advertisement

Editors Selection IGR 15-2

Medical Treatment: Selective laser trabeculoplasty

Comment by Marie-Josee Fredette on:

In this meta-analysis, Wang et al. demonstrate that SLT had a relatively higher efficacy than ALT in lowering intraocular pressure (IOP), with a weighted mean difference of 0.60 (95% CI, 0.06-1.14). Their study included six randomized controlled trials with a total of 463 eyes (456 patients) for analysis of IOP reduction (IPR). The pertinent studies were selected through extensive searches in Pubmed, Cochrane Library, Embase, meeting abstracts and reference lists of original reports and included patients with primary and secondary OAG. All studies were reviewed by two authors independently and assessed for methodological quality. Data were also abstracted independently by two authors. The difference in IOP reduction did not, however, translate into a difference in therapeutic IOP response (defined as IPR ≥ 3 mmHg and/or a decrease of > 20% from baseline) between SLT and ALT, but only four trials (280 eyes) could be included in this analysis. Nonetheless, a difference was found in the reduction of the number of glaucoma medications in favor of SLT.

Another interesting finding came from the sensitivity analysis done by the authors. The studies were divided into two groups, patients who had previous laser and naïve patients. The results revealed that SLT was more effective than ALT in reducing IOP in previously failed laser treatment. This sensitivity analysis, however, included only two trials (88 eyes).

Tolerability of the lasers was also evaluated with regards to anterior chamber flare and IOP spike and no statistically difference was found, but that analysis was done on a smaller subgroup including only two trials and 120 eyes.

The major limit of this study comes from the combination of data with different durations of follow-up (from six months to two years). Heterogeneity in the patient population included also limits the possibility of drawing conclusions on specific glaucoma populations.

• ← Previous
• Next →