Selective laser trabeculoplasty (SLT) vs other treatment modalities for glaucoma: systematic review

Abstract

Purpose Systemic review to compare selective laser trabeculoplasty (SLT) to other glaucoma treatment options in terms of their intraocular pressure (IOP)-lowering effect. Methods Searches of the following databases were performed: PubMed, Cochrane Central Register of Controlled Trials, Ovid, EMBASE, metaRegister of Controlled Trials, and ClinicalTrials.gov. Only randomised controlled trials (RCTs) published in peer-reviewed journals comparing SLT to other glaucoma treatment options were considered. The main outcome measure was the change in IOP from baseline. Results An initial search of PubMed identified 23 RCTs with 17 meeting the inclusion criteria. Nine RCTs compared 1801 SLT to 1801 argon laser trabeculoplasty (ALT) and one trial compared 3601 SLT to 3601 ALT, all reporting no difference in terms of IOP reduction from baseline. One RCT reported better outcomes with SLT at 1 year but this effect regressed at 2 years. Three trials compared 3601 SLT to medical therapy and found no difference between the two treatment options. One trial found greater IOP reduction with latanoprost vs 901 and 1801 SLT, and greater IOP reduction with 1801 and 3601 SLT versus 901 SLT, however no differences were found between 3601 SLT versus latanoprost or 3601 vs 1801 SLT. Two trials compared 1801 SLT to 3601 SLT finding no difference in IOP reduction. Two trials compared 1801 SLT to 901 SLT, one finding no significant difference and one finding greater IOP reduction with 1801 SLT over 901 SLT. One trial compared excimer laser trabeculotomy (ELT) to 1801 SLT, finding no differences in IOP reduction up to 3 months follow-up but greater IOP reduction with ELT at time intervals between 9 and 24 months. There were no RCTs identified that compared SLT to surgery. Conclusion In terms of the IOP lowering effect, there is no difference between SLT and ALT. Three trials indicate no difference between 3601 SLT and medical therapy, with one of the trials indicating greater IOP reduction with latanoprost over 901 and 1801 SLT. Three trials indicate no difference between 1801 SLT and 3601 SLT. It is inconclusive whether 901 is less efficacious than 1801 SLT. One trial reports greater IOP reduction with ELT over 1801 SLT in the long term.

Ocular Cubosome Drug Delivery System for Timolol Maleate: Preparation, Characterization, Cytotoxicity, Ex Vivo, and In Vivo Evaluation

“…The major risk factor for the development of glaucoma is the increase in intraocular pressure (IOP) [3], which results in progressive loss of vision and irreversible blindness. Therefore, current treatments for glaucoma aim to lower IOP mainly via medical therapy and/or eye surgery (including laser treatment) [4]. Between these two methods, medical therapy is considered as an initial therapeutic strategy.…”

Comparison between 90‐degree and 360‐degree selective laser trabeculoplasty (SLT): A 2‐year follow‐up

“…). Selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) have similar efficacy and safety profiles (McAlinden ). Recently, SLT has been the focus of considerable research due to its potential as a first‐line treatment (Schlote ).…”

Developments in laser trabeculoplasty: Table 1

“…A large multicentre prospective clinical trial demonstrated its safety and efficacy 3. There has been a shift from ALT to the newer selective laser trabeculoplasty (SLT) when studies demonstrated that there is no difference between 360° SLT and 180° ALT in terms of IOP-lowering effect 4 5. SLT produces less postlaser anterior chamber inflammation, and leaves the trabecular meshwork intact with minimal damage to the endothelial cells 6.…”