Meta-analysis of selective laser trabeculoplasty with argon laser trabeculoplasty in the treatment of open-angle glaucoma

Nanomedicine in glaucoma treatment; Current challenges and future perspectives

Glaucoma presents a significant global health concern and affects millions of individuals worldwide and predicted a high increase in prevalence of about 111 million by 2040. The current standard treatment involves hypotensive eye drops; however, challenges such as patient adherence and limited drug bioavailability hinder the treatment effectiveness. Nanopharmaceuticals or nanomedicines offer promising solutions to overcome these obstacles. In this manuscript, we summarized the current limitations of conventional antiglaucoma treatment, role of nanomedicine in glaucoma treatment, rational design, factors effecting the performance of nanomedicine and different types of nanocarriers in designing of nanomedicine along with their applications in glaucoma treatment from recent literature. Current clinical challenges that hinder real-time application of antiglaucoma nanomedicine are highlighted. Lastly, future directions are identified for improving the therapeutic potential and translation of antiglaucoma nanomedicine into clinic.

Selective laser trabeculoplasty: An updated narrative review

Selective laser trabeculoplasty (SLT) has experienced a resurgence in interest, primarily driven by promising findings from the Laser in Glaucoma and Ocular Hypertension Trial. By offering SLT as an initial drug-free treatment option, we may be able to thwart issues such as adherence and persistence that plague our current medical management protocols. In this comprehensive narrative review, we delve into the current body of literature that explores the utility of SLT across a wide spectrum of scenarios and glaucoma subtypes. We present evidence that provides valuable insight into the efficacy and benefits of SLT, positioning it as a viable option in the management of glaucoma. Careful consideration of the associated risks and challenges is also necessary for successful adoption into clinical practice. Despite the ample evidence supporting SLT's efficacy, some questions remain regarding its long-term effects and the potential need for retreatment. This review aims to shed light on these aspects to guide clinicians in making informed decisions and tailoring treatment plans to individual patient needs. This review also provides the readers with a bird's eye view of the potential impact of SLT and adds clarity to the various therapeutic protocols that one can follow to ensure optimal clinical outcomes for our patients.

An Exploratory Retrospective Data Analysis Comparing the Outcomes of Selective Laser Trabeculoplasty and Argon Laser Trabeculoplasty in Patients with Open-Angle Glaucoma or Ocular Hypertension in Vienna, Austria, from the Year 2012 to 2022

Background and Objectives: The aim of the present study was to compare the short-term outcomes of selective laser trabeculoplasty (SLT) with argon laser trabeculoplasty (ALT) in patients with glaucoma in a real-world setting. Materials and Methods: The present study was conducted as a retrospective case-control study. The main outcome was the change in intraocular pressure (IOP) three months after laser surgery. In addition, the number of substances used for lowering of IOP and adverse events (AEs) were assessed. Results: Charts from 25 patients were included in the present study, of which 12 had received ALT and 13 SLT. In both groups, IOP significantly decreased from baseline values 6 weeks and 3 months after laser treatment (p < 0.01 vs. baseline at each timepoint for both groups). While after 6 weeks, no difference between groups was found, after 3 months, the decrease in IOP was significantly more pronounced in the SLT group (-26 ± 21% in the ALT group vs. -41 ± 14% in the SLT group, p = 0.018 between groups, ANOVA). Three months after laser treatment, the number of IOP-lowering substances used by each patient had decreased with no difference between groups (ALT: from 2.7 ± 0.8 to 2.3 ± 0.9 substances; SLT: from 1.8 ± 1.2 to 1.3 ± 1.1 substances, p = 0.386). Only a few AEs were observed. Two patients in the ALT and one patient in the SLT group required trabeculectomy within 1 year after laser treatment due to IOP decompensation. Conclusions: In the present study, SLT was at least as effective as ALT with fewer AEs and a similar reduction in concomitant IOP-lowering medication.

Micropulse Laser Trabeculoplasty with 577 nm Wavelength at 1500 or 1000 mW for Primary Open-Angle Glaucoma: A Pilot Study

Aim: To investigate the efficacy and safety of micropulse laser trabeculoplasty (MLT) using a 577 nm yellow wavelength laser randomly assigned to either 1500 or 1000 mW in patients with primary open-angle glaucoma (POAG). Methods: A prospective, double-blinded study of POAG patients was performed in a single center. MLT treatment included a 577 nm micropulse laser (IRIDEX IQ 577^TM, IRIDEX, Mountain View, CA, USA) to 360° of the trabecular meshwork at randomly assigned varying powers: 1500 mW in one eye (MLT 1500 group) and 1000 mW in the other (MLT 1000 group). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal central thickness (CCT), and endothelial cell count (ECC) were evaluated at baseline (T0), post-operative 1 h (T1), 24 h (T2), 1 month (T3), 3 months (T4), and 6 months (T5) after laser treatment. Topical medications were assessed pre-treatment and at T4. Results: Among the 18 eyes included, we achieved a success rate (IOP reduced > 20%) in 77% of sampled eyes. In particular, IOP reduced at T2 and T3 with both MLT 1500 and 1000 without any significant differences (IOP reduction 22.9% vs. 17.3%, respectively, MLT1500 vs. MLT1000 at T2). The IOP returned to baseline values at T4 and T5 in both groups, with a reduction in topical medications administered from 2.5 ± 1.1 to 2.0 ± 1.2 to the 1500 mW group and from 2.4 ± 1.0 to 1.9 ± 1.0 to the 1000 mW group. At 1 h post-laser treatment, a transient IOP spike was registered among the MLT1500 group. There were no differences in CCT and ECC at any timepoint according to the laser powers. Conclusions: Over a 6-month follow-up period, 577 nm MLT at either 1500 or 1000 mW reduces IOP, enabling a stable reduction in the number of topical medications required for patients treated for POAG without any significant difference in terms of effectiveness and safety.

A Review of Selective Laser Trabeculoplasty: "The Hype Is Real"

Presently, there is no efficacious treatment for glaucomatous optic neuropathy; the current treatment is focused on lowering intraocular pressure (IOP). Studies have demonstrated the safety and efficacy of selective laser trabeculoplasty (SLT) in reducing the IOP in eyes with open-angle (OAG) glaucoma or ocular hypertension (OH). Moreover, the European Glaucoma Society has instated SLT as the first-line or adjunctive treatment in OAG or OH, reiterating its clinical significance. In this review, we outline the old and the new roles of SLT, with an emphasis on clinical practice, and look further into its renewed appeal and future developments.

Peripheral anterior synechiae after selective laser trabeculoplasty among Chinese patients

PURPOSE

Peripheral anterior synechiae (PAS) have been reported as a complication after argon laser trabeculoplasty, but rarely reported after selective laser trabeculoplasty (SLT). This study aims to determine the incidence and predictors of this potential complication in phakic eyes of Chinese patients.

METHODS

A retrospective review of consecutive Chinese phakic patients who underwent SLT for primary open-angle glaucoma or ocular hypertension from 2011 to 2015 was analyzed for post-operative outcomes, including the development of PAS.

RESULTS

There was a total of 292 patients (509 eyes) that were of Chinese ethnicity and eligible in our analysis. The 4-year incidence of PAS was 13.57% for the 221 eyes with documented gonioscopy after SLT, and the time, since first SLT, to PAS diagnosis was 5.62 years (2052 ± 75.2 days). After accounting for the inter-eye correlation by the mixed effect Cox regression model (AUC = 0.885), the predictors of earlier PAS diagnosis were baseline intraocular pressure (≥ 18 versus < 18) (HR = 4.6, p = 0.031), baseline use of bimatoprost (HR = 14.97, p = 0.006), and pre-existing hypertension (HR = 11.78, p = 0.016). There was no significant association of earlier PAS diagnosis with age (p = 0.434), baseline number of medications used (p = 0.693), and baseline use of brinzolamide (p = 0.326).

CONCLUSION

PAS development after SLT appears to be more common in Chinese patients, with a presumed 4-year incidence of 13.6%, based on retrospective review of eyes with subsequent documented gonioscopy findings.

TRIAL REGISTRATION

Hong Kong University Clinical Trials Registry (HKUCTR-2350).

Spotlight on MicroPulse Laser Trabeculoplasty in Open-Angle Glaucoma: What’s on? A Review of the Literature

Glaucoma is the most common cause of permanent blindness in the world, caused by a progressive optic neuropathy. Patients with glaucoma are often treated with topical medicines therapy in order to reduce intra-ocular pressure (IOP). On the other hand, laser therapies, with the introduction of Argon Laser Trabeculoplasty (ALT) and successively with Selective Laser Trabeculoplasty (SLT), were reported to be effective in IOP control, with low adverse effect rates. In recent years, the micropulse laser, a subthreshold laser technology, was introduced with the goal of reducing side effects while maintaining the effectiveness of the laser treatments. Several studies focused on Micropulse Diode Laser Trabeculoplasty (MDLT) in open-angle glaucoma, to evaluate its effectiveness and possible side effects. Promising results were reported, but irradiation circumstances have not been standardized yet and its role as a substitute for previous laser techniques has yet to be defined. As a result, the goal of this review was to analyze the physical principles at the basis of MDLT and to frame it in the open-angle glaucoma management setting, highlighting the advantages and shortfalls of this technique.

Laser Trabeculoplasty for Open-Angle Glaucoma: A Systematic Review and Network Meta-Analysis

PURPOSE

We sought 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 were identified by searching PubMed, EMBASE, Cochrane Library, SCOPUS, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Service System for studies published between January 1, 2000 and April 20, 2020. Eight interventions were evaluated, including argon LT (ALT), medications, 180-degree selective LT (SLT), 270-degree SLT, 360-degree SLT, new LT, transscleral 360-degree SLT with SLT performed without gonioscopy, and low-energy 360-degree SLT. The primary outcome was reduction of medicated and unmedicated intraocular pressure (IOP) at 6 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 2859 eyes of 2704 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 > .05). In terms of reduction of medications, the individuals treated with 180-degree SLT required fewer medications than those treated with ALT at 12 months (0.28 [95% confidence interval, 0.06-0.50]; P = .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 with medication-based therapy. The 180-degree SLT was slightly more effective than ALT in terms of reducing the number of medications needed. Additional well-performed randomized controlled trials with larger sample sizes are needed.

Selective laser trabeculoplasty: A review

Glaucoma is the second most prevalent cause of blindness worldwide, and the only effective management is the lowering of intraocular pressure (IOP). Selective laser trabeculoplasty (SLT) has become an essential part of glaucoma management since its commercial release in 2001. It has been an improvement from the previous argon laser trabeculoplasty (ALT), by using 1% of the laser energy, reducing the amount of anterior segment inflammation and minimising the degree of mechanical injury to the trabecular meshwork. There is now a large volume of work that demonstrates SLT is equally effective as ALT and topical medication in lowering IOP. It is simple to perform, with a well described side-effect profile, and is long-lasting and repeatable. This review will summarise the current literature on SLT for each of these topics.

Novel Drug Delivery Systems Fighting Glaucoma: Formulation Obstacles and Solutions

Glaucoma is considered to be one of the biggest health problems in the world. It is the main cause of preventable blindness due to its asymptomatic nature in the early stages on the one hand and patients' non-adherence on the other. There are several approaches in glaucoma treatment, whereby this has to be individually designed for each patient. The first-line treatment is medication therapy. However, taking into account numerous disadvantages of conventional ophthalmic dosage forms, intensive work has been carried out on the development of novel drug delivery systems for glaucoma. This review aims to provide an overview of formulation solutions and strategies in the development of in situ gel systems, nanosystems, ocular inserts, contact lenses, collagen corneal shields, ocular implants, microneedles, and iontophoretic devices. The results of studies confirming the effectiveness of the aforementioned drug delivery systems were also briefly presented.

Glaucoma: Management and Future Perspectives for Nanotechnology-Based Treatment Modalities

Glaucoma, being asymptomatic for relatively late stage, is recognized as a worldwide cause of irreversible vision loss. The eye is an impervious organ that exhibits natural anatomical and physiological barriers which renders the design of an efficient ocular delivery system a formidable task and challenge scientists to find alternative formulation approaches. In the field of glaucoma treatment, smart delivery systems for targeting have aroused interest in the topical ocular delivery field owing to its potentiality to oppress many treatment challenges associated with many of glaucoma types. The current momentum of nano-pharmaceuticals, in the development of advanced drug delivery systems, hold promises for much improved therapies for glaucoma to reduce its impact on vision loss. In this review, a brief about glaucoma; its etiology, predisposing factors and different treatment modalities has been reviewed. The diverse ocular drug delivery systems currently available or under investigations have been presented. Additionally, future foreseeing of new drug delivery systems that may represent potential means for more efficient glaucoma management are overviewed. Finally, a gab-analysis for the required investigation to pave the road for commercialization of ocular novel-delivery systems based on the nano-technology are discussed.

Minimally Invasive Glaucoma Surgery: What Do We Know? Where Should We Go?

With the arrival of a plethora of new and revolving minimally invasive glaucoma surgery techniques, glaucoma specialists currently are fortunate to have various surgical options that aim to recovery of the function of the aqueous outflow system in different ways. Meanwhile, the aqueous outflow system has become the hot point of researching. In ARVO 2019, a special interest group session was held on new perspectives on minimally invasive glaucoma surgery. Ten surgeons, clinical professors, and experimental scientists were invited to report their latest studies and discussed on five hot topics in this special interest group. This review summarizes the special interest group session and posts the issues of greatest concern, providing insight to the aqueous outflow system and areas that require further study.

Laser Trabeculoplasty Perceptions and Practice Patterns of Canadian Ophthalmologists

Aim

To describe the current practice patterns and perceptions of Canadian ophthalmologists using laser trabeculoplasty (LTP).

Materials and methods

A cross-sectional survey of 124 members of the Canadian Ophthalmological Society (COS) who perform LTP was conducted. Descriptive statistics and Chi-square comparative analyses were performed on anonymous self-reported survey data.

Results

Of the 124 respondents, 34 (27.4%) completed a glaucoma fellowship. Use of selective laser trabeculoplasty (SLT) (94.4%) was preferred over argon laser trabeculoplasty (ALT) (5.6%). The most frequently cited reasons for SLT preference was less damage to trabecular meshwork (30.7%), availability (16.2%), and repeatability (16.2%). In all, 47.6% of the respondents performed LTP concurrently with medical treatment, 33.9% used it after medical treatment, and 17.7% used it as first-line treatment. Majority (87.1%) of the respondents believed that SLT is effective when repeated. In suitable patients, 41.9% of the respondents stated on average they repeat SLT once, 26.6% twice, and 19.4% greater than 2 times, respectively. Of those who repeat SLT on patients, 80.7% found repeat SLT treatments have good outcomes for patients. In all, 105 (84.7%) ophthalmologists responded they would benefit from an LTP practice guideline. Significantly more ophthalmologists without glaucoma fellowships perceived they would benefit from a practice guideline (p value <0.001).

Conclusion

This survey provides valuable practical information on how LTP is used in the treatment of glaucoma in Canada.

Clinical significance

The findings may serve as a baseline survey to trend future practices.

How to cite this article

Lee EY, Farrokhyar F, Sogbesan E. Laser Trabeculoplasty Perceptions and Practice Patterns of Canadian Ophthalmologists. J Curr Glaucoma Pract 2020;14(3):81–86.

Selective laser trabeculoplasty vs micropulse laser trabeculoplasty in open-angle glaucoma

Aim

The aim of this study was to prospectively compare the efficacy, safety, and tolerability of selective laser trabeculoplasty (SLT) vs micropulse laser trabeculoplasty (MLT) in reducing intraocular pressure (IOP) in open-angle glaucoma patients.

Patients and methods

In all, 38 patients were randomized to 360° MLT and 31 patients were randomized to 360° SLT. IOP was measured at intervals of 1 hour and 1, 1–6, 6–12, 6–24, 24–36, and 36–52 weeks. Patients completed a survey 1 week after the procedure. Patients with end-stage, neovascular, uveitic, or angle-closure glaucoma were excluded. Treatment response was defined as an IOP reduction of ≥20.0% or ≥3 mmHg from baseline.

Results

IOP was lowered to ≥3 mmHg from baseline among 37.0% of the micropulse patients and 36.0% of patients in the selective laser group at 24–52 weeks. Similarly, 29.6% of the micropulse patients and 36.0% of the selective laser patients experienced a 20.0% IOP decrease from baseline during the 24–52-week interval (P=0.77). Both groups revealed similar reductions in IOP as absolute values and percentage decreases from baseline at all intervals up to 52 weeks post treatment. There were more treatment failures in the micropulse group up to 52 weeks post laser treatment; however, this was not statistically significant. The micropulse group reported less pain both during and after the procedure (P=0.005).

Conclusion

Micropulse trabeculoplasty has demonstrated similar efficacy to SLT over a 52-week follow-up period with less discomfort experienced both during and after the procedure.

Selective laser trabeculoplasty: past, present, and future

Over the past two decades, selective laser trabeculoplasty (SLT) has increasingly become an established laser treatment used to lower intraocular pressure in open-angle glaucoma and ocular hypertensive patients. In this review we trace the origins of SLT from previous argon laser trabeculoplasty and review the current role it has in clinical practice. We outline future directions of SLT research and introduce emerging technologies that are further developing this intervention in the treatment paradigm of glaucoma.

Randomized Controlled Comparison of Titanium-Sapphire Versus Standard Q-Switched Nd: YAG Laser Trabeculoplasty

PURPOSE

To evaluate the clinical effects of laser trabeculoplasty using a novel 790 nm wavelength titanium-sapphire laser (TLT) compared with a 532 nm Q-switched Nd:YAG laser used in standard selective laser trabeculoplasty (SLT).

METHODS

Single institution prospective clinical trial of open-angle glaucoma patients randomized to TLT or SLT at the Yale Eye Center from 2011 to 2012. Patients with previous glaucoma surgery or trabeculoplasty were excluded. Trabeculoplasty was performed by a single surgeon unmasked to treatment group. All patients received 360 degrees of treatment. The main outcome measure was intraocular pressure (IOP) at 2 years.

RESULTS

Thirty-seven patients were enrolled. The mean baseline IOPs were 19.7 in TLT (n=18) and 20.4 mm Hg in SLT (n=19, P=0.69).At 2 years, the mean IOP was 12.9 mm Hg (35% decrease, P<0.001) in the TLT group and 15.4 mm Hg (25% decrease, P=0.006) in the SLT group. The 2 groups did not differ in glaucoma medication use. Success, defined as IOP<21 mm Hg with >20% reduction from baseline without the need for secondary glaucoma procedures, occurred in 44% of TLT patients and 61% of SLT patients at 1 year and in 22% of TLT patients and 46% of SLT patients at 2 years (P=0.11). No patients experienced significant pain, anterior chamber reaction, corneal edema, or loss of vision.

CONCLUSIONS

TLT may be a safe and effective alternative to SLT to lower IOP in patients with open-angle glaucoma.

Comparing pattern scanning laser trabeculoplasty to selective laser trabeculoplasty: A randomized controlled trial

PURPOSE

To compare safety, tolerability and intraocular pressure (IOP)-lowering efficacy of pattern scanning laser trabeculoplasty (PSLT) with selective laser trabeculoplasty (SLT) in fellow eyes of untreated patients with glaucoma.

DESIGN

Randomized controlled trial.

PARTICIPANTS

Twenty-nine patients (58 eyes) with primary and secondary open angle glaucoma (OAG) were randomized to undergo PSLT or SLT in each eye.

METHODS

Pattern scanning laser trabeculoplasty was performed using the Pascal laser (Pascal Streamline 577; Topcon Inc., Tokyo, Japan). Patients' comfort level to treatment was assessed using a visual analogue scale (VAS). Follow-up visits were at week 1, month 1, 3 and 6. Success was defined as IOP reduction ≥20%.

MAIN OUTCOME MEASURES

Safety, tolerability and IOP reduction.

RESULTS

The mean age of patients was 54.1 ± 15.5 years. Baseline IOP was similar between both groups (PSLT, 17.3 ± 4.0 mmHg; SLT, 16.8 ± 3.6 mmHg, p > 0.05). In the PSLT group, the mean IOP at 1, 3 and 6 months was 14.2 ± 3.5, 13.9 ± 2.6 and 14.0 ± 2.7 mmHg, respectively. In the SLT group, the mean IOP at 1, 3 and 6 months was 14.4 ± 4.1, 13.7 ± 3.2 and 13.7 ± 3.1 mmHg, respectively. The IOP reduction in the PSLT group was greater than the SLT group at 1 month (p < 0.01) and 3 months (p < 0.01). VAS score was better in PSLT eyes: 23.9 ± 20.5 (range, 0-82) than in SLT eyes: 50.4 ± 25.3 (range, 0-98) (p < 0.001). No serious adverse events were recorded.

CONCLUSIONS

Both laser modalities had similar safety and efficacy profiles while PSLT was better tolerated by patients.

Impact of laser pulse duration on the reduction of intraocular pressure during selective laser trabeculoplasty

PURPOSE

To evaluate the efficacy of selective laser trabeculoplasty (SLT) to lower intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG), normal tension glaucoma (NTG) or ocular hypertension (OHT), when performed with laser pulse duration of 1 ns compared with standard 3-5 ns.

METHODS

Bilateral SLT with a 532 nm Q-switched neodymium-doped yttrium aluminium garnet laser was conducted in 30 patients (60 eyes) with POAG (n = 5), NTG (n = 2) or OHT (n = 23). Pulse duration was 1 ns in the right eye (30 eyes; cases) and 3-5 ns in all left eyes (controls). Main outcome measures were IOP at 1 h, 1 day, 8 weeks and 6 months, and the rate of adverse ocular tissue reactions in all eyes.

RESULTS

Mean 1 ns and 3-5 ns SLT IOPs were 24.1 and 24.3 mmHg, respectively, at baseline. No statistically significant difference in mean 1 ns and 3-5 ns SLT IOP was observed at 1 h (P = 0.761), 1 day (P = 0.758), 8 weeks (P = 0.352) and 6 months postoperatively (P = 0.879). No significant difference in postoperative anterior chamber inflammation was observed between the eyes (P = 0.529). Treatment with both laser pulse durations resulted in minor ultrastructural changes in the drainage angle.

CONCLUSIONS

SLT performed with a 1 ns laser pulse duration does not appear to be inferior to SLT performed with the standard 3-5 ns duration at lowering IOP in treatment-naïve patients with POAG, NTG or OHT.

Practice patterns and treatment changes for open-angle glaucoma: the RiGOR study

AIMS

The RiGOR study provides a current picture of the types of glaucoma treatment over 12 months.

METHODS

Patients were identified and enrolled at the time of decision to proceed with laser surgery procedure or other procedure such as incisional surgery or drainage device implantation, or initiation of a new or additional course of therapy with medication for glaucoma treatment.

RESULTS

The most frequent type of treatments were prostaglandin analogues (60%) among patients with additional medication, selective laser trabeculoplasty (87%) among patients with laser surgery and trabeculectomy (57%) among patients with incisional surgery.

CONCLUSION

For 36% of patients, a treatment cascade involves two or more therapies over a year. This demonstrates the complex nature of open-angle glaucoma treatment.

Association of CX3CR1 (V249I and T280M) polymorphisms with age-related macular degeneration: a meta-analysis

OBJECTIVE

Studies investigating the associations between CX3CR1 genetic polymorphisms and age-related macular degeneration (AMD) have reported controversial results. Therefore, this meta-analysis aims to clarify the effects of CX3CR1 T280M and V249I polymorphisms on AMD risk.

DESIGN

Meta-analysis.

PARTICIPANTS

Results from six studies were pooled in the meta-analysis.

METHODS

Relevant studies were selected through an extensive search of PubMed, EMBASE, and the Web of Science databases. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random-effects model.

RESULTS

Six studies with were included in this systematic review and meta-analysis. There was no significant association between CX3CR1 T280M polymorphism and risk of AMD under all genetic models (TT vs

CC/CT

OR = 1.57, 95% CI = 0.87-2.84; CC vs TT/CT: OR = 0.75, 95% CI = 0.54-1.06; TT vs CC: OR = 0.58, 95% CI = 0.30-1.144; CT vs CC: OR = 1.25, 95% CI = 0.91-1.70). The CX3CR1 V249I polymorphism also did not significantly affect the AMD risk (AA vs

GG/AG

OR = 1.23, 95% CI = 0.98-1.55; AG/AA vs GG: OR = 0.56, 95% CI = 0.29-1.07; AA vs GG: OR = 1.43, 95% CI = 0.97-2.09; AG vs GG: OR = 1.07, 95% CI = 0.85-1.36).

CONCLUSIONS

This meta-analysis suggested that CX3CR1 T280M and V249I polymorphisms may not be associated with an increased risk of AMD based on current published data. Given the limited sample size, the finding on CX3CR1 polymorphisms needs further investigation.

Meta-analysis of selective laser trabeculoplasty versus topical medication in the treatment of open-angle glaucoma

Background

The aim of this study was to examine possible differences in clinical outcomes between selective laser trabeculoplasty (SLT) and topical medication in the treatment of open-angle glaucoma.

Methods

Pertinent prospective comparative controlled trials comparing SLT with medication were selected through extensive searches of the PubMed, Embase, Web of Science, Chinese Biomedicine Database, and the Cochrane Controlled Trials Register database from their inception up to March 2014. Efficacy estimates were measured by their weighted mean difference (WMD) to calculate the intraocular pressure reduction (IOPR) from baseline to endpoint and by the odds ratio (OR) to determine success rates.

Results

Five prospective studies, which met the predefined criteria, were included in the meta-analysis. Four studies were randomized clinical trials and one study was a prospective non-randomized clinical trial. There were a total of 492 eyes of 366 patients with open-angle glaucoma. Four studies involving 325 eyes compared SLT with medication in terms of the IOPR. The WMD of the IOPR from the baseline was 0.6 (95 % confidence intervals: −0.24,1.43) when comparing SLT with medication. No statistical heterogeneity was observed between studies (χ2 = 1.30, P = 0.75, I² = 0.0 %). All five studies reported success rates, with a pooled OR of 0.84 (95 % confidence intervals: 0.42, 1.68), which was not statistically significant. No statistical heterogeneity was observed between studies (χ2 = 5.98, P = 0.200, I² = 33.1 %). Subgroup and sensitivity analysis confirmed the high stability of the meta-analysis results.

Conclusions

Both SLT and topical medication demonstrate similar success rates and effectiveness in lowering intraocular pressure in patients with open-angle glaucoma.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-015-0091-2) contains supplementary material, which is available to authorized users.

Selective laser trabeculoplasty as a first-line therapy: a review

Poor adherence with glaucoma medications has been well documented. There remains a significant unmet need for a relatively safe intraocular pressure (IOP)-lowering procedure that minimizes or eliminates patient participation, and thus reduce the incidence of treatment failures attributable to nonadherence. Selective laser trabeculoplasty (SLT) offers several advantages: It effectively reduces IOP in most patients with open-angle glaucoma, it is cost-effective compared with eye drops, it can be repeated if needed, and it eliminates the issue of adherence to medications when used as an initial treatment. This article reviews the evidence supporting the use of SLT as a first-line therapy in glaucoma.

One Year of Glaucoma Research in Review: 2012 to 2013

PURPOSE

The objective of this study was to provide the practicing clinical ophthalmologist with an update of pertinent glaucoma literature published from 2012 to 2013.

DESIGN

Literature review.

METHODS

The authors conducted a 1-year (July 1, 2012, to September 30, 2013) English-language glaucoma literature search on PubMed using the following terms: glaucoma, automated perimetry, optic nerve imaging, optical coherence tomography, glaucoma structure and function, intraocular pressure, central corneal thickness, glaucoma medical therapy, neuroprotection, glaucoma laser treatment, secondary glaucoma, glaucoma surgery, and miscellaneous topics in glaucoma.

RESULTS

Of 2659 articles on glaucoma published during our time frame, this review selected original and review articles that reflect novel aspects and updates in the field of glaucoma, while excluding letters to the editor, unpublished works, and abstracts. Preference was given to human research.

CONCLUSIONS

This review focuses on literature that is applicable to ophthalmologists in practice and also highlights studies that may enhance the diagnosis and management of glaucoma.

Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with open-angle glaucoma: a systematic review and meta-analysis

Objective

To examine possible differences in clinical outcomes between selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) in open-angle glaucoma at different times post-treatment.

Methods

Randomized controlled trials (RCTs) comparing SLT versus ALT were searched through August 2013. The main outcome measure was IOP, and secondary outcomes included the number of glaucoma medications, the success rate, and adverse events.

Results

Six RCTs, involving 482 eyes treated with laser trabeculoplasty, were included in the meta-analysis. For all patients (including first and previous laser trabeculoplasy), no significant difference in IOP lowering was observed between SLT and ALT at one hour (P = 0.40), one week (P = 0.72), one month (P = 0.37), six months (P = 0.08), one year (P = 0.34), two years (P = 0.58), three years (P = 0.34), four years (P = 0.47), and five years (P = 0.50). A statistically significant difference in favor of SLT was found when comparing the IOP reduction at three months after intervention (weighted mean difference (WMD): 1.19 mmHg [0.41; 1.97]; I²=0%; P = 0.003). For patients who were naive to laser, there was no significant difference of reduction in IOP comparing SLT with ALT at any time point. In patients’ previous LT, no statistically significant difference in IOP reduction was found at six months (WMD: 1.92 mmHg [-0.91; 4.74]; I² = 77.3%; P = 0.18). There was no significant difference in the reduction in the number of glaucoma medications, the success rate, or adverse event rates between the two treatments.

Conclusions

SLT has equivalent efficacy to ALT with a similar constellation of side effects. In the case of retreatment, SLT appears to be similar to ALT in IOP lowering at six months.