Selective Laser Trabeculoplasty Compared to Medication for Open-Angle Glaucoma Patients: A Systematic Review and...

An alternative glaucoma treatment is selective laser trabeculoplasty (SLT) that can effectively reduce intraocular pressure (IOP) and decrease the burden of glaucoma management. With newly published randomized controlled trials (RCTs) comparing SLT and medication, an updated systematic review and meta-analysis was needed.

A literature search of RCTs comparing SLT and medication in open-angle glaucoma patients was conducted until January 12, 2024 in CINAHL, Cochrane Library, EMBASE, MEDLINE, Web of Science, ClinicalTrials.gov, and Dissertations and Theses databases. Cochrane Risk of Bias 2 (ROB2) was used to assess the quality of the included RCTs.

The included 16 RCTs comprised 2412 patients. At 26 weeks, the combination treatment of SLT and medication had a significant IOP reduction (SMD = 0.78, 95% CI = [0.56, 1.01], p < 0.01, I ² = 0.00%). At 52 weeks or longer, both the SLT group (SMD = 1.91, 95% CI = [1.55, I ² = 73.99%) and the medication group (SMD = 1.70, 95% CI = [1.01, 2.38], p < 0.01, I ² = 92.87%) had significant IOP reduction. At 6 months, the combination treatment significantly reduced the mean number of medications used by 0.78 (SMD = 0.78, 95% CI = [0.56, 1.01], p < 0.01, I ² = 0.00%) where the medication treatment had no significant decrease (SMD = -0.01, 95% CI = [-0.23, 0.21], p = 0.93, I ² = 0.00%). Quality of life between participants in the SLT and medication groups was found to be similar.

Long-term IOP reduction was greater in the SLT treatment compared to medication. SLT treatment significantly reduced the number of medications used by participants whereas medication group had no significant change.