Meta-analysis of selective laser trabeculoplasty with argon laser trabeculoplasty in the treatment of open-angle glaucoma

Objective: To evaluate the efficacy and tolerability of selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) in the treatment of open-angle glaucoma. Design: Systematic review and meta-analysis. Participants: Six clinic studies, all of which were random controlled trials. Methods: Pertinent studies were selected through extensive searches of Pub Med, Cochrane Library, Embase, and meeting abstracts. Efficacy measures were weighted by mean differences for intraocular pressure (IOP), as well as change of number of glaucoma medications and relative risks (RRs) for therapeutic IOP responses. Tolerability measures were RRs for adverse events. Pooled estimates were carried out in Rev Man software 5.1. Results: SLT was associated with a numerically larger reduction compared with ALT, with a weighted mean difference (WMD) of 0.60(95% CI, 0.06-1.14). There was no significant difference in therapeutic IOP responses between SLT and ALT, with a pooled RR of 0.84 (95% CI, 0.51-1.38). Patients who received SLT took fewer glaucoma medications after operations than those who received ALT, with a WMD of 0.29 (95% 01, 0.01-0.56). When compared in patients with previous failed laser treatment (ALT or SLT), SLT was more effective in IOP reduction than ALT with a WMD of 1.48 (95% Cl, 0.75-2.21). The frequencies of anterior chamber flare and IOP peak after operation were similar comparing SLT and ALT, with pooled RRs of 0.90 (95% Cl, 0.74-1.11) and 0.90 (95% Cl, 0.45-1.82), respectively. Conclusions: SLT was associated with relatively higher efficacy of IOP lowering compared with ALT. SLT results in a larger reduction of number of glaucoma medications versus ALT, and it appeared to be more effective for patients who did not respond adequately to previous laser treatment. The difference in tolerability of the 2 lasers was not significant.