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  • Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials

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Clinical science
Selective laser trabeculoplasty versus medication for open-angle glaucoma: systematic review and meta-analysis of randomised clinical trials
  1. Sheng Chu Chi1,
  2. Yi-No Kang2,
  3. De-Kuang Hwang1,3,
  4. Catherine Jui-ling Liu1,3
  1. 1Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  3. 3Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Dr Catherine Jui-ling Liu, Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; jlliu{at}vghtpe.gov.tw

Abstract

Background The only widely accepted, effective treatment for open-angle glaucoma (OAG) is to reduce the intraocular pressure (IOP), with medical therapy being the typical first-line therapy. Notably, an alternative therapy is selective laser trabeculoplasty (SLT), which is safe and effective in lowering the IOP. Nonetheless, whether SLT could replace medication as the first-line therapy for OAG is still under debate.

Methods Studies involving randomised controlled trials conducted before August 2019 that compared the efficacy of SLT-related and medication-only treatments for OAG were selected from PubMed, Embase, Cochrane Library and Web of Science. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology was employed to rate the quality of the body of evidence.

Results 1229 patients in eight trials were included. The overall results revealed no significant differences between SLT-related and medication-only treatments regarding the IOP reduction (mean difference (MD): 0.18, 95% CI −0.72 to 1.07, p=0.70, I2=73%) and the success rate of IOP control (risk ratio: 1.02, 95% CI 0.99 to 1.04, p=0.74, I2=0%). The SLT-related therapy group required significantly fewer medications compared with the medication-only group (MD: −1.06, 95% CI −1.16 to −0.96, p<0.0000, I2=5%). A quantitative analysis was not performed concerning adverse events and quality of life because of the limited data available.

Conclusion SLT is safe and has a lower incidence of ocular side effects. SLT can be the choice of first-line therapy for OAG. However, clinicians should consider the cost-effectiveness, as well as the patient’s characteristics, before deciding on the therapeutic option.

  • glaucoma
  • treatment lasers

https://doi.org/10.1136/bjophthalmol-2019-315613

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    Footnotes

    • SCC and Y-NK are joint first authors.

    • Contributors SCC conceived and designed the study. SCC and Y-NK contributed to the literature search, extracted data, made a quality assessment of the included studies and performed the data analysis. SCC and Y-NK wrote the first draft of the study. CJ-lL and D-KH provided critical revision of the manuscript. CJ-L supervised and revised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was exempted from institutional review board approval because of its nature—analysis of published data.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. Data are available on request.