| Abstract [eng] |
Background. Selective laser trabeculoplasty is widely used in primary open-angle glaucoma, yet evidence on its effectiveness in secondary open-angle glaucomas is limited and inconsistently reported. Because secondary glaucoma subtypes differ in pathophysiology, the effect, treatment success and safety of selective laser trabeculoplasty may also vary. Aim. To systematically evaluate the effectiveness of selective laser trabeculoplasty in the treatment of secondary open-angle glaucomas. Objectives. To assess the effect of selective laser trabeculoplasty on intraocular pressure in patients with secondary open-angle glaucomas, evaluate changes in antiglaucoma medication use, additional interventions and review procedure-related complications. Methods. A systematic literature review was conducted in PubMed (MEDLINE) and Cochrane CENTRAL databases. Predefined inclusion and exclusion criteria were applied with a search strategy based on PICO framework. Study selection was performed in a stepwise manner. Rayyan literature screening platform was used for duplicate removal and abstract screening. The risk of bias in the studies was assessed using design-appropriate critical appraisal instruments. Where feasible, a meta-analysis was performed using a random-effects model. Heterogeneity was assessed using inconsistency statistics and results were presented with 95 % confidence intervals. Results. Fifteen clinical studies published in 2015-2025 were included, covering pseudoexfoliative, steroid-induced, uveitic and pigmentary glaucoma. In the pseudoexfoliative glaucoma subgroup, meta-analysis demonstrated a reduction in intraocular pressure over a 3-12 months period (pooled effect was approximately -5 mmHg), but heterogeneity was high. Meta-analysis was not performed for steroid-induced and uveitic glaucoma due to differences in outcomes and follow-up periods. Most studies in the latter subgroups reported intraocular pressure reduction after treatment. The only pigmentary glaucoma study also demonstrated an early reduction in intraocular pressure. Changes in antiglaucoma medication use were inconsistent across subgroups: in pseudoexfoliative glaucoma, reduction in medication burden was generally small and inconsistent, in steroid-induced glaucoma, a reduction in the need for antiglaucoma medications was observed, in uveitic glaucoma, the findings were conflicting – treatment burden decreased in the short term, whereas medication use increased in a longer follow-up study. In pigmentary glaucoma, no significant change in medication use was observed. In the pseudoexfoliative, steroid-induced and uveitic glaucoma subgroups, some eyes required additional interventions, while in the pigmentary glaucoma subgroup this need was more pronounced. In pseudoexfoliative glaucoma, complications were usually rare or mild, in steroid-induced glaucoma, the highest number of complications was reported, in uveitic glaucoma, complications were generally rare and transient and in pigmentary glaucoma, transient intraocular pressure spikes were the most notable adverse events. Conclusions. Selective laser trabeculoplasty was generally effective in secondary open-angle glaucomas, but the magnitude and duration of its intraocular pressure-lowering effect differed between glaucoma subtypes. In pseudoexfoliative glaucoma subgroup, a significant reduction in intraocular pressure was observed. Findings in steroid-induced, uveitic and pigmentary glaucomas were favorable, but should be interpreted cautiously because of the limited evidence. Changes in antiglaucoma medication use and the need for additional interventions varied across subgroups, however, a reduction in antiglaucoma eye drops was observed and some eyes required additional intraocular pressure-lowering interventions. Selective laser trabeculoplasty was a safe procedure for secondary open-angle glaucomas: in all subgroups, adverse events after selective laser trabeculoplasty were mild and transient. |
