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Audrey Paulo, Lalatiana Razafindrabe, Marie-Josee Fredette; Comparison of argon laser trabeculoplasty and selective laser trabeculoplasty: a meta-analysis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1861.
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Selective laser trabeculoplasty (SLT) is currently used as an alternative to argon laser trabeculoplasty (ALT); despite the reduction of visible thermal damage with SLT, the superiority of either treatment has not yet been clearly established. This meta-analysis aims to determine if there is a significant difference on intraocular pressure lowering between ALT and SLT at different times post-treatment.
The electronic search was conducted through Embase, PubMed central, and the Cochrane Central Register of Controlled Trials with a predefined search strategy including strict criteria for inclusion and exclusion. No restriction was applied on language or year of publication. Eligible studies were prospective randomized clinical trials comparing the use of ALT and SLT in patients with ocular hypertension or any form of open-angle glaucoma. Effectiveness of intraocular pressure (IOP) lowering at different times post-treatment and post-retreatment were considered. Selection, data collection and assessment of methodological quality of studies were conducted independently by two reviewers in a standardized way. Analyzes were performed using RevMan software 5.1.
Nine studies, involving 761 eyes treated with laser trabeculoplasty (LT), were included in the meta-analysis. In the context of a first LT, a statistically significant difference in favor of ALT was found when comparing the IOP reduction 1 hour after intervention (weighted mean difference (WMD): 1.13 mmHg [0.06; 2.20]; N=266; P=0.04; I2=0%). No significant difference was observed between the 2 treatments at 1 month (P=0.34), 3 months (P=0.46), 6 months (P=0.26), 12 months (P=0.84) and 24 months (P=0.60). In case of a previous LT, a statistically significant difference in favor of SLT was observed 6 months after retreatment (WMD: -2.15 mmHg [-3.49;-0.82]; N=72; P=0.002; I2=30%). In previous 360° LT, a statistically significant difference in favor of SLT was found 12 months after the retreatment (WMD: -1.94 mmHg [-3.18;-0.69]; N=56; P=0.002; I2=0%).
The meta-analysis did not reveal any significant difference between ALT and SLT within 1 to 24 months post-treatment after an initial intervention. Only a significant difference in the very short term (one hour post-treatment) was found in favor of ALT. For re-treatment, SLT seems to be a better choice as it provided significantly lower IOP at 6 and 12 months post-laser.
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