Meta-analysis of selective laser trabeculoplasty versus topical medication in the treatment of open-angle glaucoma

Abstract

Background: The aim of this study was to examine possible differences in clinical outcomes between selective laser trabeculoplasty (SLT) and topical medication in the treatment of open-angle glaucoma.

Methods: Pertinent prospective comparative controlled trials comparing SLT with medication were selected through extensive searches of the PubMed, Embase, Web of Science, Chinese Biomedicine Database, and the Cochrane Controlled Trials Register database from their inception up to March 2014. Efficacy estimates were measured by their weighted mean difference (WMD) to calculate the intraocular pressure reduction (IOPR) from baseline to endpoint and by the odds ratio (OR) to determine success rates.

Results: Five prospective studies, which met the predefined criteria, were included in the meta-analysis. Four studies were randomized clinical trials and one study was a prospective non-randomized clinical trial. There were a total of 492 eyes of 366 patients with open-angle glaucoma. Four studies involving 325 eyes compared SLT with medication in terms of the IOPR. The WMD of the IOPR from the baseline was 0.6 (95 % confidence intervals: -0.24,1.43) when comparing SLT with medication. No statistical heterogeneity was observed between studies (χ2 = 1.30, P = 0.75, I(2) = 0.0 %). All five studies reported success rates, with a pooled OR of 0.84 (95 % confidence intervals: 0.42, 1.68), which was not statistically significant. No statistical heterogeneity was observed between studies (χ2 = 5.98, P = 0.200, I(2) = 33.1 %). Subgroup and sensitivity analysis confirmed the high stability of the meta-analysis results.

Conclusions: Both SLT and topical medication demonstrate similar success rates and effectiveness in lowering intraocular pressure in patients with open-angle glaucoma.

Fig. 1

The selection flowchart of clinical trials included in this meta-analysis

Fig. 2

Comparison of intraocular pressure reduction from the baseline between SLT group and topical medication group. WMDs indicate weighted mean difference, which were computed by using a random-effects model

Fig. 3

Comparison of percent intraocular pressure reduction from the baseline between SLT group and topical medication group. WMDs indicate weighted mean difference, which were computed by using a random-effects model

Fig. 4

Comparison of success rates between SLT group and topical medication group. ORs indicate odds ratios, which were computed by using a random-effects model