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Zhu D, Shah PP, Zhang C, Wong A, Bouaziz M, Barmas-Alamdari D, Mootz J, Yu A, Tirsi A, Tello C. Outcomes of Micropulse Laser Trabeculoplasty Compared to Selective Laser Trabeculoplasty: A Systematic Review and Meta-Analysis. Clin Ophthalmol 2024; 18:2205-2215. [PMID: 39131544 PMCID: PMC11316492 DOI: 10.2147/opth.s476257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose To perform a meta-analysis and systematic review to compare the efficacy and complications of micropulse laser trabeculoplasty (MLT) and selective laser trabeculoplasty (SLT) in adult patients with open-angle glaucoma (OAG) and ocular hypertension (OHT). Methods We performed a systematic review utilizing PubMed, Embase, and Scopus, on April 8, 2024. Meta-analyses were performed for the mean change in intraocular pressure (IOP) at one-month, six-month, and one-year follow-up visits, rate of IOP spikes (>5 mmHg increase from the pre-procedure baseline IOP), rate of treatment failure (<20% or <3 mmHg reduction in IOP or requiring additional medications or procedures), and mean change in number of medications. Results Six studies, with a total of 593 eyes, were included: 283 underwent MLT, while 310 underwent SLT. A statistically significant difference in the efficacy of MLT versus SLT at one-month and six-month follow-ups was present, with SLT reducing IOP by 0.83 mmHg (95% CI: 0.20, 1.47; P = 0.01) more and 0.55 mmHg (95% CI: 0.02, 1.08; P = 0.04) more than MLT, respectively. At the one-year follow-up, there was no significant disparity in IOP reduction between SLT and MLT (WMD = 0.16; 95% CI: -0.40, 0.71; P = 0.58). There was a significantly lower rate of IOP spikes in the MLT treatment group (RR = 0.37; 95% CI: 0.16, 0.89; P = 0.03). There was no statistically significant difference in the rate of treatment failures (RR = 1.05; 95% CI: 0.68, 1.62; P = 0.84) or number of topical medications reduced (WMD = 0.06; 95% CI: -0.13, 0.26; P = 0.53). Conclusion While SLT may offer greater short-term reductions in IOP, it may be associated with more postoperative IOP spikes when compared to MLT. At one-year follow-up, there were no significant differences in IOP reduction or failure rates between the MLT and SLT groups.
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Affiliation(s)
- Daniel Zhu
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Paras P Shah
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Charles Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY, 14203, USA
| | - Amanda Wong
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York, 10003, USA
| | - Michael Bouaziz
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Daniel Barmas-Alamdari
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Joseph Mootz
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Austin Yu
- Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA
| | - Andrew Tirsi
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
| | - Celso Tello
- Department of Ophthalmology, Northwell Health Eye Institute, Great Neck, New York, 11021, USA
- Manhattan Eye, Ear, & Throat Hospital, New York, New York, 10065, USA
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Verdina T, Gironi M, Battaglia B, Gentile M, Chester J, Kaleci S, Scatigna G, Mastropasqua R, Cavallini GM. Micropulse Laser Trabeculoplasty with 577 nm Wavelength at 1500 or 1000 mW for Primary Open-Angle Glaucoma: A Pilot Study. Life (Basel) 2023; 13:life13040982. [PMID: 37109510 PMCID: PMC10142494 DOI: 10.3390/life13040982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/26/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
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 577TM, 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.
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Affiliation(s)
- Tommaso Verdina
- Ophthalmology Clinic, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41122 Modena, Italy
| | - Matteo Gironi
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, 66100 Chieti, Italy
| | - Bruno Battaglia
- Ophthalmology Clinic, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41122 Modena, Italy
| | - Michele Gentile
- Ophthalmology Clinic, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41122 Modena, Italy
| | - Johanna Chester
- Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Shaniko Kaleci
- Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Gianluca Scatigna
- Ophthalmology Clinic, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41122 Modena, Italy
| | - Rodolfo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, 66100 Chieti, Italy
| | - Gian Maria Cavallini
- Ophthalmology Clinic, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41122 Modena, Italy
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Sarenac T, Bečić Turkanović A, Ferme P, Gračner T. A Review of Selective Laser Trabeculoplasty: “The Hype Is Real”. J Clin Med 2022; 11:jcm11133879. [PMID: 35807163 PMCID: PMC9267824 DOI: 10.3390/jcm11133879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/10/2022] Open
Abstract
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.
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Affiliation(s)
- Tomislav Sarenac
- Department of Ophthalmology, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (T.S.); (A.B.T.); (P.F.)
- Faculty of Medicine, University of Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia
| | - Anela Bečić Turkanović
- Department of Ophthalmology, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (T.S.); (A.B.T.); (P.F.)
| | - Peter Ferme
- Department of Ophthalmology, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (T.S.); (A.B.T.); (P.F.)
| | - Tomaž Gračner
- Department of Ophthalmology, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; (T.S.); (A.B.T.); (P.F.)
- Faculty of Medicine, University of Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia
- Correspondence:
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