Direct selective Laser trabeculoplasty in the management of glaucoma: The first systematic review and meta-analysis
Shahad T. Ahmad, Rashed A Alasoosi, Ahmed Mohammad, Yaqoub AlFoudari, Sara Almutawtah, Farah R Alqussair, Abdullah Alzoabi, Abdullah AlOtaibi, Fahad Mohammad, Sulaiman D Almusaileem, Abdulrahman Alfailakawi, Abdullah M AlharranBackground
Glaucoma management heavily relies on controlling intraocular pressure (IOP). While selective laser trabeculoplasty (SLT) is a standard first-line therapy, its contact-based approach requires gonioscopy, which demands specialized skills and introduces minor corneal risks. Direct selective laser trabeculoplasty (DSLT) has emerged as an automated, non-contact evolution.
Methods
A comprehensive search across five databases was conducted up to March 2026 for randomized controlled trials and non-randomized studies. Primary outcomes were mean absolute IOP reduction and treatment success (>20% IOP reduction). Secondary outcomes included reductions in medication burden and adverse events. Mean differences (MD), risk ratios (RR), and proportions were pooled using a random-effects model.
Results
Seven studies involving 341 patients (446 eyes) were included. In single-arm analyses, DSLT achieved a significant reduction in IOP (Mean Change: −4.35 mmHg, 95% CI [-5.17, −3.53];
Conclusion
DSLT appears to be a promising non-contact procedure, with reductions in IOP and medication use; however, current evidence remains preliminary and largely non-randomized. Also, limited comparative data did not show significant differences compared with SLT. Larger randomized trials are needed before firm clinical recommendations can be made.