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. 2022 Aug 9;8(8):CD003919.
doi: 10.1002/14651858.CD003919.pub3.

Laser trabeculoplasty for open-angle glaucoma and ocular hypertension

Christiane R Rolim-de-Moura  1 , Augusto Paranhos Jr  2 , Mohamed Loutfi  3 , David Burton  4 , Richard Wormald  5 , Jennifer R Evans  6
Affiliations

Laser trabeculoplasty for open-angle glaucoma and ocular hypertension

Christiane R Rolim-de-Moura et al. Cochrane Database Syst Rev. .

Abstract

Background: Open-angle glaucoma (OAG) is an important cause of blindness worldwide. Laser trabeculoplasty, a treatment modality, still does not have a clear position in the treatment sequence.

Objectives: To assess the effects of laser trabeculoplasty for treating OAG and ocular hypertension (OHT) when compared to medication, glaucoma surgery or no intervention. We also wished to compare the effectiveness of different laser trabeculoplasty technologies for treating OAG and OHT.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2021, Issue 10); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; LILACS, ClinicalTrials.gov and the WHO ICTRP. The date of the search was 28 October 2021. We also contacted researchers in the field.

Selection criteria: We included randomised controlled trials (RCTs) comparing laser trabeculoplasty with no intervention, with medical treatment, or with surgery in people with OAG or OHT. We also included trials comparing different types of laser trabeculoplasty technologies.

Data collection and analysis: We used standard methods expected by Cochrane. Two authors screened search results and extracted data independently. We considered the following outcomes at 24 months: failure to control intraocular pressure (IOP), failure to stabilise visual field progression, failure to stabilise optic neuropathy progression, adverse effects, quality of life, and costs. We graded the 'certainty' of the evidence using GRADE.

Main results: We included 40 studies (5613 eyes of 4028 people) in this review. The majority of the studies were conducted in Europe and in the USA. Most of the studies were at risk of performance and/or detection bias as they were unmasked. None of the studies were judged as having low risk of bias for all domains. We did not identify any studies of laser trabeculoplasty alone versus no intervention. Laser trabeculoplasty versus medication Fourteen studies compared laser trabeculoplasty with medication in either people with primary OAG (7 studies) or primary or secondary OAG (7 studies); five of the 14 studies also included participants with OHT. Six studies used argon laser trabeculoplasty and eight studies used selective laser trabeculoplasty. There was considerable clinical and methodological diversity in these studies leading to statistical heterogeneity in results for the primary outcome "failure to control IOP" at 24 months. Risk ratios (RRs) ranged from 0.43 in favour of laser trabeculoplasty to 1.87 in favour of medication (5 studies, I2 = 89%). Studies of argon laser compared with medication were more likely to show a beneficial effect compared with studies of selective laser (test for interaction P = 0.0001) but the argon laser studies were older and the medication comparator group in those studies may have been less effective. We considered this to be low-certainty evidence because the trials were at risk of bias (they were not masked) and there was unexplained heterogeneity. There was evidence from two studies (624 eyes) that argon laser treatment was associated with less failure to stabilise visual field progression compared with medication (7% versus 11%, RR 0.70, 95% CI 0.42 to 1.16) at 24 months and one further large recent study of selective laser also reported a reduced risk of failure at 48 months (17% versus 26%) RR 0.65, 95% CI 0.52 to 0.81, 1178 eyes). We judged this outcome as moderate-certainty evidence, downgrading for risk of bias. There was only very low-certainty evidence on optic neuropathy progression. Adverse effects were more commonly seen in the laser trabeculoplasty group including peripheral anterior synechiae (PAS) associated with argon laser (32% versus 26%, RR 11.74, 95% CI 5.94 to 23.22; 624 eyes; 2 RCTs; low-certainty evidence); 5% of participants treated with laser in three studies of selective laser group had early IOP spikes (moderate-certainty evidence). One UK-based study provided moderate-certainty evidence that laser trabeculoplasty was more cost-effective. Laser trabeculoplasty versus trabeculectomy Three studies compared laser trabeculoplasty with trabeculectomy. All three studies enrolled participants with OAG (primary or secondary) and used argon laser. People receiving laser trabeculoplasty may have a higher risk of uncontrolled IOP at 24 months compared with people receiving trabeculectomy (16% versus 8%, RR 2.12, 95% CI 1.44 to 3.11; 901 eyes; 2 RCTs). We judged this to be low-certainty evidence because of risk of bias (trials were not masked) and there was inconsistency between the two trials (I2 = 68%). There was limited evidence on visual field progression suggesting a higher risk of failure with laser trabeculoplasty. There was no information on optic neuropathy progression, quality of life or costs. PAS formation and IOP spikes were not reported but in one study trabeculectomy was associated with an increased risk of cataract (RR 1.78, 95% CI 1.46 to 2.16) (very low-certainty evidence).

Authors' conclusions: Laser trabeculoplasty may work better than topical medication in slowing down the progression of open-angle glaucoma (rate of visual field loss) and may be similar to modern eye drops in controlling eye pressure at a lower cost. It is not associated with serious unwanted effects, particularly for the newer types of trabeculoplasty, such as selective laser trabeculoplasty.

Trial registration: ClinicalTrials.gov NCT01384149 NCT01126203 NCT02231515 NCT01687465 NCT00000132 NCT02512133 NCT00000149 NCT00551395 NCT02928289 NCT01639807 NCT01704989 NCT01444105 NCT01886456 NCT02327312 NCT02507687 NCT02636946 NCT03529591.

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Conflict of interest statement

None known.

Figures

1
1
Prisma flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
1.1
1.1. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 1: Failure to control IOP at 6 months
1.2
1.2. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 2: Failure to control IOP at 12 months
1.3
1.3. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 3: Failure to control IOP at 24 months
1.4
1.4. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 4: Failure to control IOP at 36 months
1.5
1.5. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 5: Failure to control IOP at 5 years
1.6
1.6. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 6: Failure to stabilise visual field progression at 12 months
1.7
1.7. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 7: Failure to stabilise visual field progression at 24 months
1.8
1.8. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 8: Failure to stabilise visual field progression at 48 months
1.9
1.9. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 9: Failure to stabilise optic neuropathy progression at 24 months
1.10
1.10. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 10: Adverse effects: PAS formation
1.11
1.11. Analysis
Comparison 1: Laser trabeculoplasty versus medication, Outcome 11: Adverse effects: early IOP spikes
2.1
2.1. Analysis
Comparison 2: Laser trabeculoplasty versus trabeculectomy, Outcome 1: Failure to control IOP at 6 months
2.2
2.2. Analysis
Comparison 2: Laser trabeculoplasty versus trabeculectomy, Outcome 2: Failure to control IOP at 24 months
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD003919.pub2

References

References to studies included in this review

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References to studies excluded from this review

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    1. Hutnik C, Crichton A, Ford B, Nicolela M, Shuba, Birt C, et al. Selective laser trabeculoplasty versus argon laser trabeculoplasty in glaucoma patients treated previously with 360 selective laser trabeculoplasty. Ophthalmology 2019;126(2):223-32. - PubMed
Chudoba 2014 {published data only}
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Detry‐Morel 2008 {published data only}
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Douglas 1987 {published data only}
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EMGT 1999 {published data only}
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    1. Heijl A, Leske MC, Bengtsson B, Bengtsson B, Hussein M, Early Manifest Glaucoma Trial Group. Measuring visual field progression in the Early Manifest Glaucoma Trial. Acta Ophthalmologica Scandinavia 2003;81(3):286-93. - PubMed
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Englert 1997 {published data only}
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Fea 2017 {published data only}
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Fink 1988 {published data only}
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Germano 2021 {published data only}
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Glaucoma Intensive Treatment Study 2018 {published and unpublished data}
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    1. Lindén C, Heijl A, Jóhannesson G, Aspberg J, Andersson Geimer S, Bengtsson B. Initial intraocular pressure reduction by mono- versus multi-therapy in patients with open-angle glaucoma: results from the Glaucoma Intensive Treatment Study. Acta Ophthalmologica 2018;96(6):567-72. - PMC - PubMed
Goyal 2010 {published data only}ISRCTN65144700
    1. Goyal S, Beltran-Agullo L, Rashid S, Shah SP, Nath R, Obi A, et al. Effect of primary selective laser trabeculoplasty on tonographic outflow facility: a randomised clinical trial. British Journal of Ophthalmology 2010;94(11):1443-7. - PubMed
Heijl 1984 {published data only}
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Hollo 1996 {published data only}
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Hua 2014 {published data only}
    1. Hua PY, Xu WH, Zhang YQ. Effect of phacoemulsification with selective laser trabeculoplasty on primary open angle glaucoma. International Eye Science 2014;14(3):496-8.
Huk 1991 {published data only}
    1. Huk B, Garus HJ, Bleckmann H. Anti-inflammatory treatment after argon laser trabeculoplasty. Ophthalmologica 1991;203(1):24-9. - PubMed
ISRCTN17339574 {published data only}ISRCTN17339574
    1. ISRCTN17339574. Effect of selective laser trabeculoplasty and standard medical treatment on day tension curve and intra-ocular pressure. www.isrctn.com/ISRCTN17339574 (first received 1 July 2005).
ISRCTN27208571 {unpublished data only}
    1. ISRCTN27208571. Laser compared to topical medicine as primary treatment for glaucoma in Africa. www.isrctn.com/ISRCTN27208571 (first received 13 December 2015). [DOI: ]
ISRCTN42557387 {published data only}42557387
    1. ISRCTN42557387. Selective laser trabeculoplasty for primary angle-closure glaucoma: a pilot case study. www.isrctn.com/ISRCTN42557387 (first received 5 May 2006).
ISRCTN66330584 {published data only}ISRCTN66330584
    1. ISRCTN66330584. A randomized prospective study investigating the optimum power settings for selective laser trabeculoplasty (SLT) in ocular hypertension (OHT) and primary open angle glaucoma (POAG). www.isrctn.com/ISRCTN66330584 (first received 28 September 2007).
Jinapriya 2014 {published data only}
    1. Jinapriya D, D'Souza M, Hollands H, El-Defrawy SR, Irrcher I, Smallman D, et al. Anti-inflammatory therapy after selective laser trabeculoplasty: a randomized, double-masked, placebo-controlled clinical trial. Ophthalmology 2014;121(12):2356-61. - PubMed
Kara 2011 {published data only}
    1. Kara N, Altan C, Satana B, Altinkaynak H, Bozkurt E, Demirok A, et al. Comparison of selective laser trabeculoplasty success in patients treated with either prostaglandin or timolol/dorzolamide fixed combination. Journal of Ocular Pharmacology and Therapeutics 2011;27(4):339-42. - PubMed
Kiddee 2017 {published data only}
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Kocabora 2013 {published data only}
    1. Kocabora MS, Ozsutcu M, Kandemir N, Gocmez E, Fazil K, Gulkilik G. Efficacy and safety of pneumatic trabeculoplasty versus timolol added to latanoprost in primary open angle glaucoma. Clinica Terapeutica 2013;164(Suppl 4):e259-62. - PubMed
Krasnov 1982 {published data only}
    1. Krasnov MM, Akopian VS, Il'ina TS, Kazakova EL. Laser treatment of primary open-angle glaucoma. Randomized comparative studies. Cyclotrabeculospasis and trabeculoplasty. Vestnik Oftalmologii 1982;5:18-22. - PubMed
McWherter 2021 {published data only}30070325
    1. McWherter I, Lanham M, Peplinski L, Zagorianos N, Steele A, Slayden K, et al. Selective laser trabeculoplasty versus brimonidine tartrate 0.2%/timolol maleate 0.5% as adjunct therapy in primary open angle glaucoma: a randomized prospective pilot study. HSOA Journal of Ophthalmology and Clinical Research (accessed 7 January 2021). [DOI: 10.24966/OCR-8887/100075] - DOI
Mermoud 1992 {published data only}
    1. Mermoud A, Herbort C, Schnyder C, Pittet N. Comparison of argon and Nd-YAG laser trabeculoplasty. Investigative Ophthalmology and Visual Science 1992;33(4):ARVO E-abstract 2339.
    1. Mermoud A, Herbort CP, Schnyder CC, Pittet N. Comparison of the effects of trabeculoplasty using the Nd-YAG laser and the argon laser [Comparaison des effets de la trabéculoplastie effectuée avec le laser Nd-YAG et le laser argon]. Klinische Monatsblätter für Augenheilkunde 1992;200(5):404-6. - PubMed
Moriarty 1993 {published data only}
    1. Moriarty AP, McHugh JD, Spalton DJ, Ffytche TJ, Shah SM, Marshall J. Comparison of the anterior chamber inflammatory response to diode and argon laser trabeculoplasty using a laser flare meter. Ophthalmology 1993;100(8):1263-7. - PubMed
NCT00000149 {published data only}
    1. NCT00000149. Collaborative Initial Glaucoma Treatment Study (CIGTS). clinicaltrials.gov/ct2/show/NCT00000149 (first received 24 September 1999).
NCT00551395 {published data only}
    1. NCT00551395. Timing of treatment completion in staged selective laser trabeculoplasty (SLT): early vs. late completion. clinicaltrials.gov/ct2/show/NCT00551395 (first received 31 October 2007).
NCT02774811 {published data only}
    1. NCT02774811. Primary glaucoma treatment trial in Kenya and South Africa - SLT vs. medication (SLT/med). clinicaltrials.gov/ct2/show/NCT02774811 (first received 17 May 2016).
NCT02928289 {unpublished data only}
    1. NCT02928289. Randomized study of the safety and effectiveness of the Sight Sciences VISCO™360 viscosurgical system versus SLT in primary open angle glaucoma (VISCO360 Study). clinicaltrials.gov/ct2/show/NCT02928289 (first received 10 October 2016).
NCT03648229 {published data only}
    1. NCT03648229. African glaucoma laser trial (AGLT). clinicaltrials.gov/ct2/show/NCT03648229 (first received 27 August 27 2018).
Popiela 2000 {published data only}
    1. Popiela G, Muzyka M, Szelepin L, Cwirko M, Nizankowska MH. Use of YAG-Selecta laser and argon laser in the treatment of open angle glaucoma [Zastosowanie lasera YAG-Selecta i lasera argonowego w leczeniu jaskry otwartego kata]. Klinica Oczna 2000;102(2):129-33. - PubMed
Realini 2010 {published data only}
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Russo 2009 {published data only}
    1. Russo V, Barone A, Cosma A, Stella A, Noci N. Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with uncontrolled open-angle glaucoma. European Journal of Ophthalmology 2009;19(3):3429-34. - PubMed
Schrems 1988 {published data only}
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Shin 1996 {published data only}
    1. Shin DH, Frenkel RE, David R, Cheetham JK. Effect of topical anti-inflammatory treatment on the outcome of laser trabeculoplasty. The Fluorometholone-Laser Trabeculoplasty Study Group. American Journal of Ophthalmology 1996;122(3):349-54. - PubMed
Stunf Pukl 2018 {published data only}
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Tabak 1998 {published data only}
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Tardif 2014 {published data only}
    1. Tardif A, Bonnin N, Borel A, Viennet A, Pereira B, Chiambaretta F. Selective laser trabeculoplasty: results after a first and a second session, overall comparison and results for three indications [Trabéculoplastie au laser sélective: résultats après première et deuxième séances, comparaison globale puis dans trois indications ]. Journal Français d'Ophtalmologie 2014;37(5):353-7. - PubMed
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Tuulonen 1989 {published data only}
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Uva 2010 {published data only}
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Vaidergorn {published data only}
    1. Vaidergorn PG . Study of the effects of trabeculoplasty on the reduction of ocular hypotensive medicines in glaucoma patients [Estudo do efeito da trabeculoplastia na redução de medicamentos hipotensores oculares utilizados em pacientes glaucomatosos]. pesquisa.bvsalud.org/portal/resource/pt/lil-408993?src=similardocs (accessed 7 January 2021).
Veljko 2011 {published data only}
    1. Veljko A, Miljković A, Babić N. Diode laser trabeculoplasty in open angle glaucoma: 50 micron vs. 100 micron spot size. Medicinski Pregled 2011;64(3-4):211-4. - PubMed
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WIGLS 2017 {published data only}
    1. Realini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. West Indies Glaucoma Laser Study (WIGLS): 1. 12-month efficacy of selective laser trabeculoplasty in Afro-Caribbeans with glaucoma. American Journal of Ophthalmology 2017;184:28-33. [DOI: 10.1016/j.ajo.2017.09.022] - DOI - PMC - PubMed
    1. Realini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. Crystalline lens changes after selective laser trabeculoplasty in Afro-Caribbean patients with open-angle glaucoma; report 4 of the West Indies Glaucoma Laser Study (WIGLS). Journal of Cataract and Refractive Surgery 2019;45(10):1458-62. - PMC - PubMed

References to studies awaiting assessment

NCT00145535 {published data only}
    1. NCT00145535. SOLX titanium sapphire laser for trabeculoplasty. clinicaltrials.gov/ct2/show/NCT00145535 (first received 5 September 2005).
NCT01639807 {published data only}
    1. NCT01639807. Clinical evaluation of efficacy of SLT to topical medication in lowering IOP. clinicaltrials.gov/ct2/show/NCT01639807 (first received 13 July 2012).
NCT01704989 {published data only}
    1. NCT01704989. The laser in pseudoexfoliation (LIP) study (LIP). clinicaltrials.gov/ct2/show/NCT01704989 (first received 12 October 2012).
NCT01788319 {published data only}
    1. NCT01788319. Micropulse laser trabeculoplasty (532 nm) versus conventional laser trabeculoplasty (532 nm). clinicaltrials.gov/ct2/show/NCT01788319 (first received 11 February 2013).
Sreckovic 2011 {published data only}
    1. Srećković S, Petrović MJ, Petrović N, Vukosavljević M. Comparison of primary medicament therapy effects and primary argon laser trabeculoplasty on regulation of intraocular pressure and stability of perimetry findings in open angle glaucoma [Poređenje efekata primarne medikamentne terapije i primarne argonlaser trabekuloplastike na regulaciju intraokularnog pritiska i stabilnost perimetrijskog nalaza kod glaukoma otvorenog ugla]. Vojnosanitetski Pregled 2011;68(3):225-30. - PubMed
Tawfique 2018 {published data only}
    1. Tawfique K, Khademi P, Querat L, Khadamy J, Chen E. Comparison between 90-degree and 360-degree selective laser trabeculoplasty (SLT): a 2-year follow-up. Acta Ophthalmologica 2018;97(4):427-9. - PubMed

References to ongoing studies

EudraCT 2015‐003631‐34 {published data only}
    1. EudraCT 2015-003631-34. A comparison of bimatoprost SR to selective laser trabeculoplasty in patients with open-angle glaucoma or ocular hypertension. clinicaltrialsregister.eu/ctr-search/trial/2015-003631-34/DK (first received 26 April 2018).
GLAUrious {unpublished data only}
    1. Congdon N, Azuara-Blanco A, Solberg Y, Traverso CE, Lester M, Cutolo CA, et al. Direct selective laser trabeculoplasty in open angle glaucoma study design: a multicentre, randomised, controlled, investigator-masked trial (GLAUrious). British Journal of Ophthalmology 2021 Aug 25 [epub ahead of print]. [DOI: 10.1136/bjophthalmol-2021-319379] - DOI - PMC - PubMed
LIGHT China trial {unpublished data only}
    1. Yang Y, Jiang Y, Lin M, Liu X, Fan Y, Nathwani N, et al. Laser in glaucoma and ocular hypertension trial (LIGHT) in China - an unmasked, pragmatic randomized controlled trial: design and baseline characteristics. Investigative Ophthalmology and Visual Science 2019;60(9):ARVO E-abstract 694.
    1. Yang Y, Jiang Y, Huang S, Zhang X, Nathwani N, Lin M, et al. Laser in glaucoma and ocular hypertension trial (LIGHT) in China - a randomized controlled trial: design and baseline characteristics. American Journal of Ophthalmology 2021;230:143-50. [DOI: 10.1016/j.ajo.2021.04.020] - DOI - PubMed
NCT01444105 {published data only}
    1. NCT01444105. Open-angle glaucoma subjects on one ocular hypotensive medication randomized to treatment with two trabecular micro-bypass stents or selective laser trabeculoplasty. clinicaltrials.gov/ct2/show/NCT01444105 (first received 30 September 2011).
NCT01886456 {published data only}
    1. NCT01886456. IOP lowering effect of PLT versus SLT in naive OAG patients. clinicaltrials.gov/ct2/show/NCT01886456 (first received 25 June 2013).
NCT02327312 {published data only}
    1. NCT02327312. Multicenter investigation of trabecular micro-bypass stents vs. laser trabeculoplasty. clinicaltrials.gov/ct2/show/NCT02327312 (first received 30 December 2014).
NCT02636946/NCT02507687 {unpublished data only}
    1. NCT02507687. Comparison of bimatoprost SR to selective laser trabeculoplasty in patients with open-angle glaucoma or ocular hypertension. clinicaltrials.gov/ct2/show/NCT02507687 (first received 24 July 2015).
    1. NCT02636946. A comparison of bimatoprost SR to selective laser trabeculoplasty in patients with open-angle glaucoma or ocular hypertension. clinicaltrials.gov/ct2/show/NCT02636946 (first received 22 December 2015).
NCT02955849 {unpublished data only}
    1. NCT02955849. A trial of China laser and surgery study glaucoma in rural China. clinicaltrials.gov/ct2/show/NCT02955849 (first received 4 November 2016).
NCT03529591 {published data only}
    1. NCT03529591. Is the reduction in IOP after treatment of 180 degrees equivalent to treatment of 360 degrees with SLT? (SLT). clinicaltrials.gov/ct2/show/NCT03529591 (first received 18 May 2018).
NCT03798223 {published data only}
    1. NCT03798223. Optimal treatment protocol for selective laser trabeculoplasty (OSLT). clinicaltrials.gov/ct2/show/NCT03798223 (first received 9 January 2019).

Additional references

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References to other published versions of this review

Rolim de Moura 2002
    1. Rolim de Moura C, Paranhos Jr A, Paranhos A. Laser trabeculoplasty for open angle glaucoma . Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No: CD003919. [DOI: 10.1002/14651858.CD003919] - DOI - PMC - PubMed
Rolim de Moura  2007
    1. Rolim de Moura C, Paranhos A Jr, Wormald R. Laser trabeculoplasty for open angle glaucoma. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No: CD003919. [DOI: 10.1002/14651858.CD003919.pub2] - DOI - PMC - PubMed

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