Meta-analysis of selective laser trabeculoplasty with argon laser trabeculoplasty in the treatment of open-angle glaucoma
ABSTRACT To evaluate the efficacy and tolerability of selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) in the treatment of open-angle glaucoma.
Systematic review and meta-analysis.
Six clinic studies, all of which were random controlled trials.
Pertinent studies were selected through extensive searches of PubMed, Cochrane Library, Embase, and meeting abstracts. Efficacy measures were weighted by mean differences for intraocular pressure (IOP), as well as change of number of glaucoma medications and relative risks (RRs) for therapeutic IOP responses. Tolerability measures were RRs for adverse events. Pooled estimates were carried out in RevMan software 5.1.
SLT was associated with a numerically larger reduction compared with ALT, with a weighted mean difference (WMD) of 0.60 (95% CI, 0.06-1.14). There was no significant difference in therapeutic IOP responses between SLT and ALT, with a pooled RR of 0.84 (95% CI, 0.51-1.38). Patients who received SLT took fewer glaucoma medications after operations than those who received ALT, with a WMD of 0.29 (95% CI, 0.01-0.56). When compared in patients with previous failed laser treatment (ALT or SLT), SLT was more effective in IOP reduction than ALT with a WMD of 1.48 (95% CI, 0.75-2.21). The frequencies of anterior chamber flare and IOP peak after operation were similar comparing SLT and ALT, with pooled RRs of 0.90 (95% CI, 0.74-1.11) and 0.90 (95% CI, 0.45-1.82), respectively.
SLT was associated with relatively higher efficacy of IOP lowering compared with ALT. SLT results in a larger reduction of number of glaucoma medications versus ALT, and it appeared to be more effective for patients who did not respond adequately to previous laser treatment. The difference in tolerability of the 2 lasers was not significant.
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ABSTRACT: To examine possible differences in clinical outcomes between selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) in open-angle glaucoma at different times post-treatment. Randomized controlled trials (RCTs) comparing SLT versus ALT were searched through August 2013. The main outcome measure was IOP, and secondary outcomes included the number of glaucoma medications, the success rate, and adverse events. Six RCTs, involving 482 eyes treated with laser trabeculoplasty, were included in the meta-analysis. For all patients (including first and previous laser trabeculoplasy), no significant difference in IOP lowering was observed between SLT and ALT at one hour (P = 0.40), one week (P = 0.72), one month (P = 0.37), six months (P = 0.08), one year (P = 0.34), two years (P = 0.58), three years (P = 0.34), four years (P = 0.47), and five years (P = 0.50). A statistically significant difference in favor of SLT was found when comparing the IOP reduction at three months after intervention (weighted mean difference (WMD): 1.19 mmHg [0.41; 1.97]; I(2)=0%; P = 0.003). For patients who were naive to laser, there was no significant difference of reduction in IOP comparing SLT with ALT at any time point. In patients' previous LT, no statistically significant difference in IOP reduction was found at six months (WMD: 1.92 mmHg [-0.91; 4.74]; I(2) = 77.3%; P = 0.18). There was no significant difference in the reduction in the number of glaucoma medications, the success rate, or adverse event rates between the two treatments. SLT has equivalent efﬁcacy to ALT with a similar constellation of side effects. In the case of retreatment, SLT appears to be similar to ALT in IOP lowering at six months.PLoS ONE 12/2013; 8(12):e84270. DOI:10.1371/journal.pone.0084270 · 3.53 Impact Factor
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ABSTRACT: Poor adherence with glaucoma medications has been well documented. There remains a significant unmet need for a relatively safe intraocular pressure (IOP)-lowering procedure that minimizes or eliminates patient participation, and thus reduce the incidence of treatment failures attributable to nonadherence. Selective laser trabeculoplasty (SLT) offers several advantages: It effectively reduces IOP in most patients with open-angle glaucoma, it is cost-effective compared with eye drops, it can be repeated if needed, and it eliminates the issue of adherence to medications when used as an initial treatment. This article reviews the evidence supporting the use of SLT as a first-line therapy in glaucoma. Copyright © 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.Canadian Journal of Ophthalmology 12/2014; 49(6):519-22. DOI:10.1016/j.jcjo.2014.10.003 · 1.30 Impact Factor
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ABSTRACT: Selective laser trabeculoplasty (SLT) is a relatively new type of laser in treating open-angle glaucoma (OAG) and is reported to be equally efficacious to a first line medication and argon laser trabeculoplasty (ALT). We summarize available evidence for considering SLT as an alternative treatment in OAG through systematic review and meta-analysis. Among OAG patients who range from newly diagnosed to those on maximally tolerated medical therapy, SLT results in a 6.9 to 35.9% intraocular pressure (IOP) reduction. Complications are rare and include an intraocular pressure spike requiring surgery, persistent macular edema, and corneal haze and thinning. Meta-analysis of randomized, controlled trials shows that SLT is non-inferior to ALT and medication in IOP reduction and also in achieving treatment success. Number of medications reduction is similar between SLT and ALT. More robust evidence is needed to determine its efficacy as a repeated procedure.Survey of Ophthalmology 01/2014; 60(1). DOI:10.1016/j.survophthal.2014.06.006 · 3.51 Impact Factor