Laser trabeculoplasty for open angle glaucoma.
BACKGROUND
Open angle glaucoma (OAG) is an important cause of blindness worldwide. Laser trabeculoplasty, a treatment modality, still does not have a clear position in the treatment sequence.


OBJECTIVE
The objective of this review was to study the effects of laser trabeculoplasty for OAG.


METHODS
We identified trials from CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS and manual searching. We also contacted researchers in the field.


METHODS
We included randomised controlled trials comparing laser trabeculoplasty with no intervention, with medical treatment, or with surgery. We also included trials comparing different technical modalities of laser trabeculoplasty.


METHODS
Two authors independently assessed trial quality and extracted the data. We contacted trial investigators for missing information.


RESULTS
This review included 19 trials involving 2137 participants. Only five trials fulfilled the criteria of good methodological quality. One trial compared laser trabeculoplasty with topical beta-blocker to no intervention in early glaucoma. The risk of glaucoma progression was higher in the control group at six years of follow up (risk ratio (RR) 0.71 95% confidence interval (CI) 0.53 to 0.95). No difference in health-related quality of life was observed between the two groups. Three trials compared laser trabeculoplasty to medication (regimens used before the 1990s) in people with newly diagnosed OAG. The risk of uncontrolled intraocular pressure (IOP) was higher in the medication group compared to the trabeculoplasty group at six months and two years of follow up. Three trials compared laser trabeculoplasty with trabeculectomy. The risk of uncontrolled IOP was significantly higher in the trabeculoplasty group at six months but significant heterogeneity was observed at two years. Diode and selective laser are compared to argon laser trabeculoplasty in three trials and there is some evidence showing a comparable effect in controlling IOP at six months and one year of follow up.


CONCLUSIONS
Evidence suggests that, in people with newly diagnosed OAG, the risk of uncontrolled IOP is higher in people treated with medication used before the 1990s when compared to laser trabeculoplasty at two years follow up. Trabeculoplasty is less effective than trabeculectomy in controlling IOP at six months and two years follow up. Different laser technology and protocol modalities were compared to the traditional laser trabeculoplasty and more evidence is necessary to determine if they are equivalent or not. There is no evidence to determine the effectiveness of laser trabeculoplasty compared to contemporary medication (prostaglandin analogues, topical anhydrase inhibitors and alpha2-agonists) and also with contemporary surgical techniques. Also there should be further investigation in to the effectiveness of laser trabeculoplasty in specific racial groups, specific diagnostic groups, such as pseudoexfoliation and pigmentary glaucoma and different stages of OAG. More research is also required determining cost-effectiveness of laser trabeculoplasty in the management of glaucoma.
Rolim de Moura
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C
Universidade Federal de São Paulo, Escola Paulista de Medicina, Ophthalmology, Rua Helena, 309 cj 15, São Paulo, Brazil, 04006-002. chrm@terra.com.br
Paranhos
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A
Wormald
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R
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D009798:Ocular Hypertension / Q000188:drug therapy / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D014129:Trabecular Meshwork / Q000601:surgery*; D014130:Trabeculectomy / Q000009:adverse effects / Q000379:methods*
D000319:Adrenergic beta-Antagonists