McAlinden C
College of Medicine, Swansea University, Singleton Park, Swansea, UK.
Eye (Lond). 2014 Mar;28(3):249-58. doi: 10.1038/eye.2013.267. Epub 2013 Dec 6.
Systemic review to compare selective laser trabeculoplasty (SLT) to other glaucoma treatment options in terms of their intraocular pressure (IOP)-lowering effect.
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.
An initial search of PubMed identified 23 RCTs with 17 meeting the inclusion criteria. Nine RCTs compared 180° SLT to 180° argon laser trabeculoplasty (ALT) and one trial compared 360° SLT to 360° 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 360° SLT to medical therapy and found no difference between the two treatment options. One trial found greater IOP reduction with latanoprost vs 90° and 180° SLT, and greater IOP reduction with 180° and 360° SLT versus 90° SLT, however no differences were found between 360° SLT versus latanoprost or 360° vs 180° SLT. Two trials compared 180° SLT to 360° SLT finding no difference in IOP reduction. Two trials compared 180° SLT to 90° SLT, one finding no significant difference and one finding greater IOP reduction with 180° SLT over 90° SLT. One trial compared excimer laser trabeculotomy (ELT) to 180° 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.
In terms of the IOP lowering effect, there is no difference between SLT and ALT. Three trials indicate no difference between 360° SLT and medical therapy, with one of the trials indicating greater IOP reduction with latanoprost over 90° and 180° SLT. Three trials indicate no difference between 180° SLT and 360° SLT. It is inconclusive whether 90° is less efficacious than 180° SLT. One trial reports greater IOP reduction with ELT over 180° SLT in the long term.
进行系统评价，比较选择性激光小梁成形术（SLT）与其他青光眼治疗方法在降低眼压（IOP）方面的效果。
检索了以下数据库：PubMed、Cochrane对照试验中央注册库、Ovid、EMBASE、对照试验元注册库和ClinicalTrials.gov。仅纳入在同行评审期刊上发表的、比较SLT与其他青光眼治疗方法的随机对照试验（RCT）。主要结局指标是眼压相对于基线的变化。
对PubMed的初步检索识别出23项RCT，其中17项符合纳入标准。9项RCT比较了180°SLT与180°氩激光小梁成形术（ALT），1项试验比较了360°SLT与360°ALT，所有试验均报告在眼压降低幅度方面与基线相比无差异。1项RCT报告SLT在1年时效果更好，但在2年时这种效果消退。3项试验比较了360°SLT与药物治疗，发现两种治疗方法之间无差异。1项试验发现拉坦前列素降低眼压的效果优于90°和180°SLT，180°和360°SLT降低眼压的效果优于90°SLT，然而360°SLT与拉坦前列素之间或360°与180°SLT之间未发现差异。2项试验比较了180°SLT与360°SLT，发现眼压降低方面无差异。2项试验比较了180°SLT与90°SLT，1项试验发现无显著差异，另1项试验发现180°SLT降低眼压的效果优于90°SLT。1项试验比较了准分子激光小梁切开术（ELT）与180°SLT，发现在随访3个月内眼压降低方面无差异，但在9至24个月的时间间隔内ELT降低眼压的效果更好。未识别出比较SLT与手术的RCT。
在降低眼压效果方面，SLT与ALT之间无差异。3项试验表明360°SLT与药物治疗之间无差异，其中1项试验表明拉坦前列素降低眼压的效果优于90°和180°SLT。3项试验表明180°SLT与360°SLT之间无差异。90°SLT的疗效是否低于180°SLT尚无定论。1项试验报告长期来看ELT降低眼压的效果优于180°SLT。
