Efficacy and effectiveness of selective laser trabeculoplasty in open-angle glaucoma : a systematic review and meta-analysis

Abstract

Background Glaucoma is a major cause of blindness worldwide. The affected population was projected to increase from 60.5 million in 2010 to 79.6 million in 2020. Among the various types of glaucoma, primary open angle glaucoma will account for more than 70% of this population. Treatment by lowering the intraocular pressure is the only proven method to reduce progression. This can be achieved via medication, surgery and laser. Selective laser trabeculoplasty is a relatively new type of laser that is reported to be equally efficacious to a first line medication and other established laser trabeculoplasty, namely argon laser trabeculoplasty. The evidence available, however, is limited to single trials, which may not reach adequate power to detect the difference. A systematic review and meta-analysis would add evidence to consider selective laser trabeculoplasty as an alternative treatment option in open angle glaucoma through assessing its efficacy and effectiveness in lowering the intraocular pressure and through testing for its non-inferiority when compared with other conventional treatment modalities.

Method Literature search of Pubmed, EMBASE, CENTRAL, dissertation and thesis databases and hand search of relevant journals was performed for the use of selective laser trabeculoplasty in the treatment of open angle glaucoma. English and Chinese articles were included. Meta-analysis of randomized controlled trials comparing treatment efficacy of selective laser trabeculoplasty and other treatment modalities were performed where appropriate.

Results 80 articles were identified to be relevant and provided sufficient data for interpretation for efficacy or safety assessment. It was estimated that selective laser trabeculoplasty resulted in a weighted pooled mean intraocular pressure reduction of 21.9 to 23.8% at different follow-up durations. However, sensitivity analysis including only prospective studies with baseline IOP less than 21mmHg did not show significant IOP lowering effect. Review on side effects of selective laser trabeculoplasty showed a good safety profile in general. Rare occurrences of more severe or long-term complications included persistent intraocular pressure spike requiring surgery, persistent macular edema and corneal haze. Meta-analysis of randomized controlled trials showed that selective laser trabeculoplasty is non-inferior to argon laser trabeculoplasty and medication in intraocular pressure reduction and also in achieving treatment success. Number of medication reduction is similar between selective laser trabeculoplasty and argon laser trabeculoplasty.

Conclusion This report demonstrated comparable efficacy of selective laser trabeculoplasty with argon laser trabeculoplasty and medication therapy in the treatment of open angle glaucoma.