Is Selective Laser Trabeculoplasty Effective in Reducing Intraocular Pressure for Primary Angle-Closure Glaucoma? A Systematic Review and Meta-Analysis.

Purpose: Primary angle-closure glaucoma (PACG) is a significant cause of blindness globally, particularly in Asian populations, where it accounts for 25% of glaucoma cases. Selective laser trabeculoplasty (SLT) has emerged as a promising treatment for PACG, but its efficacy varies across studies. This meta-analysis aims to evaluate the effectiveness of SLT in reducing intraocular pressure (IOP) and compare outcomes between PACG and primary open-angle glaucoma (POAG).

Methods: A systematic search was conducted in PubMed, Scopus, Medline, and EMBASE up to July 2024 using predefined criteria. Studies assessing SLT in patients with PACG were included. Data extraction included study characteristics, SLT parameters, and primary outcomes, such as mean post-intervention IOP reduction and SLT failure rates. Statistical analysis was performed using pooled estimates with 95% confidence intervals (CI) through Comprehensive Meta-Analysis software.

Results: Of the 754 potentially relevant articles assessed, 7 met the inclusion criteria. The mean IOP post-SLT among PACG patients significantly decreased to 17.30 mmHg (95% CI: 16.99-17.61; p = 0.0001). The SLT failure rate in PACG was 7.95% (95% CI: 6.15-10.28%; p = 0.00001). Studies reported varying trends in medication use and the need for further interventions post-SLT in PACG patients.

Conclusions: This study comprehensively examined the effectiveness of SLT in treating PACG across multiple studies. Despite variations in sample sizes, demographics, and study locations, SLT effectively reduced IOP in PACG patients. The meta-analysis demonstrated a statistically significant decrease in mean post-SLT IOP, highlighting its therapeutic benefit despite notable heterogeneity among the included studies.