Laser Trabeculoplasty for Open-Angle Glaucoma: A Systematic Review and Network Meta-Analysis.
Zhou Rouxi, Sun Yi, Chen Haiying, Sha Sha, He Miao, Wang Wei
AI Summary
This review found various laser trabeculoplasty types equally reduce IOP as medication for open-angle glaucoma, with 180-degree SLT slightly better than ALT at reducing medication burden.
Abstract
Purpose
We sought to comprehensively evaluate the effectiveness of different types of laser trabeculoplasty (LT) in the treatment of open-angle glaucoma.
Design
Systematic review and network meta-analysis.
Methods
Eligible randomized controlled trials were identified by searching PubMed, EMBASE, Cochrane Library, SCOPUS, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Service System for studies published between January 1, 2000 and April 20, 2020. Eight interventions were evaluated, including argon LT (ALT), medications, 180-degree selective LT (SLT), 270-degree SLT, 360-degree SLT, new LT, transscleral 360-degree SLT with SLT performed without gonioscopy, and low-energy 360-degree SLT. The primary outcome was reduction of medicated and unmedicated intraocular pressure (IOP) at 6 months. Secondary outcomes included reduction of IOP at 12 months, incidences of complications, and change in number of medications. Head-to-head meta-analysis and network meta-analysis were performed using Stata and R software.
Results
In total, 22 studies were included, involving 2859 eyes of 2704 patients. In terms of IOP reduction at 6 and 12 months, there were no statistically significant differences in both medicated and unmedicated IOP between any pairs of interventions considered herein, as determined based on both head-to-head and network meta-analyses (all P > .05). In terms of reduction of medications, the individuals treated with 180-degree SLT required fewer medications than those treated with ALT at 12 months (0.28 [95% confidence interval, 0.06-0.50]; P = .014). No severe adverse outcomes were reported for any of the interventions.
Conclusions
All the available types of LT are equally effective for decreasing IOP compared with medication-based therapy. The 180-degree SLT was slightly more effective than ALT in terms of reducing the number of medications needed. Additional well-performed randomized controlled trials with larger sample sizes are needed.
MeSH Terms
Shields Classification
Key Concepts4
There were no statistically significant differences in both medicated and unmedicated intraocular pressure (IOP) reduction at 6 and 12 months between argon laser trabeculoplasty (ALT), medications, 180-degree selective laser trabeculoplasty (SLT), 270-degree SLT, 360-degree SLT, new LT, transscleral 360-degree SLT with SLT performed without gonioscopy, and low-energy 360-degree SLT (all P > .05).
Individuals treated with 180-degree selective laser trabeculoplasty (SLT) required fewer medications than those treated with argon laser trabeculoplasty (ALT) at 12 months (0.28 [95% confidence interval, 0.06-0.50]; P = .014).
All available types of laser trabeculoplasty (LT) are equally effective for decreasing intraocular pressure (IOP) compared with medication-based therapy for open-angle glaucoma.
No severe adverse outcomes were reported for any of the interventions including argon laser trabeculoplasty (ALT), medications, 180-degree selective laser trabeculoplasty (SLT), 270-degree SLT, 360-degree SLT, new LT, transscleral 360-degree SLT with SLT performed without gonioscopy, and low-energy 360-degree SLT.
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