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Laser trabeculoplasty for open-angle glaucoma: a systematic review and network meta-analysis.

Abstract：

PURPOSE:To comprehensively evaluate the effectiveness of different types of laser trabeculoplasty (LT) in the treatment of open-angle glaucoma. DESIGN:Systematic review and network meta-analysis. METHODS:Eligible randomized controlled trials (RCT) were identified by searching PubMed, EMBASE, Cochrane Library, SCOPUS, CNKI, and CBM for studies published between January 1, 2000 and April 20, 2020. Eight interventions were evaluated, including argon LT (ALT), medications, 180° selective LT (SLT), 270° SLT, 360° SLT, new LT, transscleral 360° SLT with SLT performed without gonioscopy, and low-energy 360° SLT. The primary outcome was reduction of medicated and unmedicated intraocular pressure (IOP) at six months. Secondary outcomes included reduction of IOP at 12 months, incidences of complications, and change in number of medications. Head-to-head meta-analysis and network meta-analysis were performed using STATA and R software. RESULTS:In total, 22 studies were included, involving 2,859 eyes of 2,704 patients. In terms of IOP reduction at 6 and 12 months, there were no statistically significant differences in both medicated and unmedicated IOP between any pairs of interventions considered herein, as determined based on both head-to head and network meta-analyses (all P > 0.05). In terms of reduction of medications, the individuals treated with 180° SLT required fewer medications than those treated with ALT at 12 months (0.28, 95%CI: 0.06 to 0.50, P = 0.014). No severe adverse outcomes were reported for any of the interventions. CONCLUSIONS:All the available types of LT are equally effective for decreasing IOP compared to medication-based therapy. The 180° SLT was slightly more effective than ALT in terms of reducing the number of medications needed. Additional well-performed RCTs with larger sample sizes are needed.

journal_name

Am J Ophthalmol

journal_title

American journal of ophthalmology

authors

Zhou R,Sun Y,Chen H,Sha S,He M,Wang W

doi

10.1016/j.ajo.2020.07.046

subject

Has Abstract

pub_date

2020-09-01 00:00:00

eissn

0002-9394

issn

1879-1891

pii

S0002-9394(20)30412-8

pub_type

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Laser trabeculoplasty for open-angle glaucoma: a systematic review and network meta-analysis.