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C. Rolim de Moura, A. Paranhos, R. Belfort, Jr.; Argon Laser Trabeculoplasty for Open Angle Glaucoma: A Sistematic Review . Invest. Ophthalmol. Vis. Sci. 2005;46(13):109.
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Purpose: Investigate the evidences of the effect of laser trabeculoplasty for treating open angle glaucoma. This approach is compared with hypotensive medication, incisional surgery and no intervention, since there is no consensus on the clinical use of this method. Methods: The review included all relevant randomized controlled trials identified from Cochrane Library, MEDLINE, EMBASE, LILACS and manual search, in which open angle glaucoma subjects were submitted to trabeculoplasty or no intervention, medical therapy, incisional surgery or different techniques of trabeculoplasty. The outcomes were failure to control intraocular pressure or stabilize visual field or optic nerve damage progression. Results: 20 randomized controlled trials met the inclusion criteria (2805 eyes). Nine trials were graded at relatively low risk of bias. For newly diagnosed subjects, trabeculoplasty associated with hypotensive medication seems to reduce the risk of progressive visual field damage and optic disk deterioration when compared with no intervention. Still for this group of participants, trabeculoplasty seems to reduce risk of failure in controlling intraocular pressure at six months of follow up when compared with hypotensive medication (Relative Risk 0.37 Confidence Interval 0.27–0.51). But this finding was not evident for 24 months of follow up or more. Also compared with trabeculectomy, trabeculoplasty didn’t show evidences of reduce the risk of uncontrolled intraocular pressure.In subjects with maximal medical therapy, trabeculoplasty seems to increase the risk of uncontrolled intraocular pressure when compared with trabeculectomy (Relative Risk 1.97 Confidence Interval 1.53–2.53).Comparing different techniques, argon laser trabeculoplasty does not seem to reduce the risk of intraocular pressure control than diode, krypton or Nd:Yag laser trabeculoplasty. Conclusions: Laser trabeculoplasty seems to reduce the risk of glaucoma progression when compared with no intervention in newly diagnosed subjects. Also in these groups, trabeculoplasty seems to reduce the risk of increasing intraocular pressure when compared to medication, but only at early periods. We should stress that these evidences are applicable to the medical regimen used in the past. When compared to trabeculectomy, trabeculoplasty does not reduce the risk of uncontrolled intraocular pressure.
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