Meta-analysis on the efficacy of selective laser trabeculoplasty in open-angle glaucoma

Abstract

Purpose: To compare the efficacy of selective laser trabeculoplasty(SLT) with argon laser trabeculoplasty(ALT) and medication in the treatment of open-angle glaucoma(OAG) Method: We identified randomized controlled trials from databases including Pubmed, EMBASE, CENTRAL, thesis and dissertation databases as well as hand searching. Two authors independently assessed the quality of eligible trials. Outcome measures included absolute mean IOP reduction and odds ratio(OR) for treatment success. Heterogeneity was assessed through I2 statistics. Sensitivity analyses were performed to assess pooled estimates after excluding studies with outlying results. Result: 244 relevant records were identified. After qualitative assessment, 4 trials were included for comparison between SLT and ALT, involving a pooled total of 150 and 140 eyes in the SLT and ALT group respectively. There was no significant difference in the pooled mean IOP reduction (pooled estimate -0.5 mmHg, 95% confidence interval (C.I.) -1.5 to 0.4 mmHg). SLT was also non-inferior to ALT in achieving treatment success (OR 1.2, 95% C.I.: 0.7 to 1.8). Another 4 trials were included for comparison between SLT and medication. There was a pooled total of 166 eyes involved in SLT and 107 eyes in medication. The difference in pooled mean IOP reduction was not significant (pooled estimate 0.85 mmHg, 95% C.I. -0.2 to 1.9). SLT was also comparable to medication in achieving treatment success (OR 0.8, 95% C.I. 0.33 to 2.0). Conclusion: This meta-analysis provides evidence that SLT has comparable efficacy to ALT and medication in IOP lowering and achieving treatment success. For newly diagnosed OAG patients, SLT may be offered as a primary treatment apart from medication. In those having uncontrolled IOP with maximally tolerated medication, SLT can be offered as an alternative to ALT before considering invasive surgery.