Laser Trabeculoplasty for Open-Angle Glaucoma: A Systematic Review and Network Meta-Analysis

Area of Science:

• Ophthalmology
• Glaucoma Research
• Laser Therapy

Background:

• Open-angle glaucoma (OAG) is a leading cause of irreversible blindness worldwide.
• Intraocular pressure (IOP) is the primary modifiable risk factor for OAG progression.
• Laser trabeculoplasty (LT) and medical therapy are common IOP-lowering strategies.

Purpose of the Study:

• To comprehensively evaluate and compare the effectiveness of various laser trabeculoplasty (LT) techniques against each other and medication for open-angle glaucoma.
• To determine the optimal LT approach for IOP reduction and medication de-escalation.

Main Methods:

• Systematic review and network meta-analysis of randomized controlled trials (RCTs) published between 2000 and 2020.
• Inclusion of 22 RCTs with 2859 eyes, evaluating eight interventions: argon LT (ALT), medications, and multiple selective LT (SLT) variations (180, 270, 360 degrees, new LT, transscleral SLT, low-energy SLT).
• Primary outcomes: IOP reduction at 6 and 12 months (medicated and unmedicated). Secondary outcomes: complication rates and medication number changes.

Main Results:

• No statistically significant differences in IOP reduction were found between any LT types or medications at 6 or 12 months.
• 180-degree selective LT (SLT) demonstrated a statistically significant reduction in the number of medications required compared to argon LT (ALT) at 12 months.
• No severe adverse outcomes were reported across all evaluated interventions.

Conclusions:

• All evaluated laser trabeculoplasty (LT) types are as effective as medication in reducing intraocular pressure (IOP) for open-angle glaucoma.
• 180-degree selective LT (SLT) shows a slight advantage over argon LT (ALT) in reducing the need for glaucoma medications.
• Further large-scale, high-quality RCTs are recommended to confirm these findings and guide clinical practice.