Search Results (144)

Background/Objectives: The aim of this study is to compare the parameters of the corneal endothelium in a group of patients with well-controlled type 2 diabetes (study group) to those of patients who do not have type 2 diabetes (control group). Methods: The study aims to compare the corneal endothelium parameters of 80 eyes (80 patients) with well-controlled type 2 diabetes to 80 eyes (80 patients) without type 2 diabetes. The endothelial cell density (ECD), percentage of hexagonal cells (%HEX), coefficient of variation in cell size (CV), and central corneal thickness (CCT) were recorded using a non-contact specular microscope (Nidek CEM-530, Nidek Co., Ltd., Gamagori, Japan). Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were also measured. Results: The groups were matched for age and sex. A significantly lower ECD value was observed in the group of patients with type 2 diabetes (2480.76 cells/mm² ± 303.48) compared to the control group (2629.64 cells/mm² ± 304.73) (p = 0.002). BCVA was also significantly lower in the study group (0.44 ± 0.18) compared to the control group (0.50 ± 0.19) (p = 0.049). No statistically significant differences were found between the groups in terms of IOP, CV, %HEX, and CCT. Conclusions: Patients with well-controlled type 2 diabetes exhibit a lower ECD compared to individuals without diabetes, even in the absence of advanced diabetic complications. These subtle changes may have clinical implications for preoperative evaluation and long-term management in diabetic patients. The other morphological parameters of the corneal endothelium remain comparable between the groups. Full article

Objectives: The objective of this study was to evaluate the agreement and clinical interchangeability of intraocular pressure (IOP) measurements obtained with the mechanical Haag-Streit AT900 Goldmann applanation tonometer (mGAT) and the digital Huvitz HT5000 applanation tonometer (dGAT). Methods: This retrospective comparative study included 53 eyes of 28 patients undergoing routine ophthalmologic evaluation. Each eye underwent IOP measurement using both mGAT and dGAT in a randomized sequence. Central corneal thickness (CCT) was also recorded. Pearson’s correlation coefficient was used to determine correlation between paired IOP measurements. Bland–Altman plots were graphed for the analysis of differences for IOP between the instruments. Results: A total of 53 eyes of 28 patients (15 males) were included in the study. The mean age of the patients was 62.6 years. The mean mGAT and dGAT measurements were 16.3 ± 6.6 mmHg (range 9–50) and 16.4 ± 6.2 mmHg (range 8.8–45.9), respectively (p = 0.53). A strong, significant positive correlation was found for paired IOP measurements by the two instruments (r = 0.98; p < 0.0001). Bland–Altman analysis revealed 95% limits of agreement from −2.5 to +2.3 mmHg, with a small but statistically significant proportional bias favoring mGAT at higher IOP levels. Additionally, 91% of paired measurements were within ±2 mmHg. CCT-related differences were statistically and clinically insignificant. Conclusions: IOP measurements obtained with mGAT and dGAT were highly correlated and clinically interchangeable for the range tested. The Huvitz HT5000 may serve as a reliable alternative to the classic Goldmann tonometer in routine clinical settings. Full article

Background/Objectives: The aim of this study was to evaluate the associations between optical coherence tomography angiography (OCTA)-based retinal vessel diameter (RVD) measurements, with retinal ganglion cell (RGC) function assessed by means of steady-state pattern electroretinography (ssPERG) using ganglion cell layer-inner plexiform layer thickness (GCL-IPLT) measurements and with Humphrey field analyzer (HFA) global indices in glaucoma suspects (GSs). Methods: Thirty-one eyes (20 participants) underwent a comprehensive ophthalmologic examination, ssPERG measurements utilizing the PERGLA paradigm, HFA, optical coherence tomography (OCT), and OCTA. The OCTA scans were processed using ImageJ software, Version 1.53, allowing for measurement of the RVD. Multiple linear regression models were used. Results: After controlling for age, race, central corneal thickness (CCT), and spherical equivalent (SE), a linear regression analysis found that the RVD explained the 4.7% variance in magnitude (Mag) (p = 0.169), 9.2% variance in magnitudeD (MagD) (p = 0.021), and 16.9% variance in magnitudeD/magnitude (p = 0.009). After controlling for age, CCT, and signal strength (SS), a linear regression analysis found that the RVD was significantly associated with the GCL-IPLT measurements (average GCL-IPL, minimum GCL-IPL, superior, superonasal, inferior, and inferonasal sectors) (p ≤ 0.023). An identical regression analysis where the RVD was replaced with the PERG parameters showed a significant association between the MagD and almost all GCI-IPLT measurements. RVD measurements were significantly associated with HFA VFI 24-2 (p = 0.004), MD 24-2 (p < 0.001), and PSD 24-2 (p = 0.009). Conclusions: Decreased RVD measurements were significantly associated with RGC dysfunction, decreased GCL-IPLT, and all HFA global indices in the GSs. Full article

Objective: To conduct a comparative analysis of layer-by-layer macular thickness, peripapillary retinal nerve fiber layer (pRNFL), and minimum rim width (MRW) between the eyes of patients with prostate cancer undergoing treatment with androgen receptor pathway inhibitors (ARPIs) and those of age- and sex-matched healthy controls, with the aim of assessing the potential effects of ARPIs on retinal structure. Methods: In this prospective cross-sectional study, 80 eyes of 80 patients with ARPI-treated metastatic prostate cancer and 80 eyes of 80 age-matched healthy controls were evaluated using Heidelberg Spectralis optical coherence tomography (OCT). Layer-by-layer macular thickness, pRNFL, and MRW were measured and compared between groups. Results: Thickness in most segments of retinal layers and pRNFL, as well as all MRW values, were significantly lower in the ARPI-treated group than in the controls (p < 0.05). No significant differences were observed between groups in terms of age, visual acuity, intraocular pressure, central corneal thickness, or lens status. Conclusions: This study is the first to evaluate layer-by-layer macular thickness in patients with metastatic prostate cancer treated with ARPIs, revealing significant thinning in nearly all macular layers, pRNFL, and MRW. These findings suggest that ARPI therapy may induce neurodegenerative changes in retinal and optic nerve structures. Therefore, further research is warranted to assess the ocular safety of these therapeutic agents. Full article

Background/Objectives: Rho-associated coiled-coil-containing protein kinase inhibitors (ROCKis) have now become known as modulators of corneal endothelial wound repair and cell survival. However, evidence remains fragmented across laboratory and clinical reports. We performed a systematic review to synthesize preclinical and clinical data on ROCKis in corneal disease, assess their efficacy and safety, and identify research gaps. Methods: We searched PubMed, Web of Science, Scopus, and Google Scholar (until May 2025) for English-language original studies evaluating ROCKis in corneal models or patients. Inclusion criteria encompassed in vitro, ex vivo, in vivo, and clinical trials reporting functional outcomes (endothelial cell density, wound closure, visual acuity). Results: Thirty-one studies met criteria: 14 preclinical studies and 17 clinical studies. Preclinical models (rabbit, porcine, human explants) uniformly showed ROCKis (Y-27632, Ripasudil, Netarsudil, H-1152) accelerate corneal endothelial cell proliferation, migration, and restoration of a hexagonal monolayer with improved barrier and pump function over days to weeks. In 17 clinical investigations, topical Ripasudil or Netarsudil and cultured cell injections achieved significant corneal thinning, endothelial cell density and central corneal thickness changes, and visual acuity improvements (≥2 lines) with minimal adverse events. Overall bias was moderate in non-randomized studies and low in the RCTs. Conclusions: ROCKis demonstrate consistent pro-regenerative effects on corneal endothelium in multiple models and show promising clinical efficacy in Fuchs endothelial dystrophy and pseudophakic endothelial failure. Future work should explore novel delivery systems and larger controlled trials to optimize dosing, safety, and long-term outcomes. Full article

Background/Objectives: The corneal epithelium plays a vital role in maintaining corneal transparency and ocular surface integrity. Chronic topical use of antiglaucoma medications may induce epithelial changes, especially with the concurrent use of multiple agents. This study aimed to evaluate the association between the number and class of antiglaucoma medications and central corneal epithelial thickness (CET), measured using a spectral-domain optical coherence tomography (SD-OCT) device. Methods: This cross-sectional study included 456 eyes from 242 adults (median age 72 years), grouped by the number of antiglaucoma agents used (0–4 medications). All pharmacologically treated participants had received the same regimen for ≥6 months. CET was measured using SD-OCT (SOLIX, Optovue). Generalized estimating equations (GEEs) accounted for inter-eye correlation. Two models were constructed: one evaluating specific medication effects and another assessing CET reduction per additional drug used. Age and sex were included as covariates. Results: CET progressively decreased with the number of medications, ranging from 53 µm in controls to 48 µm with quadruple therapy. Multivariable GEE analysis confirmed a cumulative thinning effect, with each additional medication associated with further CET reduction (β = −2.83 to −9.17 µm, p < 0.001). Latanoprost exerted the most pronounced single-drug effect (β = −3.01 µm, p < 0.001). Age was a modest negative predictor, while sex showed no significant effect. Conclusions: The cumulative number and specific class of antiglaucoma medications have a significant impact on corneal epithelial thickness. These results emphasize the need for vigilant ocular surface evaluation in patients on multi-drug regimens and propose CET as a surrogate marker for the burden of topical therapy. Full article

(1) Background: The early diagnosis of keratoconus is critical for prognosis. Traditional methods like ORA and Corvis ST measure overall corneal biomechanics but lack regional specificity and are affected by intraocular pressure. In contrast, Brillouin microscopy assesses regional corneal biomechanics without such limitations; (2) Methods: In total, 25 keratoconus patients and 28 healthy controls were included in this study. Corneal biomechanics were measured using the BOSS system (Brillouin Optical Scanning System) in a 10-point mode within an 8 mm diameter, and included the mean, maximum, minimum and standard Brillouin shift. The Corvis ST parameters extracted included the CBI (Corneal Biomechanical Index), CCBI (Corvis Biomechanical Index for Chinese populations), SSI (Stress–Strain Index), DA (Deformation Amplitude), IIR (Inverse Integrated Radius), and SP-A1 (Stiffness Parameter at First Applanation); (3) Results: BOSS showed significant differences in the inferior nasal region (p = 0.004) and central region (p = 0.029) between groups, but not in peripheral regions (p = 0.781). In a comparison of the Brillouin frequency shifts measured between groups, there was no difference in the Mean (p = 0.452) and Max (p = 0.487), but the Min (p = 0.003), Standard (p = 0.000), and Max–Min (p = 0.006) all showed differences. Corvis ST identified significant differences in six parameters (CBI, CCBI, SSI, DA, IIR, and SP-A1) between groups (p < 0.001). Correlations were found between the BOSS and Corvis ST results, with moderate correlations in the inferior nasal region; (4) Conclusions: The BOSS Brillouin microscope can provide an accurate diagnostic evaluation for the corneal biomechanical differences between normal eyes and keratoconus, independent of IOP (Intraocular Pressure) and CCT (Central Corneal Thickness), with a good correlation with Corvis ST, especially in assessing regional biomechanics. Full article

Background/Objectives: This study assessed the reliability of the Barrett True-K formula in patients who had undergone laser-based corneal refractive surgery by comparing outcomes using measured vs. predicted posterior corneal astigmatism (PCA) within the Barrett True-K No History formula. Methods: We selected 49 eyes out of 41 patients with a history of uncomplicated laser visual correction (LVC) that underwent cataract surgery between 2020 and 2024. The Front K1 and K2, the Back K1 and K2, the anterior chamber depth, the lens thickness, the horizontal white-to-white, and the central corneal thickness were measured using Pentacam. The axial length was measured using the IOL Master 500 or NIDEK AL-Scan. These data were then imported into the freely available online Barrett True-K calculator for post-LVC eyes, and the postoperative results were compared with the predicted IOL target. The cumulative distribution of the refractive prediction error, absolute refractive prediction error, and refractive prediction error were calculated as the difference between the postoperative spherical equivalent and the expected spherical equivalent for both the predicted and measured PCA calculations. Results: The results suggest improved accuracy with the Barrett True-K formula when incorporating measured PCA values, supporting the use of corneal tomography for optimized refractive outcomes in post-LVC cataract patients. Conclusions: It is always advisable to measure the posterior corneal surface using corneal tomography in all patients who have undergone LVC to achieve better refractive outcomes after cataract surgery. Full article

Background/Objectives: The Visual Function and Corneal Health Status (V-FUCHS) questionnaire assesses vision-related quality of life in patients affected by Fuchs endothelial corneal dystrophy (FECD) through 15 items, which are divided into the “visual acuity (VA) Factor” and “glare Factor” domains. The purpose of this study was to translate and validate the Italian version of the V-FUCHS instrument. Methods: The original V-FUCHS questionnaire was translated into Italian using certified forward and backward translation methods and administered to patients with FECD undergoing a unilateral or bilateral Descemet membrane endothelial keratoplasty (DMEK) for FECD and healthy controls. Its test–retest reliability was assessed by administering the questionnaire twice, four weeks apart. Modified Krachmer grade, best-corrected visual acuity (BCVA) and central corneal thickness (CCT) were also measured. Results: A total of 74 participants, aged 45 to 83 years, were prospectively enrolled and divided into five subgroups: mild-to-moderate FECD (n = 18), advanced FECD (n = 15), unilateral DMEK (n = 9), bilateral DMEK (n = 12), and healthy controls (n = 20). Retest reliability confirmed the consistency and agreement of their responses (intraclass correlation coefficient > 0.90 for both factors). The Italian V-FUCHS effectively discriminated between different stages of FECD severity, with significant differences in VA and glare factor scores across all subgroups (p < 0.001). While both BCVA and CCT showed correlations with V-FUCHS scores, only the association between the VA factor and BCVA was statistically significant (p < 0.05), indicating that the VA factor meaningfully reflects patients’ measured VA. Conclusions: The proposed Italian version of the V-FUCHS questionnaire is a valid and reliable tool for assessing visual disability in patients with FECD before and after DMEK. This instrument may aid in optimizing endothelial keratoplasty timings and evaluating postoperative symptomatic improvements in FECD patients. Full article

Objective: The aim of this study was to evaluate the clinical outcomes of sutureless scleral-fixated (SSF) Soleko Fil Carlevale intraocular lens (SC-IOL) implants associated with pars plana vitrectomy (PPV) in patients with aphakia secondary to complicated cataract surgery or IOL luxation nationwide. Methods: A multicenter, national, retrospective study of 268 eyes (268 patients) which underwent simultaneous PPV and SC-IOL implantation was conducted. Demographics; ocular data; pre-surgical, surgical and post-surgical details; and refractive results were collected. Intra- and postoperative complications and management details were described. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central retinal thickness (CRT) were collected at 1 week and at 1, 3, 6 and 12 months post-surgery. Kaplan–Meier curves were constructed to assess the cumulative probability of postoperative BCVA, IOP levels, macular edema (ME) and corneal decompensation. Results: The cumulative probability of final VA ≤ 0.3 logMAR was 64.4% at 12 months follow-up. The probability of IOP > 21, ≥25 and ≥30 mmHg was 29.8%, 16.9% and 10.1%, respectively, and the cumulative probability of IOP-lowering treatment was 42.3% at 12 months. Glaucoma surgery was required in 3.7% of the eyes (10/268). The cumulative probability of postoperative ME development was 26.6% at 12 months, managed with topical treatment alone (73.5%) and intravitreal injections (26.5%). Corneal transplantation was required in 3.7% of the eyes (10/268). Conclusions: Sutureless scleral-fixated SC-IOL is an adequate therapeutic alternative in the management of aphakia with good visual results and an acceptable safety profile in routine clinical care. Longer-term studies are needed to evaluate its results and complications compared to other therapeutic alternatives. Full article

Background and Objectives: Descemet stripping automated endothelial keratoplasty (DSAEK) is a widely used surgical technique for treating corneal endothelial dysfunctions such as Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK). This study aimed to investigate the association between postoperative visual acuity and various corneal morphological and optical parameters, including corneal densitometry (CD) and higher-order aberrations (HOAs), measured using the Pentacam (OCULUS Optikgeräte GmbH, Wetzlar, Germany), as well as graft thickness, which was assessed by anterior segment optic coherence tomography (AS-OCT), (Optovue Inc., Fremont, CA, USA), and corneal thickness, assessed by both AS-OCT and Pentacam. Materials and Methods: This prospective, observational cohort study included 17 eyes from 13 patients who underwent DSAEK. Data on preoperative visual acuity were collected, while postoperative parameters were assessed during follow-up visits. Corneal measurements included the total corneal and corneal graft thickness, corneal densitometry in 20 defined subregions, and corneal higher-order aberrations. Associations between these parameters and postoperative visual acuity were evaluated using nonparametric statistical tests. Results: The postoperative visual acuity improved significantly (p < 0.001). Strong correlations were found between poorer visual acuity and higher CD values. The strongest correlations with visual acuity were found for CD 2–6 mm total (Rho = 0.795; p < 0.001), CD central 2–6 mm (Rho = 0.791; p < 0.001), and CD central 0–2 mm (Rho = 0.730; p < 0.001). Significant associations were also observed with anterior and posterior HOAs (Rho = 0.624, p = 0.01; and Rho = 0.556, p = 0.02, respectively). No correlation was found between visual outcomes and graft thickness measured by AS-OCT (Rho = 0.051; p = 0.85), nor with total corneal thickness measured by AS-OCT (Rho = −0.227; p = 0.38) or Pentacam (Rho = −0.369; p = 0.14). Conclusions: This study demonstrates that CD and HOAs are more strongly associated with postoperative visual acuity after DSAEK than traditionally monitored parameters such as graft or corneal thickness. The results highlight the value of detailed corneal imaging and support the use of advanced optical diagnostics in postoperative evaluation. Full article

To describe the corneal histomorphometry of 8 birds from different species, this study analyzed 11 eyes from individuals that had recently died due to various causes. Only healthy eyes were included, representing the following species: Asio stygius, Crotophaga ani, Pitangus sulphuratus, Turdus rufiventris, Ramphastos toco, Rhea americana, Ara macao, and Nyctibius griseus. The eyes were enucleated within 30 min after death and fixed in 10% formaldehyde. The corneas were analyzed by light microscopy to measure and describe their layers. While the general structure and composition were consistent with those of other vertebrates, significant differences were found among species in the thickness of the corneal layers. These differences were observed between the central and peripheral regions of the same cornea, as well as between species. The central region was predominantly thinner than the periphery. Epithelial thickness varied from 2% to 16% of the total corneal thickness. The number of epithelial layers also varied between species, ranging from three to six. Bowman’s layer was present in all birds studied, and the stroma was the thickest layer in every sample. These findings contribute to a better understanding of the corneal morphology in diverse bird species and may support future ophthalmic or comparative anatomical research. Full article

Background: The aim of this study was to evaluate corneal endothelial changes following phacoemulsification cataract surgery with intraocular lens implantation in patients with type 2 diabetes (study group) and without diabetes (control group). The study aimed to determine the extent of endothelial cell damage and the regenerative capacity of the cornea in patients with well-controlled diabetes. Methods: This study compared corneal endothelial parameters in 80 eyes (80 patients) with well-controlled type 2 diabetes and 80 eyes (80 patients) without diabetes, all of whom underwent uneventful phacoemulsification cataract surgery. Patients were examined preoperatively and at 14 days, 3 months, and 6–8 months postoperatively. Endothelial cell density (ECD), percentage of hexagonal cells (%HEX), cell size variability (CV), and central corneal thickness (CCT) were assessed using a specular microscope. Visual acuity, intraocular pressure (IOP), and cumulative dissipated energy (CDE) during phacoemulsification were also measured. Results: The study and control groups were matched for age and sex. Preoperatively, patients with type 2 diabetes had significantly lower endothelial cell density (2480.76 ± 303.48 cells/mm²) compared to the control group (2629.64 ± 304.73 cells/mm², p = 0.002). Visual acuity was also significantly lower in the study group (0.44 ± 0.18) than in the control group (0.50 ± 0.19, p = 0.049). No significant preoperative differences were observed in IOP, CV, %HEX, or CCT. Postoperatively, both groups experienced ECD decline: −18.44%, −18.77%, and −19.05% in the study group and −15.12%, −16.42%, and −16.73% in the control group at 14 days, 3 months, and 6–8 months, respectively. Differences between groups were not statistically significant (p = 0.285). A significant %HEX decrease was observed in both groups at all time points, with a greater decline in the study group at 14 days and 3 months. CV significantly increased in both groups at 14 days and 3 months postoperatively, but no significant difference was found between groups. A significant increase in CCT was observed at 14 days and 3 months postoperatively, with a greater increase in the study group at 14 days. Preoperative visual acuity negatively correlated with CDE in both groups. Additionally, CDE negatively correlated with ECD at all time points. Conclusions: Endothelial cell density is lower in patients with well-controlled type 2 diabetes than in non-diabetic individuals. Both groups are at risk of endothelial cell loss during phacoemulsification. Despite good glycemic control and comparable preoperative endothelial morphology, the cornea in diabetic patients is more vulnerable to damage, with a prolonged regeneration process. The impaired regenerative capacity of the corneal endothelium suggests the need for additional precautions during cataract surgery in diabetic patients. Despite ECD decline and delayed endothelial regeneration, the functional status of the cornea, as indicated by visual acuity and CCT, remains stable. The adequate corneal endothelial cell reserve in well-controlled type 2 diabetes patients allows for cataract surgery without significant corneal complications. Full article

Background/Objectives: To analyze corneal endothelial changes and intraocular pressure (IOP) after phacoemulsification combined with the eight-chop technique and intraoperative parameters in patients with diabetes mellitus. Methods: The eyes of patients with cataracts who underwent phacoemulsification were analyzed in this study. Based on their hemoglobin A1c levels, patients were divided into two groups. The eight-chop technique was used for cataract surgery. The operative time, the phaco time, the aspiration time, the cumulative energy dissipated, and the volume of fluid used were determined. Best corrected visual acuity, IOP, corneal endothelial cell density (CECD), central corneal thickness (CCT), coefficient of variation (CV), and percentage of hexagonal cells (PHC) were recorded before and after surgery. Results: Overall, 181 eyes of 138 patients with cataracts were evaluated. In the diabetes group, the CECD loss rates were 5.1%, 3.9%, and 2.1% at 7 weeks, 19 weeks, and 1 year postoperatively, respectively. In the control group, the CECD loss rates were 2.8%, 2.6%, and 1.2% at 7 weeks, 19 weeks, and 1 year postoperatively, respectively. Significant differences in the percentage decrease in CECD were observed between the two groups at 7 and 19 weeks postoperatively. Significant differences in the CV and PHC were observed preoperatively and postoperatively between the diabetes and control groups (p < 0.01 or p = 0.01, 0.02). Significant differences were also observed between CV and PHC preoperatively, at 19 weeks, and 1 year postoperatively in the diabetes and control groups (p < 0.01). At 1 year postoperatively, IOP reduction rates were 8.0% and 11.2% in the diabetes and control groups, respectively. Conclusions: CECD loss was minimal with the eight-chop technique; however, the diabetes group showed a higher percentage decrease than the control group up to 19 weeks postoperatively. In addition, although IOP decreased in both groups after surgery, the percentage decrease was significantly different at 1 year postoperatively. This study suggests that the corneal endothelial cells of diabetic eyes may be more fragile than those of normal eyes and that the long-term postoperative IOP-lowering effect may be attenuated. These findings will contribute to advances in personalized treatment strategies for patients with diabetes. Full article

Objectives: The objective of this study is to investigate the two-year continuous efficacy, risk factors, and safety profile of selective laser trabeculoplasty (SLT) in Japanese individuals diagnosed with normal-tension glaucoma (NTG) who underwent SLT as either a first-line or second-line treatment. Methods: A retrospective chart review was conducted of patients with NTG who underwent SLT as either an initial or secondary therapy at 26 medical institutions in Japan between January 2020 and December 2021 with a 2-year follow-up. The primary endpoint was a reduction in the rate of intraocular pressure (IOP) over 2 years after SLT. To estimate the time-varying effect of IOP reduction, a linear mixed-effects model was employed. The secondary endpoints were numerical IOP reduction, treatment success rates shown by a Kaplan–Meier analysis, and complications. Success was defined as an outflow pressure improvement rate (ΔOP) ≥ 20% (definition A) or an IOP reduction rate ≥ 20% (definition B) without further treatment. A Cox proportional hazards regression analysis was used to identify the risk factors to successful SLT treatment. The study was registered with UMIN-CTR (ID: UMIN R000064045). Results: A total of 230 eyes from 230 individuals participated in this study, with 148 eyes receiving SLT as an initial (first-line) therapy and 82 eyes undergoing SLT as a secondary (second-line) intervention. In the first-line group, the mean IOP dropped from 16.7 ± 2.3 mmHg to 13.7 ± 2.4 mmHg at two years post-treatment, reflecting a 16.8% reduction. In the second-line group, the average IOP declined from 15.9 ± 2.5 mmHg to 13.2 ± 2.0 mmHg, marking a 14.4% decrease over the same period. The treatment success rate according to definition A (ΔOP ≥ 20%) was 73.7% at 2 years. Analysis using a linear mixed-effects model identified time (p < 0.001), age (p = 0.044), baseline IOP (p < 0.001), and central corneal thickness (CCT) (p < 0.001) as statistically significant contributors to IOP reduction following SLT. However, neither the Group (first-line vs. second-line) variable (p = 0.386) nor the Time × Group interaction (p = 0.298) reached statistical significance. A lower baseline IOP and a thicker CCT were confirmed as significant predictors of SLT treatment failure. Conclusions: Both initial and secondary SLT treatments for NTG proved to be effective and safe over a two-year period, although the extent of IOP reduction was smaller in cases with a lower baseline IOP. Our findings indicate that the IOP-lowering effect of SLT in NTG is influenced by pretreatment IOP levels, aligning with previous studies on primary open-angle glaucoma and ocular hypertension. However, in contrast to those earlier findings, our research identified pretreatment central corneal thickness as a statistically significant factor influencing SLT efficacy in NTG. These results support the role of SLT as a reliable and safe therapeutic option for managing NTG. Full article