Real world outcomes of Selective Laser Trabeculoplasty as Primary Treatment for glaucoma in Enugu Nigeria: A Retrospective study

Real world outcomes of Selective Laser Trabeculoplasty as Primary Treatment for glaucoma in Enugu Nigeria: A Retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Real world outcomes of Selective Laser Trabeculoplasty as Primary Treatment for glaucoma in Enugu Nigeria: A Retrospective study Nkiru Nwamaka Kizor-Akaraiwe, Suhanyah Okeke, Chukwu Oko, Nkechi Uche, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7259184/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Feb, 2026 Read the published version in BMC Ophthalmology → Version 1 posted 10 You are reading this latest preprint version Abstract Background 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. Methods A retrospective chart review was conducted on 116 eyes of 64 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. SLT 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. Results Mean baseline IOP was 17.0 ± 5.0 mmHg. Post-SLT, mean IOP decreased to 13.1 ± 4.5 mmHg (23.1% reduction) at 3 months, 12.5 ± 3.4 mmHg (26.3%) at 6 months, 12.2 ± 3.2 mmHg (28.2%) at 12 months, 12.8 ± 3.0 mmHg (25.0%) at 24 months, and 15.3 ± 6.4 mmHg (20.3%) 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 0.74 ± 1.13 at 12 months and 1.25 ± 1.34 at 36 months (p < 0.001). Cumulative success rates were 82.8% at 3 months, 75.9% at 6 months, 64.2% at 12 months, 53.5% at 24 months, and 43.8% at 36 months. Conclusion 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. Selective Laser Trabeculoplasty Open-Angle Glaucoma Intraocular Pressure Nigeria Enugu Primary Treatment Glaucoma Management Laser Therapy Retrospective Study African Population Figures Figure 1 Figure 2 BACKGROUND Glaucoma is a progressive, multifactorial disease characterized by damage to the optic nerve, often associated with elevated intraocular pressure (IOP)[ 1 ]. After glaucoma diagnosis, the clinician is mostly concerned with lowering the IOP to safe limits where further damage is averted using available treatment options [ 2 , 3 ]. The Treatment option adopted is usually one which would efficiently reduce the IOP with maximal safety considering the severity, type and age of patient amidst other factors [ 4 ]. The use of topical medication has traditionally remained first-line treatment options in many countries including the United States of America despite recent advances in laser and surgical techniques in glaucoma management [ 5 ]. However, issues of poor adherence, cost, unavailability of drugs and side effects has persistently plagued the effective use of medical therapy in glaucoma management especially in developing countries [ 6 ]. Laser trabeculoplasty introduced more than 20years ago featured the use of argon laser trabeculoplasty which produced lower IOPs and better visual fields compared to fellow eyes first treated with topical medication in the Glaucoma Laser Trial [ 7 , 8 ]. The selective laser trabeculoplasty (SLT) got along in 1995 and has been found to produce better IOP outcomes with less damage to the trabecular meshwork and fewer side effects [ 9 , 10 ]. SLT is an advanced laser procedure often used for managing primary open-angle glaucoma (POAG) [ 11 ]. It is a non-invasive technique that selectively targets the trabecular meshwork to improve aqueous humor outflow reducing IOP, which is essential in halting glaucoma progression [ 12 , 13 ]. The success rate of SLT in lowering intraocular pressure has been found to range from 6.9–35.9% [ 14 , 15 , 16 ]. Recent large clinical trials compare the effectiveness of SLT as first-line treatment option for glaucoma compared to topical medications and have found better outcomes with SLT [ 17 , 18 ]. Gus-Gazzard and his colleagues reported findings of the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial [ 17 ], a multicenter randomized controlled trial comparing selective laser trabeculoplasty to topical medication as a first-line treatment for ocular hypertension and open angle glaucoma. It was found that glaucoma progression occurred in a lower proportion of those who has SLT first compared to those who had medicine first. Furthermore, over 36months, IOP control was better in the laser-first group and the overall cost of treatment was lower in the laser group with lower number of medications required. Hence the LiGHT study results support and strongly advocates for the use of SLT as primary treatment for POAG and ocular hypertension. The majority (68.2%) of the study patients in the LiGHT trial were European whites hence it may be argued that these findings may only be generalized among such patients however existing literature on SLT in African-derived people have reported mean IOP reductions at 12 months ranging from 30–40% [ 19 – 22 ], with 80% -90% of patients maintaining IOP reduction of 20% 1 year after treatment. SLT is gaining acceptance as a primary treatment in glaucoma however barriers to its widespread use such as initial cost of procedure, equipment availability and training deficiencies may hinder implementation. [ 23 ] Few published Studies in Nigeria have assessed the efficacy of selective laser trabeculoplasty as first line treatment in glaucoma management and to the best of our knowledge no published study on the subject exist in south eastern Nigeria found to have a high burden of glaucoma in the country.[ 24 ] This is however the first clinical study in south eastern Nigeria exploring the use of SLT in treatment-naïve eyes of glaucoma patients. The objective of this study is to assess the efficacy of SLT as primary treatment in clinical care of black patients with glaucoma in south east Nigeria using data collected from patients’ medical records. METHODS Study Design and Setting This retrospective chart review evaluated the efficacy of Selective Laser Trabeculoplasty (SLT) as a primary treatment for open-angle glaucoma in patients treated at The Eye Specialists Hospital, Enugu, Nigeria, from 2019 to 2021. The study aimed to assess SLT's efficacy in reducing intraocular pressure (IOP). Study Participants Eligible patients’ case notes were retrieved from theatre records for data collection. Inclusion criteria encompassed patients with open-angle glaucoma, including primary open-angle glaucoma (POAG), juvenile open-angle glaucoma (JOAG), or normal-tension glaucoma (NTG), with a minimum follow-up of three months. The sample size of 116 eyes from 64 patients was determined by the availability of complete medical records meeting these criteria within the study period. Of these, 80% (93 eyes) were treatment-naïve, while 20% (23 eyes) previously on antiglaucoma medications underwent a 4–6-week wash-out period with non-steroidal anti-inflammatory drugs (NSAIDs) before SLT. Patients with less than three months of follow-up were excluded. Baseline characteristics included age, sex, glaucoma severity (assessed via visual acuity and/or mean deviation on automated Humphrey visual field), SLT treatment details, and baseline IOP (defined as the last measurement before SLT). Intervention SLT was performed by a single surgeon (either one of the authors) using a Q-switched, frequency-doubled 532 nm Nd:YAG laser (Selecta Duet, Lumenis, Israel) with a 400 µm spot size and 3-nanosecond pulse duration. The protocol involved 100–120 applications across 360° of the anterior chamber angle, with 25 spots per quadrant at an energy level of 0.8–1.2 mJ. Patients received a pretreatment drop of Brimonidine or Apraclonidine 0.2%. Outcome Measures Primary outcomes were changes in IOP and the number of antiglaucoma medications post-SLT. Secondary outcomes included treatment success rates over time and additional glaucoma procedures post-SLT. Outcomes were assessed at 3, 6, 9, 12, 18, 24, and 36 months, using time windows of ± 1–2 weeks due to the retrospective design. Success was defined as either: (1) IOP reduction of ≥ 3 mmHg without additional interventions (e.g., glaucoma surgery), or (2) IOP reduction of ≥ 20% from baseline. Statistical Analysis Data were analyzed using the Statistical Package for Social Sciences (SPSS) software version 26.0 (SPSS, Inc., Chicago, IL, USA). Continuous variables were summarized as means and standard deviations, and categorical variables as frequencies and percentages. Group comparisons used the chi-square test for categorical data and Student’s T-test for continuous data. Statistical significance was set at P < 0.05. Due to the retrospective nature of the study, IOP measurements were not standardized across patients, and no formal power calculation was performed to determine the sample size, as it was based on available records. This limitation is acknowledged, and the sample size is comparable to similar retrospective studies in African populations [ 22 , 25 ]. Ethical Considerations Ethical approval was obtained from the Ethical Committee of the College of Medicine, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla Enugu (Reference number: UNTH/HREC/2024/04/951). The Committee waived the requirement for informed consent due to the retrospective nature of the study, which utilised existing medical records. No personal identifiers of participants were collected or included in the analysis. The study adhered to good clinical practice guidelines and the principles of the Declaration of Helsinki. RESULTS Baseline Characteristics A total of 116 eyes from 64 patients (31 males [48.4%], 33 females [51.6%]) were included, with a mean age of 52.8 ± 16.5 years (range: 12–83 years). All eyes had a minimum follow-up of 3 months. Diagnoses included primary open-angle glaucoma (POAG; 65 eyes [56.0%]), normal-tension glaucoma (NTG; 41 eyes [35.4%]), and juvenile open-angle glaucoma (JOAG; 10 eyes [8.6%]). Glaucoma severity was mild to moderate in 103 eyes (88.8%) and advanced in 13 eyes (11.2%). All eyes were treatment-naïve at baseline, with no antiglaucoma medications used prior to SLT (Table 1 ). Table 1 Baseline characteristics of patients which had SLT Characteristic Value Mean age (SD) years 52.8(16.5) Sex, n (%) Male 31(48.4%) Female 33(51.6%) Diagnosis, n (%) POAG 65(56.0%) NTG 41(35.4%) JOAG 10(8.6%) Glaucoma severity, n (%) Mild-moderate 103(88.8%) Advanced 13(11.2%) Number of antiglaucoma medication 0 (100%) Intraocular Pressure Changes Over Time The mean baseline IOP was 17.0 ± 5.0 mmHg (range: 8.0–40.0 mmHg). Post-SLT, mean IOP decreased significantly at all time points ( P < 0.05). At 3, 6, 12, 24, and 36 months, mean IOP values were 13.5 ± 4.5 mmHg (23.1% reduction), 12.5 ± 3.4 mmHg (26.3%), 12.2 ± 3.2 mmHg (28.2%), 12.8 ± 3.0 mmHg (25.0%), and 15.3 ± 6.4 mmHg (20.3%), respectively. The number of eyes decreased over time due to loss to follow-up: 116 at 3 months, 86 at 6 months, 74 at 12 months, 27 at 24 months, and 16 at 36 months. Table 2 summarizes IOP changes, and Fig. 1 illustrates the trend over time. Table 2 Intraocular Pressure Changes Over Time Time Number of Eyes Mean IOP ± SD (mmHg) Mean IOP Drop ± SD (mmHg) Mean % IOP Drop ± SD P -value Pre-treatment 116 17.0 ± 5.0 - - - 3 months 116 13.5 ± 4.5 3.94 ± 2.6 23.1 ± 12.8 < 0.001* 6 months 86 12.5 ± 3.4 4.71 ± 2.6 26.3 ± 18.6 < 0.001* 12 months 74 12.2 ± 3.2 4.67 ± 2.0 28.2 ± 16.9 < 0.001* 24 months 27 12.8 ± 3.0 5.10 ± 2.3 25.0 ± 18.7 < 0.001* 36 months 16 15.3 ± 6.4 4.06 ± 1.0 20.3 ± 12.1 0.018* *P-value < 0.05 was considered significant Subgroup Analysis by Glaucoma Severity Subgroup analysis compared IOP changes between mild-moderate (103 eyes) and advanced (13 eyes) glaucoma. Baseline IOP was significantly higher in advanced glaucoma (20.0 ± 9.1 mmHg) than in mild-moderate glaucoma (16.6 ± 4.2 mmHg; P = 0.020). Both groups showed significant IOP reductions at 3 and 12 months ( P < 0.05). At 24 months, advanced glaucoma eyes had a lower mean IOP (10.4 ± 2.5 mmHg) compared to mild-moderate (13.2 ± 2.9 mmHg; P = 0.008). At 36 months, only one advanced glaucoma eye remained in follow-up (IOP: 36.5 mmHg), precluding statistical comparison (Table 3 ). Table 3 Subgroup Analysis of Mean IOP Changes by Glaucoma Severity Time N Mild-Moderate glaucoma Mean IOP ± SD N Advanced Glaucoma Mean IOP ± SD p-value Pre-treatment 103 16.6 ± 4.2 13 20.0 ± 9.1 0.020* 3months 103 12.7 ± 3.9 13 16.6 ± 6.6 0.002* 6months 76 12.7 ± 3.4 10 11.1 ± 2.5 0.111 12months 64 12.4 ± 3.3 10 10.9 ± 2.0 0.006* 24months 23 13.2 ± 2.9 4 10.4 ± 2.5 0.008* 36months 15 13.9 ± 3.1 1 36.5 - *P-value < 0.05 was considered significant Antiglaucoma Medication Use At baseline, all 116 eyes used no antiglaucoma medications. Post-SLT, the mean number of medications increased significantly ( P < 0.05): 0.31 ± 0.67 (range: 0–3) at 3 months, 0.47 ± 0.87 (range: 0–4) at 6 months, 0.74 ± 1.13 (range: 0–4) at 12 months, 0.97 ± 1.07 (range: 0–4) at 24 months, and 1.25 ± 1.34 (range: 0–4) at 36 months (Table 4 ). Table 4 Mean Number of Antiglaucoma Medications Over Time Time Mean Number of Medications ± SD Range P -value Pre-treatment 0.00 ± 0.00 - - 3 months 0.31 ± 0.67 0–3 < 0.001* 6 months 0.47 ± 0.87 0–4 < 0.001* 12 months 0.74 ± 1.13 0–4 < 0.001* 24 months 0.97 ± 1.07 0–4 < 0.001* 36 months 1.25 ± 1.34 0–4 0.002* *P-value < 0.05 was considered significant Success Rates Kaplan-Meier survival analysis estimated cumulative success rates based on two criteria: (1) IOP reduction ≥ 3 mmHg without additional interventions, or (2) IOP reduction ≥ 20% from baseline. Success rates were 82.8% at 3 months, 75.9% at 6 months, 64.2% at 12 months, 53.5% at 24 months, and 43.8% at 36 months. Figure 2 illustrates the survival curve over time. Additional Glaucoma Procedures During follow-up, 16 eyes (13.8%) received repeat SLT, and 2 eyes (1.7%) underwent trabeculectomy after 12 months post-SLT. DISCUSSION This study, the first to evaluate Selective Laser Trabeculoplasty (SLT) as a primary treatment for open-angle glaucoma in southeastern Nigeria, demonstrates its effectiveness in reducing intraocular pressure (IOP) over 36 months. The mean IOP decreased from 17.0 ± 5.0 mmHg at baseline to 12.2 ± 3.2 mmHg at 12 months (28.2% reduction) and 15.3 ± 6.4 mmHg at 36 months (20.3% reduction), with all reductions statistically significant ( P < 0.05). Success rates, defined as IOP reduction of ≥ 3 mmHg or ≥ 20% from baseline without additional interventions, were 82.8% at 3 months, 64.2% at 12 months, and 43.8% at 36 months. Notably, eyes with higher baseline IOP (e.g., advanced glaucoma, 20.0 ± 9.1 mmHg) showed greater reductions, up to 50% at 12 months. The need for antiglaucoma medications increased from 0 at baseline to 1.25 ± 1.34 at 36 months, and only 13.8% of eyes required repeat SLT, with 1.7% needing trabeculectomy. The IOP reductions observed in this study are consistent with, but slightly lower than, those reported in other African and African-derived populations. The West Indies Glaucoma Laser Study (WIGLS) reported a 12-month IOP drop of 6.4–8.5 mmHg among Afro-Caribbeans with higher baseline IOP (20.9–26.8 mmHg) [ 20 ]. Similarly, a prospective study in Egypt found a 7.4 mmHg reduction with a baseline IOP of 26.8 mmHg [ 26 ], and Melamed et al. reported a 7.7 mmHg drop [ 16 ]. A South African retrospective study with a baseline IOP of 27.07 mmHg achieved a 13-mmHg reduction [ 25 ]. The lower baseline IOP in our study (17.0 mmHg) likely explains the smaller reductions, as higher pre-treatment IOP is associated with greater SLT efficacy [ 26 , 27 ]. In contrast, a Western Nigerian study with a baseline IOP of 15.4 mmHg reported smaller reductions (3.5 mmHg at 3 months, 2.8 mmHg at 6 months) [ 28 ], suggesting regional variations in response. The increase in antiglaucoma medication use (0.74 ± 1.13 at 12 months, 1.25 ± 1.34 at 36 months) aligns with findings from Goosen et al., who reported a rise from 0 to 1.7 medications at 12 months with a higher baseline IOP (27.07 mmHg) [ 25 ]. The lower medication use in our study may reflect the milder baseline IOP, reducing the need for aggressive supplementation. Success rates in our study (64.2% at 12 months) are comparable to Weinand et al. (50% failure at 24 months) [ 29 ] and Bovell et al. [ 30 ], though our high loss to follow-up (86.2% at 36 months) may affect long-term estimates. The low rate of additional procedures (13.8% repeat SLT, 1.7% trabeculectomy) supports SLT’s role as a sustainable primary treatment, consistent with the LiGHT trial’s findings of reduced surgical needs [ 17 ]. SLT’s effectiveness in this Nigerian population, particularly for patients with higher baseline IOP, supports its use as a primary treatment in resource-limited settings. The minimal need for additional procedures and moderate increase in medication use suggest SLT can reduce treatment burden compared to lifelong topical therapy, which is often plagued by cost, availability, and adherence issues in sub-Saharan Africa [ 6 , 23 ]. The ability to repeat SLT without permanent trabecular meshwork damage [ 13 ] further enhances its suitability for low-resource settings, where access to incisional surgery is limited [ 24 , 31 ]. These findings advocate for increased adoption of SLT in Nigeria, particularly in regions with high glaucoma prevalence. This study has several limitations. The retrospective design led to significant loss to follow-up (86.2% at 36 months), potentially introducing bias in long-term success rate estimates. IOP measurements were not standardized across patients or time points, as they were not taken at consistent times of day or by the same examiner, which may affect reliability. The absence of a formal power calculation, due to the retrospective reliance on available records, limits the ability to assess statistical power. The sample size (116 eyes of 64 patients) is comparable to similar studies [ 22 , 25 ], but a larger, prospective study could provide more robust data. Additionally, the study did not assess visual field progression or quality of life, limiting its scope to IOP outcomes. Future research should focus on prospective, randomized controlled trials in southeastern Nigeria to confirm SLT’s efficacy and assess long-term outcomes, including visual field preservation and patient quality of life. Standardizing IOP measurements and reducing loss to follow-up through better patient retention strategies could enhance reliability. Exploring the cost-effectiveness of SLT in Nigeria, as suggested by the LiGHT trial [ 17 ], could further support its integration into national glaucoma management protocols. Studies comparing SLT with topical medications in this population would also clarify its role as a first-line treatment. CONCLUSION Selective Laser Trabeculoplasty (SLT) is an effective primary treatment for open-angle glaucoma in Nigerian patients, achieving significant intraocular pressure (IOP) reductions over 36 months, particularly in eyes with higher baseline IOP. With a cumulative success rate of 64.2% at 12 months and minimal need for additional medications or surgery, SLT offers a sustainable option for glaucoma management in resource-limited settings like southeastern Nigeria. These findings support its integration into local treatment protocols to address the high burden of glaucoma. Abbreviations IOP : Intraocular Pressure JOAG : Juvenile Open-Angle Glaucoma LiGHT : Laser in Glaucoma and Ocular Hypertension NTG : Normal-Tension Glaucoma NSAIDs : Non-Steroidal Anti-Inflammatory Drugs POAG : Primary Open-Angle Glaucoma SD : Standard Deviation SLT : Selective Laser Trabeculoplasty SPSS : Statistical Package for the Social Sciences UNTH : University of Nigeria Teaching Hospital WIGLS : West Indies Glaucoma Laser Study Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ethical Committee of the College of Medicine, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla Enugu (Reference number: UNTH/HREC/2024/04/951). The Committee waived the requirement for informed consent due to the retrospective nature of the study, which utilised existing medical records. No personal identifiers of participants were collected or included in the analysis. The study adhered to good clinical practice guidelines and the principles of the Declaration of Helsinki. Consent for publication Not Applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare that they have no competing interests Funding Not applicable Authors’ contributions All authors contributed to the study’s conception and design. Data collection and analysis were performed by N.N. K, S.O, C.O, N.U. and O. J. S. The manuscript was drafted by N.K and S.O and all authors reviewed and approved the final manuscript. The corresponding author is N. N.K Acknowledgements Not applicable. References Callahan C, Sassani J, Glaucoma. Foundation. Duane’s Foundation of Clinical Ophthalmology. Volume 3. Philadelphia: Lippincott Williams & Wilkins; 2000. Migdal C, Gregory W, Hitchings R. Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma. Ophthalmology. 1994;101(10):1651–6. 10.1016/s0161-6420(94)31120-1 . discussion 1657. Quigley HA, Glaucoma. Lancet. 2011;377(9774):1367–77. 10.1016/S0140-6736(10)61423-7 . American Academy of Ophthalmology. Glaucoma. Basic Clinical Science Course Section 10. 3rd ed. San Francisco: American Academy of Ophthalmology; 2012. p. 167. Prum BE Jr, Rosenberg LF, Gedde SJ, Mansberger SL, Stein JD, Moroi SE, Herndon LW Jr, Lim MC, Williams RD. Primary Open-Angle Glaucoma Preferred Practice Pattern(®) Guidelines. Ophthalmology. 2016;123(1):P41–111. 10.1016/j.ophtha.2015.10.053 . Reardon G, Kotak S, Schwartz GF. Objective assessment of compliance and persistence among patients treated for glaucoma and ocular hypertension: a systematic review. Patient Prefer Adherence. 2011;5:441–63. 10.2147/PPA.S23780 . The Glaucoma Laser Trial (GLT). 2. Results of argon laser trabeculoplasty versus topical medicines. The Glaucoma Laser Trial Research Group. Ophthalmology. 1990;97(11):1403–13. 10.1016/S0161-6420(90)32402-8 . Shingleton BJ, Richter CU, Dharma SK, Tong L, Bellows AR, Hutchinson BT, et al. Long-term efficacy of argon laser trabeculoplasty. A 10-year follow-up study. Ophthalmology. 1993;100(9):1324–9. 10.1016/S0161-6420(93)31492-7 . Latina MA, Sibayan SA, Shin DH, Noecker RJ, Marcellino G. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998;105(11):2082–8. 10.1016/S0161-6420(98)91129-0 . Wong MO, Lee JW, Choy BN, Chan JC, Lai JS. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol. 2015;60(1):36–50. 10.1016/j.survophthal.2014.06.006 . McAlinden C. Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review. Eye. 2014;28(3):249–58. 10.1038/eye.2013.267 . Leahy KE, White AJ. Selective laser trabeculoplasty: current perspectives. Clin Ophthalmol. 2015;9:833–41. 10.2147/OPTH.S79294 . Garg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye. 2018;32(5):863–76. 10.1038/s41433-017-0021-2 . Realini T. Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia. JAMA Ophthalmol. 2013;131(3):321–7. 10.1001/jamaophthalmol.2013.1706 . Wong MO, Lee JW, Choy BN, Chan JC, Lai JS. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol. 2015;60(1):36–50. 10.1016/j.survophthal.2014.06.006 . Melamed S, Ben Simon GJ, Levkovitch-Verbin H. Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study. Arch Ophthalmol. 2003;121(7):957–60. 10.1001/archopht.121.7.957 . Gazzard G, Konstantakopoulou E, Garway-Heath D, Adeleke M, Vickerstaff V, Ambler G, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505–16. 10.1016/S0140-6736(18)32213-X . Modi CR, Solu TM, Korat D, Mavani J, Rana JU. Evaluation of the effectiveness of selective laser trabeculoplasty (SLT) in patients with open angle glaucoma. Int J Ocular Oncol Oculoplasty. 2020;6(3):147–51. 10.18231/j.ijooo.2020.038 . Realini T. Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia. JAMA Ophthalmol. 2013;131(3):321–7. 10.1001/jamaophthalmol.2013.1706 . Realini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. West Indies Glaucoma Laser Study (WIGLS): 1. 12-month efficacy of selective laser trabeculoplasty in Afro-Caribbeans with glaucoma. Am J Ophthalmol. 2017;184:28–33. 10.1016/j.ajo.2017.09.029 . Seck SM, Agboton G, Dieng M, Ndiaye Sow MN, Diakhate M, Gueye NN, Seck CM, Lam A. La trabéculoplastie au laser sélectif (TLS) : notre expérience chez le noir africain [Selective laser trabeculoplasty (SLT): our experience in African blacks]. J Fr Ophtalmol. 2015;38(3):238 – 46. French. 10.1016/j.jfo.2014.11.002 Goosen E, Coleman K, Visser L, Sponsel WE. Racial differences in selective laser trabeculoplasty efficacy. J Curr Glaucoma Pract. 2017;11(1):22–7. 10.5005/jp-journals-10008-1218 . Alwazae M, Alhumud A, Alsarhan S, Aljasim LA. Acceptance of selective laser trabeculoplasty as a first-line treatment for primary open-angle glaucoma in Saudi Arabia. Cureus. 2024;16(3):e52360. 10.7759/cureus.52360 . Kyari F, Wormald R, Murthy GVS, Evans JR, Gilbert CE. Ethnicity and deprivation are associated with blindness among adults with primary glaucoma in Nigeria. J Glaucoma. 2016;25(10):e861–72. 10.1097/IJG.0000000000000492 . Goosen E, Visser L, Sartorius B. Selective laser trabeculoplasty in primary open-angle glaucoma: primary versus secondary treatment outcomes. Afr Vis Eye Health. 2016;75(1):a338. 10.4102/aveh.v75i1.338 . Realini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. Long-Term Outcomes of Selective Laser Trabeculoplasty for Open-Angle Glaucoma in the Caribbean. Am J Ophthalmol. 2021;232:83–9. 10.1016/j.ajo.2021.06.012 . Realini T, Olawoye O, Kizor-Akaraiwe N, Manji S, Sit A. The Rationale for Selective Laser Trabeculoplasty in Africa. Asia Pac J Ophthalmol (Phila). 2018 Nov-Dec;7(6):387–93. 10.22608/APO.2018271 . Onakoya AO, Abikoye TM, Onyekwelu OM, Olowoyeye AO. Comparison of intraocular pressure reduction of initial and adjunct selective laser trabeculoplasty for primary open angle glaucoma in Nigerians. Niger J Ophthalmol. 2015;23:7–11. Weinand FS, Althen F. Long-term clinical results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma. Eur J Ophthalmol. 2006;16(1):100–4. 10.1177/112067210601600116 . Bovell AM, Damji KF, Hodge WG, Rock WJ, Buhrmann R, Pan YI. Long term effects on the lowering of intraocular pressure: selective laser or argon laser trabeculoplasty? Can J Ophthalmol. 2011;46(5):408–13. 10.1016/j.jcjo.2011.07.016 . Waisbourd M, Katz LJ. Selective laser trabeculoplasty as a first-line therapy: a review. Can J Ophthalmol. 2014;49(6):519–22. 10.1016/j.jcjo.2014.10.003 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Feb, 2026 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 24 Sep, 2025 Reviews received at journal 17 Sep, 2025 Reviews received at journal 01 Sep, 2025 Reviewers agreed at journal 25 Aug, 2025 Reviewers agreed at journal 22 Aug, 2025 Reviewers invited by journal 18 Aug, 2025 Editor assigned by journal 06 Aug, 2025 Editor invited by journal 05 Aug, 2025 Submission checks completed at journal 04 Aug, 2025 First submitted to journal 04 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7259184","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504230734,"identity":"8254a8b1-d090-4924-9897-981dbc66a555","order_by":0,"name":"Nkiru Nwamaka Kizor-Akaraiwe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYFACNhAhwcDA3gCkDSxI0cJzAKRFgmgtIF0JUL2EgDn7scTPFTUWif2Sz69u+FEgwcDf3p2AV4tlT9phyTPHJBJnzs4pu9kDdJjEmbMb8GoxOJDeINnAJpG74XZO2g0eoBYDIBu/lvPPm382/JPI3X/zTNrNP0RpuZF2TLKxDahMgv3YbeJsufEszbKxT6J+xpkcttsyBhI8hP1yPs34ZsO3OmP+9uPPbr75YyPH396LXwsS4DEAk8QqBwH2B6SoHgWjYBSMghEEAEbnSU+kziv9AAAAAElFTkSuQmCC","orcid":"","institution":"Enugu State University of Technology","correspondingAuthor":true,"prefix":"","firstName":"Nkiru","middleName":"Nwamaka","lastName":"Kizor-Akaraiwe","suffix":""},{"id":504230735,"identity":"8411d5de-03ca-486a-8d59-0fc509a5374e","order_by":1,"name":"Suhanyah Okeke","email":"","orcid":"","institution":"Enugu State University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Suhanyah","middleName":"","lastName":"Okeke","suffix":""},{"id":504230736,"identity":"fc4c37e8-48c9-4a28-8c26-e31fb9c3ea34","order_by":2,"name":"Chukwu Oko","email":"","orcid":"","institution":"Enugu State University Teaching Hospital Parklane","correspondingAuthor":false,"prefix":"","firstName":"Chukwu","middleName":"","lastName":"Oko","suffix":""},{"id":504230737,"identity":"cb58cd98-e9a9-4bd5-a092-c0ec546a042e","order_by":3,"name":"Nkechi Uche","email":"","orcid":"","institution":"University of Nigeria Teaching Hospital Ituku Ozalla","correspondingAuthor":false,"prefix":"","firstName":"Nkechi","middleName":"","lastName":"Uche","suffix":""},{"id":504230738,"identity":"8c3caf06-a814-4bed-bca5-bc8d9aa60ed3","order_by":4,"name":"Obinna Jude Shiweobi","email":"","orcid":"","institution":"Alex Ekwueme University Teaching Hospital, Abakaliki","correspondingAuthor":false,"prefix":"","firstName":"Obinna","middleName":"Jude","lastName":"Shiweobi","suffix":""}],"badges":[],"createdAt":"2025-07-31 07:23:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7259184/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7259184/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-026-04665-4","type":"published","date":"2026-02-14T15:58:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89990412,"identity":"48a2a0ce-e9f7-4bd2-a3ce-c8d69e23b5ac","added_by":"auto","created_at":"2025-08-27 07:12:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24302,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMean IOP Over Time Post-SLT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLine graph showing mean IOP from baseline to 36 months post-SLT, demonstrating significant reductions at all time points\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7259184/v1/ed2dd3519c9e9cc6c0946609.png"},{"id":89988414,"identity":"2f8f982d-1625-4152-89bf-541265f2f4a6","added_by":"auto","created_at":"2025-08-27 07:04:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":40918,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCumulative Success Rates Post-SLT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKaplan-Meier survival curve showing the proportion of eyes maintaining success (IOP reduction ≥3 mmHg or ≥20% from baseline) from 3 to 36 months post-SLT.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7259184/v1/af20f896f21e52217e66e1d8.png"},{"id":102785283,"identity":"15f9c609-0181-499b-8982-1871554676d1","added_by":"auto","created_at":"2026-02-16 16:04:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1004490,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7259184/v1/459a96bd-192f-4755-998c-db82fe7b1465.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Real world outcomes of Selective Laser Trabeculoplasty as Primary Treatment for glaucoma in Enugu Nigeria: A Retrospective study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eGlaucoma is a progressive, multifactorial disease characterized by damage to the optic nerve, often associated with elevated intraocular pressure (IOP)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. After glaucoma diagnosis, the clinician is mostly concerned with lowering the IOP to safe limits where further damage is averted using available treatment options [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The Treatment option adopted is usually one which would efficiently reduce the IOP with maximal safety considering the severity, type and age of patient amidst other factors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe use of topical medication has traditionally remained first-line treatment options in many countries including the United States of America despite recent advances in laser and surgical techniques in glaucoma management [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, issues of poor adherence, cost, unavailability of drugs and side effects has persistently plagued the effective use of medical therapy in glaucoma management especially in developing countries [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLaser trabeculoplasty introduced more than 20years ago featured the use of argon laser trabeculoplasty which produced lower IOPs and better visual fields compared to fellow eyes first treated with topical medication in the Glaucoma Laser Trial [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The selective laser trabeculoplasty (SLT) got along in 1995 and has been found to produce better IOP outcomes with less damage to the trabecular meshwork and fewer side effects [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. SLT is an advanced laser procedure often used for managing primary open-angle glaucoma (POAG) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It is a non-invasive technique that selectively targets the trabecular meshwork to improve aqueous humor outflow reducing IOP, which is essential in halting glaucoma progression [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe success rate of SLT in lowering intraocular pressure has been found to range from 6.9–35.9% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Recent large clinical trials compare the effectiveness of SLT as first-line treatment option for glaucoma compared to topical medications and have found better outcomes with SLT [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Gus-Gazzard and his colleagues reported findings of the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], a multicenter randomized controlled trial comparing selective laser trabeculoplasty to topical medication as a first-line treatment for ocular hypertension and open angle glaucoma. It was found that glaucoma progression occurred in a lower proportion of those who has SLT first compared to those who had medicine first. Furthermore, over 36months, IOP control was better in the laser-first group and the overall cost of treatment was lower in the laser group with lower number of medications required. Hence the LiGHT study results support and strongly advocates for the use of SLT as primary treatment for POAG and ocular hypertension. The majority (68.2%) of the study patients in the LiGHT trial were European whites hence it may be argued that these findings may only be generalized among such patients however existing literature on SLT in African-derived people have reported mean IOP reductions at 12 months ranging from 30–40% [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e–\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], with 80% -90% of patients maintaining IOP reduction of 20% 1 year after treatment.\u003c/p\u003e\u003cp\u003eSLT is gaining acceptance as a primary treatment in glaucoma however barriers to its widespread use such as initial cost of procedure, equipment availability and training deficiencies may hinder implementation. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Few published Studies in Nigeria have assessed the efficacy of selective laser trabeculoplasty as first line treatment in glaucoma management and to the best of our knowledge no published study on the subject exist in south eastern Nigeria found to have a high burden of glaucoma in the country.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] This is however the first clinical study in south eastern Nigeria exploring the use of SLT in treatment-naïve eyes of glaucoma patients. The objective of this study is to assess the efficacy of SLT as primary treatment in clinical care of black patients with glaucoma in south east Nigeria using data collected from patients’ medical records.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cb\u003eStudy Design and Setting\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis retrospective chart review evaluated the efficacy of Selective Laser Trabeculoplasty (SLT) as a primary treatment for open-angle glaucoma in patients treated at The Eye Specialists Hospital, Enugu, Nigeria, from 2019 to 2021. The study aimed to assess SLT's efficacy in reducing intraocular pressure (IOP).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEligible patients’ case notes were retrieved from theatre records for data collection. Inclusion criteria encompassed patients with open-angle glaucoma, including primary open-angle glaucoma (POAG), juvenile open-angle glaucoma (JOAG), or normal-tension glaucoma (NTG), with a minimum follow-up of three months. The sample size of 116 eyes from 64 patients was determined by the availability of complete medical records meeting these criteria within the study period. Of these, 80% (93 eyes) were treatment-naïve, while 20% (23 eyes) previously on antiglaucoma medications underwent a 4–6-week wash-out period with non-steroidal anti-inflammatory drugs (NSAIDs) before SLT. Patients with less than three months of follow-up were excluded. Baseline characteristics included age, sex, glaucoma severity (assessed via visual acuity and/or mean deviation on automated Humphrey visual field), SLT treatment details, and baseline IOP (defined as the last measurement before SLT).\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSLT was performed by a single surgeon (either one of the authors) using a Q-switched, frequency-doubled 532 nm Nd:YAG laser (Selecta Duet, Lumenis, Israel) with a 400 µm spot size and 3-nanosecond pulse duration. The protocol involved 100–120 applications across 360° of the anterior chamber angle, with 25 spots per quadrant at an energy level of 0.8–1.2 mJ. Patients received a pretreatment drop of Brimonidine or Apraclonidine 0.2%.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcome Measures\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePrimary outcomes were changes in IOP and the number of antiglaucoma medications post-SLT. Secondary outcomes included treatment success rates over time and additional glaucoma procedures post-SLT. Outcomes were assessed at 3, 6, 9, 12, 18, 24, and 36 months, using time windows of ± 1–2 weeks due to the retrospective design. Success was defined as either: (1) IOP reduction of ≥ 3 mmHg without additional interventions (e.g., glaucoma surgery), or (2) IOP reduction of ≥ 20% from baseline.\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using the Statistical Package for Social Sciences (SPSS) software version 26.0 (SPSS, Inc., Chicago, IL, USA). Continuous variables were summarized as means and standard deviations, and categorical variables as frequencies and percentages. Group comparisons used the chi-square test for categorical data and Student’s T-test for continuous data. Statistical significance was set at \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05. Due to the retrospective nature of the study, IOP measurements were not standardized across patients, and no formal power calculation was performed to determine the sample size, as it was based on available records. This limitation is acknowledged, and the sample size is comparable to similar retrospective studies in African populations [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e was obtained from the Ethical Committee of the College of Medicine, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla Enugu (Reference number: UNTH/HREC/2024/04/951). The Committee waived the requirement for informed consent due to the retrospective nature of the study, which utilised existing medical records. No personal identifiers of participants were collected or included in the analysis. The study adhered to good clinical practice guidelines and the principles of the Declaration of Helsinki.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cb\u003eBaseline Characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 116 eyes from 64 patients (31 males [48.4%], 33 females [51.6%]) were included, with a mean age of 52.8\u0026thinsp;\u0026plusmn;\u0026thinsp;16.5 years (range: 12\u0026ndash;83 years). All eyes had a minimum follow-up of 3 months. Diagnoses included primary open-angle glaucoma (POAG; 65 eyes [56.0%]), normal-tension glaucoma (NTG; 41 eyes [35.4%]), and juvenile open-angle glaucoma (JOAG; 10 eyes [8.6%]). Glaucoma severity was mild to moderate in 103 eyes (88.8%) and advanced in 13 eyes (11.2%). All eyes were treatment-na\u0026iuml;ve at baseline, with no antiglaucoma medications used prior to SLT (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of patients which had SLT\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean age (SD) years\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.8(16.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31(48.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(51.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiagnosis, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOAG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65(56.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNTG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(35.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJOAG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(8.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGlaucoma severity, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild-moderate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e103(88.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdvanced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(11.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of antiglaucoma medication\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntraocular Pressure Changes Over Time\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe mean baseline IOP was 17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 mmHg (range: 8.0\u0026ndash;40.0 mmHg). Post-SLT, mean IOP decreased significantly at all time points (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). At 3, 6, 12, 24, and 36 months, mean IOP values were 13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 mmHg (23.1% reduction), 12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 mmHg (26.3%), 12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 mmHg (28.2%), 12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 mmHg (25.0%), and 15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4 mmHg (20.3%), respectively. The number of eyes decreased over time due to loss to follow-up: 116 at 3 months, 86 at 6 months, 74 at 12 months, 27 at 24 months, and 16 at 36 months. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes IOP changes, and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the trend over time.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntraocular Pressure Changes Over Time\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of Eyes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean IOP\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (mmHg)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean IOP Drop\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (mmHg)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean % IOP Drop\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;16.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;18.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.3\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.018*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003e*P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSubgroup Analysis by Glaucoma Severity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSubgroup analysis compared IOP changes between mild-moderate (103 eyes) and advanced (13 eyes) glaucoma. Baseline IOP was significantly higher in advanced glaucoma (20.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1 mmHg) than in mild-moderate glaucoma (16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 mmHg; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020). Both groups showed significant IOP reductions at 3 and 12 months (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). At 24 months, advanced glaucoma eyes had a lower mean IOP (10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 mmHg) compared to mild-moderate (13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 mmHg; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008). At 36 months, only one advanced glaucoma eye remained in follow-up (IOP: 36.5 mmHg), precluding statistical comparison (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSubgroup Analysis of Mean IOP Changes by Glaucoma Severity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMild-Moderate glaucoma\u003c/p\u003e\u003cp\u003eMean IOP\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAdvanced Glaucoma\u003c/p\u003e\u003cp\u003eMean IOP\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.020*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.111\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.006*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.008*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003e*P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAntiglaucoma Medication Use\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt baseline, all 116 eyes used no antiglaucoma medications. Post-SLT, the mean number of medications increased significantly (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05): 0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67 (range: 0\u0026ndash;3) at 3 months, 0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87 (range: 0\u0026ndash;4) at 6 months, 0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13 (range: 0\u0026ndash;4) at 12 months, 0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07 (range: 0\u0026ndash;4) at 24 months, and 1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34 (range: 0\u0026ndash;4) at 36 months (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean Number of Antiglaucoma Medications Over Time\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean Number of Medications\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003e*P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003cp\u003e\u003cb\u003eSuccess Rates\u003c/b\u003e\u003c/p\u003e\n\u003cp\u003eKaplan-Meier survival analysis estimated cumulative success rates based on two criteria: (1) IOP reduction\u0026thinsp;\u0026ge;\u0026thinsp;3 mmHg without additional interventions, or (2) IOP reduction\u0026thinsp;\u0026ge;\u0026thinsp;20% from baseline. Success rates were 82.8% at 3 months, 75.9% at 6 months, 64.2% at 12 months, 53.5% at 24 months, and 43.8% at 36 months. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the survival curve over time.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdditional Glaucoma Procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDuring follow-up, 16 eyes (13.8%) received repeat SLT, and 2 eyes (1.7%) underwent trabeculectomy after 12 months post-SLT.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study, the first to evaluate Selective Laser Trabeculoplasty (SLT) as a primary treatment for open-angle glaucoma in southeastern Nigeria, demonstrates its effectiveness in reducing intraocular pressure (IOP) over 36 months. The mean IOP decreased from 17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 mmHg at baseline to 12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 mmHg at 12 months (28.2% reduction) and 15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4 mmHg at 36 months (20.3% reduction), with all reductions statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Success rates, defined as IOP reduction of \u0026ge;\u0026thinsp;3 mmHg or \u0026ge;\u0026thinsp;20% from baseline without additional interventions, were 82.8% at 3 months, 64.2% at 12 months, and 43.8% at 36 months. Notably, eyes with higher baseline IOP (e.g., advanced glaucoma, 20.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1 mmHg) showed greater reductions, up to 50% at 12 months. The need for antiglaucoma medications increased from 0 at baseline to 1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34 at 36 months, and only 13.8% of eyes required repeat SLT, with 1.7% needing trabeculectomy.\u003c/p\u003e\u003cp\u003eThe IOP reductions observed in this study are consistent with, but slightly lower than, those reported in other African and African-derived populations. The West Indies Glaucoma Laser Study (WIGLS) reported a 12-month IOP drop of 6.4\u0026ndash;8.5 mmHg among Afro-Caribbeans with higher baseline IOP (20.9\u0026ndash;26.8 mmHg) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similarly, a prospective study in Egypt found a 7.4 mmHg reduction with a baseline IOP of 26.8 mmHg [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and Melamed et al. reported a 7.7 mmHg drop [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A South African retrospective study with a baseline IOP of 27.07 mmHg achieved a 13-mmHg reduction [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The lower baseline IOP in our study (17.0 mmHg) likely explains the smaller reductions, as higher pre-treatment IOP is associated with greater SLT efficacy [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In contrast, a Western Nigerian study with a baseline IOP of 15.4 mmHg reported smaller reductions (3.5 mmHg at 3 months, 2.8 mmHg at 6 months) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], suggesting regional variations in response.\u003c/p\u003e\u003cp\u003eThe increase in antiglaucoma medication use (0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13 at 12 months, 1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34 at 36 months) aligns with findings from Goosen et al., who reported a rise from 0 to 1.7 medications at 12 months with a higher baseline IOP (27.07 mmHg) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The lower medication use in our study may reflect the milder baseline IOP, reducing the need for aggressive supplementation. Success rates in our study (64.2% at 12 months) are comparable to Weinand et al. (50% failure at 24 months) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and Bovell et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], though our high loss to follow-up (86.2% at 36 months) may affect long-term estimates. The low rate of additional procedures (13.8% repeat SLT, 1.7% trabeculectomy) supports SLT\u0026rsquo;s role as a sustainable primary treatment, consistent with the LiGHT trial\u0026rsquo;s findings of reduced surgical needs [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSLT\u0026rsquo;s effectiveness in this Nigerian population, particularly for patients with higher baseline IOP, supports its use as a primary treatment in resource-limited settings. The minimal need for additional procedures and moderate increase in medication use suggest SLT can reduce treatment burden compared to lifelong topical therapy, which is often plagued by cost, availability, and adherence issues in sub-Saharan Africa [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The ability to repeat SLT without permanent trabecular meshwork damage [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] further enhances its suitability for low-resource settings, where access to incisional surgery is limited [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. These findings advocate for increased adoption of SLT in Nigeria, particularly in regions with high glaucoma prevalence.\u003c/p\u003e\u003cp\u003eThis study has several limitations. The retrospective design led to significant loss to follow-up (86.2% at 36 months), potentially introducing bias in long-term success rate estimates. IOP measurements were not standardized across patients or time points, as they were not taken at consistent times of day or by the same examiner, which may affect reliability. The absence of a formal power calculation, due to the retrospective reliance on available records, limits the ability to assess statistical power. The sample size (116 eyes of 64 patients) is comparable to similar studies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], but a larger, prospective study could provide more robust data. Additionally, the study did not assess visual field progression or quality of life, limiting its scope to IOP outcomes.\u003c/p\u003e\u003cp\u003eFuture research should focus on prospective, randomized controlled trials in southeastern Nigeria to confirm SLT\u0026rsquo;s efficacy and assess long-term outcomes, including visual field preservation and patient quality of life. Standardizing IOP measurements and reducing loss to follow-up through better patient retention strategies could enhance reliability. Exploring the cost-effectiveness of SLT in Nigeria, as suggested by the LiGHT trial [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], could further support its integration into national glaucoma management protocols. Studies comparing SLT with topical medications in this population would also clarify its role as a first-line treatment.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eSelective Laser Trabeculoplasty (SLT) is an effective primary treatment for open-angle glaucoma in Nigerian patients, achieving significant intraocular pressure (IOP) reductions over 36 months, particularly in eyes with higher baseline IOP. With a cumulative success rate of 64.2% at 12 months and minimal need for additional medications or surgery, SLT offers a sustainable option for glaucoma management in resource-limited settings like southeastern Nigeria. These findings support its integration into local treatment protocols to address the high burden of glaucoma.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eIOP\u003c/strong\u003e: Intraocular Pressure\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eJOAG\u003c/strong\u003e: Juvenile Open-Angle Glaucoma\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLiGHT\u003c/strong\u003e: Laser in Glaucoma and Ocular Hypertension\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eNTG\u003c/strong\u003e: Normal-Tension Glaucoma\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eNSAIDs\u003c/strong\u003e: Non-Steroidal Anti-Inflammatory Drugs\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePOAG\u003c/strong\u003e: Primary Open-Angle Glaucoma\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSD\u003c/strong\u003e: Standard Deviation\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSLT\u003c/strong\u003e: Selective Laser Trabeculoplasty\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSPSS\u003c/strong\u003e: Statistical Package for the Social Sciences\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eUNTH\u003c/strong\u003e: University of Nigeria Teaching Hospital\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWIGLS\u003c/strong\u003e: West Indies Glaucoma Laser Study\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethical Committee of the College of Medicine, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla Enugu (Reference number: UNTH/HREC/2024/04/951). The Committee waived the requirement for informed consent due to the retrospective nature of the study, which utilised existing medical records. No personal identifiers of participants were collected or included in the analysis. The study adhered to good clinical practice guidelines and the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors’ contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study’s conception and design. Data collection and analysis were performed by N.N. K, S.O, C.O, N.U. and O. J. S. \u0026nbsp;The manuscript was drafted by N.K and S.O and all authors reviewed and approved the final manuscript. The corresponding author is N. N.K\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCallahan C, Sassani J, Glaucoma. Foundation. Duane\u0026rsquo;s Foundation of Clinical Ophthalmology. Volume 3. Philadelphia: Lippincott Williams \u0026amp; Wilkins; 2000.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMigdal C, Gregory W, Hitchings R. Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma. Ophthalmology. 1994;101(10):1651\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0161-6420(94)31120-1\u003c/span\u003e\u003cspan address=\"10.1016/s0161-6420(94)31120-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. discussion 1657.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQuigley HA, Glaucoma. Lancet. 2011;377(9774):1367\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(10)61423-7\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(10)61423-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican Academy of Ophthalmology. Glaucoma. Basic Clinical Science Course Section 10. 3rd ed. San Francisco: American Academy of Ophthalmology; 2012. p. 167.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrum BE Jr, Rosenberg LF, Gedde SJ, Mansberger SL, Stein JD, Moroi SE, Herndon LW Jr, Lim MC, Williams RD. Primary Open-Angle Glaucoma Preferred Practice Pattern(\u0026reg;) Guidelines. Ophthalmology. 2016;123(1):P41\u0026ndash;111. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ophtha.2015.10.053\u003c/span\u003e\u003cspan address=\"10.1016/j.ophtha.2015.10.053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReardon G, Kotak S, Schwartz GF. Objective assessment of compliance and persistence among patients treated for glaucoma and ocular hypertension: a systematic review. Patient Prefer Adherence. 2011;5:441\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/PPA.S23780\u003c/span\u003e\u003cspan address=\"10.2147/PPA.S23780\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Glaucoma Laser Trial (GLT). 2. Results of argon laser trabeculoplasty versus topical medicines. The Glaucoma Laser Trial Research Group. Ophthalmology. 1990;97(11):1403\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0161-6420(90)32402-8\u003c/span\u003e\u003cspan address=\"10.1016/S0161-6420(90)32402-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShingleton BJ, Richter CU, Dharma SK, Tong L, Bellows AR, Hutchinson BT, et al. Long-term efficacy of argon laser trabeculoplasty. A 10-year follow-up study. Ophthalmology. 1993;100(9):1324\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0161-6420(93)31492-7\u003c/span\u003e\u003cspan address=\"10.1016/S0161-6420(93)31492-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLatina MA, Sibayan SA, Shin DH, Noecker RJ, Marcellino G. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998;105(11):2082\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0161-6420(98)91129-0\u003c/span\u003e\u003cspan address=\"10.1016/S0161-6420(98)91129-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWong MO, Lee JW, Choy BN, Chan JC, Lai JS. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol. 2015;60(1):36\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.survophthal.2014.06.006\u003c/span\u003e\u003cspan address=\"10.1016/j.survophthal.2014.06.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcAlinden C. Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review. Eye. 2014;28(3):249\u0026ndash;58. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/eye.2013.267\u003c/span\u003e\u003cspan address=\"10.1038/eye.2013.267\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeahy KE, White AJ. Selective laser trabeculoplasty: current perspectives. Clin Ophthalmol. 2015;9:833\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/OPTH.S79294\u003c/span\u003e\u003cspan address=\"10.2147/OPTH.S79294\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarg A, Gazzard G. Selective laser trabeculoplasty: past, present, and future. Eye. 2018;32(5):863\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41433-017-0021-2\u003c/span\u003e\u003cspan address=\"10.1038/s41433-017-0021-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRealini T. Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia. JAMA Ophthalmol. 2013;131(3):321\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamaophthalmol.2013.1706\u003c/span\u003e\u003cspan address=\"10.1001/jamaophthalmol.2013.1706\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWong MO, Lee JW, Choy BN, Chan JC, Lai JS. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma. Surv Ophthalmol. 2015;60(1):36\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.survophthal.2014.06.006\u003c/span\u003e\u003cspan address=\"10.1016/j.survophthal.2014.06.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMelamed S, Ben Simon GJ, Levkovitch-Verbin H. Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study. Arch Ophthalmol. 2003;121(7):957\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archopht.121.7.957\u003c/span\u003e\u003cspan address=\"10.1001/archopht.121.7.957\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGazzard G, Konstantakopoulou E, Garway-Heath D, Adeleke M, Vickerstaff V, Ambler G, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(18)32213-X\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(18)32213-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eModi CR, Solu TM, Korat D, Mavani J, Rana JU. Evaluation of the effectiveness of selective laser trabeculoplasty (SLT) in patients with open angle glaucoma. Int J Ocular Oncol Oculoplasty. 2020;6(3):147\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18231/j.ijooo.2020.038\u003c/span\u003e\u003cspan address=\"10.18231/j.ijooo.2020.038\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRealini T. Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia. JAMA Ophthalmol. 2013;131(3):321\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamaophthalmol.2013.1706\u003c/span\u003e\u003cspan address=\"10.1001/jamaophthalmol.2013.1706\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRealini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. West Indies Glaucoma Laser Study (WIGLS): 1. 12-month efficacy of selective laser trabeculoplasty in Afro-Caribbeans with glaucoma. Am J Ophthalmol. 2017;184:28\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajo.2017.09.029\u003c/span\u003e\u003cspan address=\"10.1016/j.ajo.2017.09.029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeck SM, Agboton G, Dieng M, Ndiaye Sow MN, Diakhate M, Gueye NN, Seck CM, Lam A. La trab\u0026eacute;culoplastie au laser s\u0026eacute;lectif (TLS) : notre exp\u0026eacute;rience chez le noir africain [Selective laser trabeculoplasty (SLT): our experience in African blacks]. J Fr Ophtalmol. 2015;38(3):238\u0026thinsp;\u0026ndash;\u0026thinsp;46. French. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jfo.2014.11.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jfo.2014.11.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoosen E, Coleman K, Visser L, Sponsel WE. Racial differences in selective laser trabeculoplasty efficacy. J Curr Glaucoma Pract. 2017;11(1):22\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5005/jp-journals-10008-1218\u003c/span\u003e\u003cspan address=\"10.5005/jp-journals-10008-1218\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlwazae M, Alhumud A, Alsarhan S, Aljasim LA. Acceptance of selective laser trabeculoplasty as a first-line treatment for primary open-angle glaucoma in Saudi Arabia. Cureus. 2024;16(3):e52360. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.52360\u003c/span\u003e\u003cspan address=\"10.7759/cureus.52360\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKyari F, Wormald R, Murthy GVS, Evans JR, Gilbert CE. Ethnicity and deprivation are associated with blindness among adults with primary glaucoma in Nigeria. J Glaucoma. 2016;25(10):e861\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/IJG.0000000000000492\u003c/span\u003e\u003cspan address=\"10.1097/IJG.0000000000000492\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoosen E, Visser L, Sartorius B. Selective laser trabeculoplasty in primary open-angle glaucoma: primary versus secondary treatment outcomes. Afr Vis Eye Health. 2016;75(1):a338. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4102/aveh.v75i1.338\u003c/span\u003e\u003cspan address=\"10.4102/aveh.v75i1.338\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRealini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. Long-Term Outcomes of Selective Laser Trabeculoplasty for Open-Angle Glaucoma in the Caribbean. Am J Ophthalmol. 2021;232:83\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajo.2021.06.012\u003c/span\u003e\u003cspan address=\"10.1016/j.ajo.2021.06.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRealini T, Olawoye O, Kizor-Akaraiwe N, Manji S, Sit A. The Rationale for Selective Laser Trabeculoplasty in Africa. Asia Pac J Ophthalmol (Phila). 2018 Nov-Dec;7(6):387\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22608/APO.2018271\u003c/span\u003e\u003cspan address=\"10.22608/APO.2018271\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOnakoya AO, Abikoye TM, Onyekwelu OM, Olowoyeye AO. Comparison of intraocular pressure reduction of initial and adjunct selective laser trabeculoplasty for primary open angle glaucoma in Nigerians. Niger J Ophthalmol. 2015;23:7\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeinand FS, Althen F. Long-term clinical results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma. Eur J Ophthalmol. 2006;16(1):100\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/112067210601600116\u003c/span\u003e\u003cspan address=\"10.1177/112067210601600116\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBovell AM, Damji KF, Hodge WG, Rock WJ, Buhrmann R, Pan YI. Long term effects on the lowering of intraocular pressure: selective laser or argon laser trabeculoplasty? Can J Ophthalmol. 2011;46(5):408\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcjo.2011.07.016\u003c/span\u003e\u003cspan address=\"10.1016/j.jcjo.2011.07.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaisbourd M, Katz LJ. Selective laser trabeculoplasty as a first-line therapy: a review. Can J Ophthalmol. 2014;49(6):519\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcjo.2014.10.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jcjo.2014.10.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Selective Laser Trabeculoplasty, Open-Angle Glaucoma, Intraocular Pressure, Nigeria, Enugu, Primary Treatment, Glaucoma Management, Laser Therapy, Retrospective Study, African Population","lastPublishedDoi":"10.21203/rs.3.rs-7259184/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7259184/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSelective 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective chart review was conducted on 116 eyes of 64 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. SLT success was defined as an IOP reduction of \u0026ge;\u0026thinsp;3 mmHg without additional intervention or \u0026ge;\u0026thinsp;20% from baseline IOP. Data were analyzed using SPSS version 26, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eMean baseline IOP was 17.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 mmHg. Post-SLT, mean IOP decreased to 13.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 mmHg (23.1% reduction) at 3 months, 12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 mmHg (26.3%) at 6 months, 12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 mmHg (28.2%) at 12 months, 12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 mmHg (25.0%) at 24 months, and 15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4 mmHg (20.3%) at 36 months (all p\u0026thinsp;\u0026lt;\u0026thinsp;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 0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13 at 12 months and 1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34 at 36 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Cumulative success rates were 82.8% at 3 months, 75.9% at 6 months, 64.2% at 12 months, 53.5% at 24 months, and 43.8% at 36 months.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSLT 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.\u003c/p\u003e","manuscriptTitle":"Real world outcomes of Selective Laser Trabeculoplasty as Primary Treatment for glaucoma in Enugu Nigeria: A Retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 07:03:59","doi":"10.21203/rs.3.rs-7259184/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-24T12:13:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-17T12:26:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-01T20:19:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243370080613371719395773305601572558340","date":"2025-08-26T03:02:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242716511627083668986260667701054474510","date":"2025-08-22T13:06:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-18T19:38:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-06T12:33:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-05T07:21:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-04T09:37:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-08-04T06:09:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f01859c6-635c-41c5-a860-39821937d8e4","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:01:28+00:00","versionOfRecord":{"articleIdentity":"rs-7259184","link":"https://doi.org/10.1186/s12886-026-04665-4","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2026-02-14 15:58:37","publishedOnDateReadable":"February 14th, 2026"},"versionCreatedAt":"2025-08-27 07:03:59","video":"","vorDoi":"10.1186/s12886-026-04665-4","vorDoiUrl":"https://doi.org/10.1186/s12886-026-04665-4","workflowStages":[]},"version":"v1","identity":"rs-7259184","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7259184","identity":"rs-7259184","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}