Chen Kai-Yang, Chan Hoi-Chun, Chan Chi-Ming
School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
School of Pharmacy, China Medical University, Taichung, Taiwan.
Photodiagnosis Photodyn Ther. 2025 Aug 7:104743. doi: 10.1016/j.pdpdt.2025.104743.
Selective laser trabeculoplasty (SLT) is a laser-based intervention used to lower intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG). It has been adopted as both a primary and adjunctive therapy, with growing interest in its long-term outcomes. This systematic review and meta-analysis aimed to assess the long-term efficacy and safety of SLT in adult patients with POAG, with a focus on sustained IOP control, reduction in medication burden, preservation of visual function, and adverse event incidence.
This review was conducted in accordance with PRISMA 2020 and MOOSE guidelines and was prospectively registered in PROSPERO (CRD420251030192). A systematic literature search was performed on June 16, 2025, across PubMed, Embase, Medline, and Scopus, including all records from database inception to the search date. Randomized controlled trials and observational studies reporting SLT outcomes with a minimum follow-up duration of 12 months were included. Primary outcomes included long-term IOP reduction and SLT failure rates. Secondary outcomes included medication use, visual field changes, and adverse events. Study quality was assessed using ROB-2 and Newcastle-Ottawa tools. Data were synthesized using random-effects models, and inter-study heterogeneity was quantified using the I² statistic.
From 3,462 identified records, 60 clinical studies were included for qualitative synthesis and 50 were included in the meta-analysis, representing a pooled sample of 8,934 eyes. SLT achieved IOP reduction comparable to topical medications at 6-12 months post-treatment (mean difference: 0.04 mmHg; 95% CI: -0.27 to 0.34). Medication use significantly decreased following SLT (mean reduction: -0.87 medications; 95% CI: -1.13 to -0.62). Visual field mean deviation improved by 0.79 dB (95% CI: 0.76 to 0.82), and SLT was associated with minimal short-term IOP spikes. The health-related quality-of-life scores, as measured by EQ-5D, showed modest but consistent improvements. Risk of bias and publication bias were low in most domains.
SLT demonstrated sustained long-term efficacy in reducing intraocular pressure and minimizing pharmacological burden in patients with POAG. It maintained visual function over extended follow-up and was associated with a favorable safety profile, including a low incidence of adverse events and IOP spikes. These findings support the use of SLT as an effective and safe long-term management option for POAG and justify its consideration as a first-line or adjunctive therapy in clinical practice.
选择性激光小梁成形术（SLT）是一种基于激光的干预措施，用于降低原发性开角型青光眼（POAG）患者的眼压（IOP）。它已被用作一线治疗和辅助治疗，人们对其长期疗效的兴趣与日俱增。本系统评价和荟萃分析旨在评估SLT在成年POAG患者中的长期疗效和安全性，重点关注眼压的持续控制、药物负担的减轻、视功能的保留以及不良事件的发生率。
本评价按照PRISMA 2020和MOOSE指南进行，并在PROSPERO（CRD420251030192）中进行了前瞻性注册。2025年6月16日，在PubMed、Embase、Medline和Scopus上进行了系统的文献检索，包括从数据库建立到检索日期的所有记录。纳入了报告SLT结果且最短随访期为12个月的随机对照试验和观察性研究。主要结局包括长期眼压降低和SLT失败率。次要结局包括药物使用、视野变化和不良事件。使用ROB-2和纽卡斯尔-渥太华工具评估研究质量。使用随机效应模型对数据进行综合分析，并使用I²统计量对研究间的异质性进行量化。
从3462条识别记录中，纳入60项临床研究进行定性综合分析，50项纳入荟萃分析，代表8934只眼睛的汇总样本。SLT在治疗后6至12个月时眼压降低程度与局部用药相当（平均差异：0.04 mmHg；95% CI：-0.27至0.34）。SLT后药物使用显著减少（平均减少：-0.87种药物；95% CI：-1.13至-0.62）。视野平均偏差改善了0.79 dB（95% CI：0.76至0.82），SLT与最小的短期眼压峰值相关。以EQ-5D衡量的健康相关生活质量评分有适度但持续的改善。大多数领域的偏倚风险和发表偏倚较低。
SLT在降低POAG患者眼压和减轻药物负担方面显示出持续的长期疗效。在延长的随访期内保持了视功能，且安全性良好，包括不良事件和眼压峰值的发生率较低。这些发现支持将SLT作为POAG有效且安全的长期管理选择，并证明其在临床实践中可作为一线或辅助治疗的合理性。
