Effectiveness of selective laser trabeculoplasty in lowering IOP in steroid-induced glaucoma: a systematic review

To review the effectiveness of selective laser trabeculoplasty (SLT) for steroid-induced glaucoma and steroid-induced ocular hypertension.

Steroid-induced glaucoma and ocular hypertension often occur in medically complex eyes that may require continued corticosteroid therapy. SLT may provide intraocular pressure control while reducing dependence on topical glaucoma medications.

This systematic review was registered with PROSPERO (CRD420251274498) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (or PRISMA) guidelines. Ovid MEDLINE, Embase, and the Cochrane Library were searched from inception to December 28, 2025. Eligible studies included patients with steroid-induced glaucoma or ocular hypertension treated with SLT and reporting intraocular pressure outcomes. Two reviewers independently performed screening, full-text review, data extraction, and Risk Of Bias In Non-randomized Studies of Interventions-I (or ROBINS-I) risk-of-bias assessment. Because of heterogeneity in design, follow-up, and outcome reporting, results were synthesized descriptively.

Nine studies comprising 162 eyes were included. Most were retrospective, with sample sizes ranging from 4 to 35 eyes and follow-up from 1 to 24 months. Baseline intraocular pressure ranged from 21.7 ± 0.9 to 38.4 ± 7.3 mm Hg, and final intraocular pressure ranged from 13.3 to 16.1 ± 3.4 mm Hg. Reported intraocular pressure reduction ranged from 27.7% to 59.1%, with sustained effects beyond 12 months in several studies. Seven studies reported a reduced glaucoma medication burden after treatment. No major sight-threatening adverse events were identified. Risk of bias was moderate to serious in most studies.

SLT appears to be a promising and generally safe option for steroid-induced glaucoma and ocular hypertension, but higher-quality prospective comparative studies are needed.