To assess the effectiveness and safety of VISULAS^® green laser selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with pseudoexfoliative syndrome glaucoma (PEXG) and pseudoexfoliative syndrome ocular hypertension (PEXS-OHT).

This prospective, single-center, interventional study included 20 eyes from 20 patients diagnosed with PEXG or PEXS-OHT. Patients underwent 180° SLT using the VISULAS^® green laser, a diode-pumped, frequency-doubled Nd:YVO4 laser with a 532 nm wavelength. IOP was measured at baseline and post-treatment at 1, 3, and 6mo. Medications regimen was stable through the study. Primary outcomes included mean IOP reduction, while secondary outcomes assessed visual and structural parameters, and safety.

The mean age of participants was 72.2±6.6y, with 65% of the eyes being left eyes and 35% right eyes. At baseline, the mean IOP was 22.9±2.9 mm Hg. A significant reduction in IOP was observed at all follow-up intervals: 18.5±3.1 mm Hg at 1mo (18.8% reduction, P=0.001), 19.0±4.2 mm Hg at 3mo (16.7% reduction, P=0.002), and 18.2±4.5 mm Hg at 6mo (19.8% reduction, P=0.001). Subgroup analysis showed greater IOP reduction in patients with Shaffer grade 4 angles, phakic eyes, and those with PEXS-OHT compared to PEXG. No significant changes were detected in visual acuity, visual field index, mean deviation, or retinal nerve fiber layer thickness. At 1h post-procedure, 20% of eyes showed an IOP spike >5 mm Hg that resolved without intervention except for one patient.

SLT with the VISULAS^® green laser is an effective and safe treatment for PEXG and PEXS-OHT, achieving significant IOP reduction without increasing medication burden or causing severe complications. These findings suggest its potential as an alternative or adjunct therapy in managing pseudoexfoliative glaucoma.