Effectiveness of selective laser trabeculoplasty in lowering intraocular pressure in pseudoexfoliative glaucoma: a systematic review.

Abstract

Purpose: To evaluate the effectiveness of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with pseudoexfoliative glaucoma (PXG).

Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with International Prospective Register of Systematic Reviews (CRD420251271861). Ovid MEDLINE, Embase, and the Cochrane Library were searched from inception to December 26, 2025 for studies evaluating SLT in PXG. Randomized controlled trials and observational studies reporting IOP outcomes were included. Data regarding IOP reduction, treatment success, durability, and adverse events were narratively synthesized.

Results: Fourteen studies comprising 752 eyes were included. Follow-up ranged from 1 to 49 months. Most studies reported clinically meaningful IOP reduction after SLT, with mean reductions ranging from 2.8 to 8.1 mm Hg and percentage reductions ranging from 18.4% to 36.0%. Several studies demonstrated reductions exceeding 25% at 1 year. Although some studies demonstrated sustained efficacy up to 21-30 months, others reported rapid attenuation of effect, including return to pretreatment IOP within approximately 1 month. Treatment success rates ranged from 40.0% to 78.4%. Transient post-SLT IOP spikes occurred in 11.6%-28.0% of patients, with inflammation and ocular discomfort commonly reported. Most studies were judged to have moderate-to-serious risk of bias.

Conclusions: SLT provides clinically meaningful but variably durable IOP reduction in PXG. Given inconsistent durability and relatively common transient IOP spikes, it is best used with close follow-up rather than as a guaranteed long-term solution. Long-term prospective studies are needed to clarify its durability and optimal role in PXG management.