Al-Wizni Ahmed, Saleki Mohammad, Lee Choon Yit Preston Dean, Hurt Patrick, Adan Ahmed, Alsaif Abdulmalik, Nahrawy Ahmed
Broomfield Hospital, Chelmsford, UK.
Bolton NHS Foundation Trust, Bolton, UK.
Lasers Med Sci. 2025 Apr 17;40(1):198. doi: 10.1007/s10103-025-04450-7.
Chronic open-angle glaucoma (COAG) affecting over 70 million people globally, is one of the leading causes of irreversible blindness. To lower intraocular pressure (IOP) in COAG, common treatments include Selective Laser Trabeculoplasty (SLT) and Micropulse Laser Trabeculoplasty (MLT). This systematic review and meta-analysis evaluates the efficacy, safety, and clinical outcomes of both treatments in managing open-angle glaucoma. A systematic review and meta-analysis following PRISMA guidelines, with searches across MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to July 2024. Five studies, including 462 eyes from COAG patients, met the inclusion criteria. Primary outcomes were the success rate (defined as ≥ 20% IOP reduction) and mean IOP reduction. Secondary outcomes included adverse events, medication use, and requirement for glaucoma surgery. No significant difference was observed between both treatments in success rates (OR = 0.91, 95% CI: 0.61-1.36, P = 0.64). Mean IOP reduction at 3-6 months (MD = 0.46 mmHg, 95% CI: -0.43-1.36, P = 0.31) and 6-12 months (MD = 0.72 mmHg, 95% CI: -0.22-1.65, P = 0.13) showed no significant differences. Medication requirements, post-laser IOP spikes, and requirement for further surgery were similar between both treatments (OR = 2.31, 95% CI: 0.75-7.15, P = 0.15). SLT and MLT are both effective and safe for COAG, showing no significant differences in efficacy or safety over one year. MLT's cooling cycles may reduce IOP spikes, but further studies are needed to confirm long-term outcomes. Clinicians can choose between treatments based on patient-specific preferences and needs.
慢性开角型青光眼（COAG）全球影响着超过7000万人，是不可逆失明的主要原因之一。为降低COAG患者的眼压（IOP），常见治疗方法包括选择性激光小梁成形术（SLT）和微脉冲激光小梁成形术（MLT）。本系统评价和荟萃分析评估了这两种治疗方法在治疗开角型青光眼方面的疗效、安全性和临床结局。按照PRISMA指南进行系统评价和荟萃分析，检索截至2024年7月的MEDLINE、EMBASE、EMCARE、CINAHL以及Cochrane对照试验中央注册库（CENTRAL）。五项研究，包括来自COAG患者的462只眼，符合纳入标准。主要结局为成功率（定义为眼压降低≥20%）和平均眼压降低。次要结局包括不良事件、药物使用以及青光眼手术需求。两种治疗方法在成功率方面未观察到显著差异（OR = 0.91，95% CI：0.61 - 1.36，P = 0.64）。3至6个月时的平均眼压降低（MD = 0.46 mmHg，95% CI： - 0.43 - 1.36，P = 0.31）和6至12个月时的平均眼压降低（MD = 0.72 mmHg，95% CI： - 0.22 - 1.65，P = 0.13）均未显示出显著差异。两种治疗方法在药物需求、激光后眼压峰值以及进一步手术需求方面相似（OR = 2.31，95% CI：0.75 - 7.15，P = 0.15）。SLT和MLT对COAG均有效且安全，在一年的疗效或安全性方面未显示出显著差异。MLT的冷却周期可能会降低眼压峰值，但需要进一步研究以确认长期结局。临床医生可根据患者的具体偏好和需求在两种治疗方法之间进行选择。
