS® green laser is an effective and safe treatment for PEXG and PEXS-OHT, achieving significant IOP reduction without increasing medication burden or causing severe complications. These findings suggest its potential as an alternative or adjunct therapy in managing pseudoexfoliative glaucoma.
