Intraocular Pressure Trends After Selective Laser Trabeculoplasty with a Solid-State 532-nm System (VISULAS Green): A Real-World Study

Abstract

INTRODUCTION: To evaluate the effectiveness of selective laser trabeculoplasty (SLT) performed with the VISULAS green platform in clinical practice, with attention to diagnostic subgroups.

METHODS: Retrospective analysis of 59 eyes (48 patients) treated with VISULAS SLT. Baseline characteristics, intraocular pressure (IOP) over time, responder rates (≥20% reduction), and need for additional therapy were assessed using mixed-effects models clustered by patient. Subgroup analyses included number of baseline medications, diagnosis, and lens status.

RESULTS: Mean baseline IOP was 20.3 mmHg. IOP decreased to 18.4 mmHg at 1 month, but reductions at 3 and 6 months were not statistically significant. Eyes on fewer medications at baseline had greater pressure lowering, whereas heavily medicated eyes showed minimal response. Descriptively, ocular hypertension showed smaller reductions than primary open-angle glaucoma, although this difference was not statistically significant. In this series, pseudoexfoliative glaucoma tended to respond less favorably, contrasting with some prior reports of greater reductions. Lens status was not an independent determinant after adjustment. At 1 and 6 months, 26% and 22% of eyes, respectively, achieved ≥20% IOP reduction. Five eyes (8.5%) required filtering surgery and two (3.4%) needed escalation of medical therapy. Transient IOP spikes occurred in 7.9% of eyes, with no major adverse events.

CONCLUSION: VISULAS SLT provided modest short-term IOP lowering in real-world practice, with the greatest benefit in eyes on few or no topical medications and less reliable efficacy in pseudoexfoliative glaucoma. Safety was favorable, and the need for subsequent intervention was low. These findings highlight the importance of patient selection and contribute novel data on diagnostic subgroups treated with the VISULAS platform.