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Moderator
Nir Shoham-Hazon, MD
Panelists
Bryan C. H. Ang, MBBS, FRCOphth; Michael S. Berlin, MD, MSc
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Brian M Shafer, MD
Purpose
To evaluate the efficacy of Direct Selective Laser Trabeculoplasty (DSLT) in achieving ≥20% intraocular pressure (IOP) reduction at 6 months without medications in treatment-naive patients with newly diagnosed glaucoma, potentially establishing DSLT as a first-line, medication-free intervention.
Methods
This is a prospective, single-arm, open-label trial evaluating DSLT in 60 eyes of treatment-naive patients with newly diagnosed open-angle glaucoma or ocular hypertension. All eyes undergo a single DSLT session (120 shots, 400 µm, 1.4–1.8 mJ) delivered at the limbus over 2.4 seconds. IOP is measured at baseline, 1, 3, and 6 months using Goldmann applanation. Primary outcome is % IOP reduction at 6 months. Secondary outcomes include % achieving ≥20% IOP reduction, IOP change at 1 and 3 months, and need for secondary intervention. Exploratory data on patient experience is collected.
Results
Fifty-nine eyes were treated. Mean IOP decreased significantly from baseline at all postoperative time points. At 6 months, mean percent IOP reduction was 11.8% with 20.3% of eyes achieving ≥20% IOP reduction without the need for medications. Secondary interventions were required in 35.6% of eyes by 6 months.
Conclusion
DSLT provides statistically significant IOP reduction as a primary treatment modality in treatment-naïve open-angle glaucoma, although though it did not meet statistical noninferiority compared to conventional SLT or medication as first-line therapy at the primary 6-month endpoint
Presenting Author
Christine M. Funke, MD
Purpose
To evaluate the efficacy of Direct Selective Laser Trabeculoplasty (DSLT) in achieving a ≥20% reduction in intraocular pressure (IOP) from baseline in treatment-naïve patients with primary open-angle glaucoma (POAG)
Methods
This prospective, single-arm clinical study included treatment-naïve patients diagnosed with mild to moderate POAG. All participants underwent DSLT using a non-contact, automated laser system. Intraocular pressure (IOP) was measured at baseline and at scheduled follow-up visits at 3, 6, and 12months post-treatment. The primary endpoint was the proportion of eyes achieving ≥20% IOP reduction from baseline without additional glaucoma therapy at 12months. Other endpoints included mean IOP reduction, disease stability, and patient experience. Exclusion criteria included prior glaucoma interventions, angle-closure mechanisms, and significant ocular comorbidities.
Results
TBD
Conclusion
TBD
Presenting Author
Scott E. LaBorwit, MD
Co-Authors
Henry Shea (BSc)
Purpose
to be shortened
Methods
Prospective Single-Arm Study. Study will enroll up to 60 eyes of African American patients with primary open-angle glaucoma undergoing DSLT with untreated IOP of 21-32. Following any medication washout, baseline IOP is established and outcomes, including IOP, glaucoma medication burden, and complications, are evaluated at 1 month, 3 months, and 6 months after treatment.
Results
TBD
Conclusion
TBD
Presenting Author
Lorianne M. Provencher, MD
Co-Authors
Casey Miller (None)
Purpose
To evaluate the efficacy of Direct Selective Laser Trabeculoplasty (DSLT) in reducing intraocular pressure (IOP) and topical medication use in the first 50 patients with pseudoexfoliation glaucoma.
Methods
A retrospective chart review was performed of 50 patients treated with DSLT for pseudoexfoliation glaucoma across four clinical sites by 10 doctors. Pre- and post-procedure IOP, number of topical IOP-lowering medications, and follow-up duration were recorded. Primary outcomes included mean changes in IOP and medication reduction from baseline to the most recent follow-up. Secondary analyses compared across sites and providers. Cases with incomplete follow-up were excluded from final analysis.
Results
A total of 32 eyes from 19 patients with pseudoexfoliation glaucoma (PXG) were treated with dSLT by 6 different doctors at 4 locations. Among 23 eyes with follow-up data, severity was mild in 8 (36%), moderate in 4 (18%), severe in 7 (32%), and undetermined in 3 (14%). Nine eyes were lost to follow-up (LTFU). In these 23 eyes, mean IOP decreased from 22.7 mmHg to 21.1 mmHg (reduction 1.6 mmHg, SD 5.6). The change was not significant (paired t-test, t(22)=1.37, two-tailed p=0.184; 95% CI [-0.82, 4.02] mmHg). Glaucoma medication reduction was 0.1 ± 0.6 (p=0.43).
Conclusion
dSLT does not prove to be effective at treating pseudoexfoliation glaucoma. Further statistical analysis to look for treatment effectivity controlled for severity may show insight into the use of dSLT on PXG patients. Notably, 6 of the 9 mild PXG patients were LTFU possibly suggesting improvement of disease for this population.
Presenting Author
Kin Sheng LIM, MD
Purpose
: To report 2 year outcomes from the CONCEPT randomised controlled trial, comparing washout IOP in cataract versus cataract + ECP participants
Methods
Multicentre RCT in the UK. Participants underwent baseline washout diurnal IOP measurement and were randomised 1:1 perioperatively after uncomplicated cataract surgery to sham or 360 degree ECP. Diurnal washout IOP repeated at 24 months postop.
Results
Washout data was available for 64 patients who received ECP and 75 who received cataract surgery alone. Data was found to be non normally distributed so median reductions were compared, showing a -4.5mmhg reduction in the phaco alone arm and -6.0mmHg in the ECP arm (median test 0.03). Success rates defined as 20% reduction from baseline and IOP of <21mmHg were found to be higher in the ECP arm (59.4 vs 41.3% p=0.03). Rates of self limiting anterior uveitis were noted to be higher in the ECP arm, however other adverse events such as cytoid macular oedema were similar between the two arms.
Conclusion
: ECP demonstrated superior IOP lowering capability compared to cataract surgery alone in patients with opena angle glaucoma.
Presenting Author
Cathleen M. McCabe, MD
Purpose
To evaluate clinical outcomes of a microinvasive glaucoma surgery (MIGS) procedure, excimer laser trabeculostomy (ELT) plus cataract surgery in ocular hypertension (OHT) patients.
Methods
Between January 2024 and June 2024, patients with OHT received ELT in combination with cataract surgery at a single site in Panama. The MIGS procedure was conducted by ELIOS device (Bausch + Lomb) which uses a 308nm XeCL excimer laser to create ten 210µm microchannels in the trabecular meshwork to facilitate aqueous outflow. Retrospectively reviewed data included intraocular pressure (IOP), number of topical IOP-lowering medications, corrected distance visual acuity (CDVA) and adverse events (AEs), pre- and 1-month post-surgery,
Results
Procedures were performed in 47 patients (25 bilateral, 22 unilateral, N=72 eyes). Mean±SD age was 71±9 years; with 51% female. Preoperative mean±SD IOP was 22.2±3.2 mmHg, mean IOP-lowering medications was 0.1±0.3, and mean CDVA was 1.0±0.6 logMAR. At 1-mo follow up, postoperative mean±SD IOP was 19.0±4.0 mmHg, no IOP-lowering medications, and CDVA of 0.3±0.2 logMAR. One pt needed secondary surgery for IOP and hyphema; no other AEs reported.
Conclusion
The ELT procedure in combination with cataract surgery is effective and safe procedure lowering mean IOP to <20 mmHG without topical medications in OHT patients, with minimal interventions or AEs.
Presenting Author
Mohamed H Aly, FRCS
Co-Authors
Randa Kashif (MRCSEd)
Purpose
Background: Preserflo glaucoma mini-shunt is a recent simple way in glaucoma management. Triamcinolone acetonide is used to modulate wound healing. We studied its effect in improving success rate of this glaucoma procedure.
Methods
We did randomized controlled clinical study, eyes with medically uncontrolled or drug intolerant glaucomatous patients, who had Preserflo glaucoma mini-shunt. The eyes were randomly divided to two group. In the first group 3 corneal shield sponges soaked in 0.5 mg Mitomycin C were applied for 3 minutes. In the second group 3 corneal shield sponges soaked in 0.5 mg Mitomycin C were applied for 3 minutes and 10 mg Triamcinolone injected in sub-tenon space. The main outcome was the postoperative intraocular pressure. Secondary outcomes were, prevalence of complications, number of postoperative glaucoma molecules, and secondary interventions.
Results
A total of 67 patients were included in the final analysis. Mean IOP was lower in the triamcinolone sub-tenon group at most follow-up visits, however, the difference was bigger at 3 months (11.8 mmHg versus 13.6 mmHg) and 9 months (15.5 mmHg versus 20.5 mmHg). Linear mixed model showed that IOP was significantly lower in the triamcinolone sub-tenon group throughout the study period (P = 0.028). Similarly, there was significant less incidence in the post operative complications between the triamcinolone sub-tenon group compared to non-triamcinolone sub-tenon group (P = 0.003).
Conclusion
Triamcinolone Acetonide sub-tenon application with Preserflo min-shunt surgery is more effective in IOP reduction and decrease the incidence of complications.
Presenting Author
Gabriel Ayub, MD, PhD
Co-Authors
Edward Tran (MD), Minoo Tohidi Kaloorazi (MD), Iqbal Ike Ahmed (MD, FRCSC)
Purpose
To evaluate and compare one-year outcomes of bleb needling in trabeculectomy and MIBS.
Methods
Multicenter retrospective cohort study of consecutive patients who received a bleb needling after trabeculectomy (TB), gelatin microstent (GM) or SIBS microshunt (SM) implantation. Primary outcome was the surgical success one-year after first needling, defined as IOP?17mmHg + 20% IOP reduction from baseline with (qualified) or without (complete) medication. Failure was defined as IOP>17mmHg in 2 consecutive visits, IOP<6mmHg with 2 lines of visual acuity loss, reoperation and no light perception vision. Additional needling was considered a failure for complete but not for qualified success. Secondary outcomes included risk factors for failure, longitudinal variation on IOP and medication.
Results
Two-hundred and seven eyes (37 TB, 73 GM and 97 SM) were included. Among TB, GM and SM eyes, complete success was observed in 14%, 20% and 18% (p=0.54), while qualified success was observed in 28%, 39% and 44% (p=0.05), respectively. Diabetes (HR: 2.01, p<0.01) and IOP>21mmHg at needling (HR: 1.53, p=0.02) were risk factors for failure in the multivariate analysis. On TB, GM and SM eyes, mean IOP was reduced 10.24, 8.11 and 7.57mmHg (within-group comparison: p<0.01 for all, intergroup comparison: p=0.86), while medication was reduced 2.37, 2.41 and 1.92 classes (within-group comparison: p<0.01 for all, intergroup comparison: p=0.01).
Conclusion
Bleb needling presented a low rate of complete success and a moderate rate of qualified success after one-year. Diabetes and higher IOP were risk factors for failure. IOP and medication were reduced in the 3 procedures, with a statistically significant reduction on medication in favor of TB and GM compared to SM.
Presenting Author
Edward Averbukh, MD
Co-Authors
Itay Lavy (MD), Benjamin Stern (MD), David Smadja (MD), Nadav Shemesh (MD, MHA)
Purpose
To evaluate the efficacy of intraoperative OCT-guided ciliary cleft suturing in managing post-traumatic hypotony associated with ciliary cleft disruption.
Methods
Three patients with persistent hypotony secondary to ocular trauma and confirmed ciliary cleft were treated using targeted suturing under intraoperative optical coherence tomography (OCT) guidance. The procedure involved direct visualization of the cleft and precise suture placement to restore anatomical integrity and intraocular pressure (IOP).
Results
All three patients demonstrated resolution of hypotony following surgery. Intraoperative OCT enabled accurate localization and closure of the cleft, with no intraoperative or postoperative complications. Postoperative IOP normalized in all cases, and no additional interventions were required.
Conclusion
Intraoperative OCT-guided ciliary cleft suturing appears to be a safe and effective technique for managing traumatic hypotony. This approach offers real-time visualization, enhances surgical precision, and may improve outcomes in complex anterior segment trauma cases.
Presenting Author
Bryce P Hwang, MD
Co-Authors
Ari August (BA), Maggie Pecsok (BA), Mark Pyfer (MD, MS)
Purpose
The effect of trabecular bypass stents (TBS) on selective laser trabeculoplasty (SLT) outcomes is unclear. Prior studies, which did not control for lens status, found SLT lowered intraocular pressure (IOP) regardless of TBS. This study evaluates SLT efficacy after TBS (Glaukos iStent) implantation in pseudophakic open-angle glaucoma (OAG) patients.
Methods
A retrospective case-control study was conducted on pseudophakic adults (?18 years) with mild-moderate OAG who underwent SLT by a single surgeon. Eyes with prior filtration or tube shunt surgery, secondary glaucoma other than pseudoexfoliative or pigmentary glaucoma, or less than 8 weeks follow-up were excluded. Two groups were compared: eyes with TBS and pseudophakic controls without TBS. The primary outcome was the change in mean medicated IOP from baseline to 8 weeks. Secondary outcomes included the number of topical ocular hypotensive medications and IOP at 3, 6, 12, 18, and 36 months.
Results
We analyzed pseudophakic OAG eyes with TBS (69 eyes, 47 patients) and controls without TBS (69 eyes, 47 patients) who underwent SLT. Baseline IOP was similar in the control and TBS groups (16.3 vs 15.6 mmHg respectively, p = 0.16). SLT reduced IOP significantly in both groups at 2 months (p<0.001 for each), but only in controls at 18 months (p<0.001 vs p=0.07 for TBS). Mean IOP was similar between groups at 2 months (13.9 vs 13.2 mmHg, p=0.33), 18 months (14.7 vs 14.5 mmHg, p=0.73), and 36 months (15.1 vs 14.2 mmHg, p=0.32). The number of glaucoma medications was comparable at baseline (1.52 vs 1.15, p=0.07), 2 months (1.44 vs 1.12, p=0.30), and 36 months (2.0 vs 1.4, p=0.08).
Conclusion
SLT effectively lowers IOP in pseudophakic OAG patients with or without prior trabecular bypass stent implantation. However, the presence of an iStent does not confer additional IOP-lowering benefit. SLT remains a reasonable treatment option after iStent, but its efficacy is comparable to that in pseudophakic controls.
Presenting Author
Sharmila Rajendrababu, MBBS, MD
Purpose
To report the treatment outcomes of slow-coagulation continuous wave transscleral diode cyclophotocoagulation (SC-TSCPC) in eyes with refractory glaucoma
Methods
A retrospective study was done on 140 patients (144 eyes) with a diagnosis of refractory glaucoma and vision more than 2/60 with a minimum follow up of 6 months. All patients underwent slow coagulation continuous wave TSCPC (800-milliwatt power and 4 seconds duration). Primary outcome measure was surgical success defined as an intraocular pressure (IOP) from 6 to 21mmHg or <20% IOP reduction from baseline value, no reoperation for glaucoma and no loss of light perception vision. Secondary outcome measures include percentage of IOP reduction, glaucoma medications, visual acuity (VA) and complications.
Results
Mean IOP decreased from 40.97±12.00 mmHg preoperatively to 19.31±9.91mmHg (mean percentage IOP reduction =47%) at 6 months postoperatively (p=0.005). The preoperative number of glaucoma medications also dropped from 3.0±0.89 at baseline to 2.0±1.4 at 6 months (p<0.0001). Mean LogMAR visual acuity (BCVA) also significantly improved from 0.78(0.3-1.08) to 0.48(0.18-1.00) at 6 months(p<0.0001). The cumulative probabilities of success at 1,3 and 6 months were 86.1%,77.4% & 66.64% respectively. The most common complication observed were uncontrolled IOP & anterior chamber inflammation. Endophthalmitis and retinal detachment were seen in one patient at 6 month follow up.
Conclusion
SC-TSCPC can be safely and efficiently used in different types of glaucoma including those with good visual acuity and medically uncontrolled glaucoma and in eyes at risk for incisional surgery
Presenting Author
Banu Solmaz, MD, None
Co-Authors
Nisa Karaaslan Kaymak (MD), GÖktu? Demirci (MD), GÖksu Y?lmaz (MD)
Purpose
To evaluate the effect of prophylactic laser peripheral iridotomy (LPI) on periocular pain and/or headache with questionnaire, in patients diagnosed with intermittent angle closure glaucoma (ACG) and suspects and to investigate the association of symptomatic change with anterior segment structural parameters.
Methods
A total of 23 patients presenting with periocular pain / headache complaints and diagnosed with intermittent ACG and suspects by gonioscopy underwent prophylactic LPI. Headache severity was assessed using the HIT-6 questionnaire at baseline and 1 month postoperatively. Anterior chamber depth (ACD), anterior chamber angle (ACA), and central corneal thickness (CCT) were measured with Pentacam; retinal nerve fiber layer (RNFL), Bruch's membrane opening width (BMO-W), and ganglion cell layer (GCL) thickness were obtained with Heidelberg OCT. Pre- and post-treatment values were compared using the Wilcoxon signed-rank test and paired t-test; correlations were analyzed with Spearman's rho.
Results
The mean age was 54.87 ± 8.55 years, and 82.6% were female. HIT-6 scores decreased significantly after LPI (mean reduction: 14.17 ± 5.91; p < 0.001). ACD and ACA increased significantly postoperatively (p < 0.001), while CCT showed no significant change (p = 0.116). Baseline OCT parameters were: RNFL 98.57 ± 15.96 ?m, GCL 322.35 ± 13.11 ?m, BMO-W 290.48 ± 54.90 ?m. There was a weak negative correlation between HIT-6 score and ACD (r = -0.125; p = 0.571), whereas no significant association was found between HIT-6 and ACA or CCT.
Conclusion
Prophylactic LPI in patients with intermittent ACG/ suspects significantly reduced periocular pain/headache , and this symptomatic improvement was associated with anterior segment widening. These findings suggest that, beyond preventing glaucomatous progression, LPI may also provide symptomatic benefit and contribute to patients' quality of life.
Presenting Author
Mordechai Goldberg, MD
Purpose
To evaluate the safety and efficacy of direct selective laser trabeculoplasty (DSLT) using the VOYAGER® laser system in patients with ocular hypertension (OHT) and open-angle glaucoma (OAG), including both treatment-naïve and medically treated eyes.
Methods
A retrospective, single-center study using electronic medical records from a tertiary hospital in Jerusalem. Consecutive patients with OHT or OAG who underwent 360° DSLT between January 2023 and October 2024 were included. Demographic and clinical data were retrieved. IOP was measured pre-treatment, 30 min post-DSLT, and at 2 months. The primary endpoint was treatment success, defined as ≥20% or ≥3 mmHg IOP reduction at 2 months without extra therapy. Secondary outcomes were mean IOP change, adverse events, and BCVA change. IOP and treatment outcomes were analyzed with t-tests, ANOVA, correlations, and chi-square (p<0.05).
Results
The study included 218 eyes from 144 patients. At two months, 66.97% of eyes met treatment success criteria. Mean IOP decreased by 3.42 ± 3.62 mmHg (15.57%). Treatment-naïve eyes showed greater IOP reduction (4.54 ± 2.88 mmHg, 20.17%) and higher success rates (78.4%) compared to premedicated eyes (3.07 ± 3.11 mmHg, 14.17%; 63.4% success; p = 0.038). Subconjunctival hemorrhages occurred in 54.6% of eyes, resolving without intervention; IOP spikes were rare (1.8%) and controlled with apraclonidine. BCVA remained stable (baseline 0.20 ± 0.26 vs. 0.19 ± 0.24 logMAR; p = 0.152). No serious adverse events were observed.
Conclusion
DSLT is a safe and effective method for lowering IOP in OHT and OAG patients, particularly in treatment-naïve eyes. Its non-contact, rapid, and standardized approach may offer practical advantages over conventional SLT. Further prospective studies with extended follow-up are needed to confirm these findings.
Presenting Author
Victoria Leung, BSc
Co-Authors
Cindy Hutnik (MD, PhD), Brendan Tao (MD)
Purpose
Laser peripheral iridotomy (LPI) is commonly performed in primary angle-closure suspects and angle-closure glaucoma. While effective in preventing acute angle closure, its effect on cataract progression is unclear. We aim to systematically review and meta-analyze LPI's association with cataract progression or surgery.
Methods
We systematically searched MEDLINE, Embase, and the Cochrane Library through June 25, 2025. Eligible studies included randomized controlled trials and cohort studies reporting cataract progression or cataract surgery following LPI. Pooled odds ratios (OR) were calculated using fixed- and random-effects models. Heterogeneity was assessed with the I� statistic, and sensitivity analyses were performed. The certainty of evidence for each outcome was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results
Four studies met the inclusion criteria, comprising 1,860 eyes receiving LPI and 7,276 eyes not receiving LPI. Pooled analysis demonstrated that LPI was significantly associated with cataract progression or surgery under either the random-effects model (OR 1.60, 95% CI 1.21-2.12; I� = 56.7%, p = 0.05) and the common-effect model (OR 1.76, 95% CI 1.50-2.07; I� = 56.7%). Along with statistical significance, all included studies demonstrated a positive association between LPI and cataract progression. The certainty of evidence was rated as low using GRADE.
Conclusion
Low certainty evidence supports a significantly increased risk of cataract progression or surgery after LPI, though moderate heterogeneity and limited study numbers reduce certainty. Further long-term, standardized studies are needed on the relative balance of risks and benefits of LPI.
