Intervention Review

Laser trabeculoplasty for open angle glaucoma

  1. Christiane R Rolim de Moura1,*,
  2. Augusto Paranhos Jr1,
  3. Richard Wormald2

Editorial Group: Cochrane Eyes and Vision Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 16 AUG 2007

DOI: 10.1002/14651858.CD003919.pub2

How to Cite

Rolim de Moura CR, Paranhos Jr A, Wormald R. Laser trabeculoplasty for open angle glaucoma. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003919. DOI: 10.1002/14651858.CD003919.pub2.

Author Information

  1. 1

    Universidade Federal de São Paulo, Escola Paulista de Medicina, Ophthalmology, São Paulo, Brazil

  2. 2

    London School of Hygiene & Tropical Medicine, Cochrane Eyes and Vision Group, ICEH, London, UK

*Christiane R Rolim de Moura, Ophthalmology, Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Helena, 309 cj 15, São Paulo, São Paulo, 04006-002, Brazil. chrm@terra.com.br .

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Background

Open angle glaucoma (OAG) is an important cause of blindness worldwide. Laser trabeculoplasty, a treatment modality, still does not have a clear position in the treatment sequence.

Objectives

The objective of this review was to study the effects of laser trabeculoplasty for OAG.

Search methods

We identified trials from CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS and manual searching. We also contacted researchers in the field.

Selection criteria

We included randomised controlled trials comparing laser trabeculoplasty with no intervention, with medical treatment, or with surgery. We also included trials comparing different technical modalities of laser trabeculoplasty.

Data collection and analysis

Two authors independently assessed trial quality and extracted the data. We contacted trial investigators for missing information.

Main results

This review included 19 trials involving 2137 participants. Only five trials fulfilled the criteria of good methodological quality. One trial compared laser trabeculoplasty with topical beta-blocker to no intervention in early glaucoma. The risk of glaucoma progression was higher in the control group at six years of follow up (risk ratio (RR) 0.71 95% confidence interval (CI) 0.53 to 0.95). No difference in health-related quality of life was observed between the two groups. Three trials compared laser trabeculoplasty to medication (regimens used before the 1990s) in people with newly diagnosed OAG. The risk of uncontrolled intraocular pressure (IOP) was higher in the medication group compared to the trabeculoplasty group at six months and two years of follow up. Three trials compared laser trabeculoplasty with trabeculectomy. The risk of uncontrolled IOP was significantly higher in the trabeculoplasty group at six months but significant heterogeneity was observed at two years. Diode and selective laser are compared to argon laser trabeculoplasty in three trials and there is some evidence showing a comparable effect in controlling IOP at six months and one year of follow up.

Authors' conclusions

Evidence suggests that, in people with newly diagnosed OAG, the risk of uncontrolled IOP is higher in people treated with medication used before the 1990s when compared to laser trabeculoplasty at two years follow up. Trabeculoplasty is less effective than trabeculectomy in controlling IOP at six months and two years follow up. Different laser technology and protocol modalities were compared to the traditional laser trabeculoplasty and more evidence is necessary to determine if they are equivalent or not. There is no evidence to determine the effectiveness of laser trabeculoplasty compared to contemporary medication (prostaglandin analogues, topical anhydrase inhibitors and alpha2-agonists) and also with contemporary surgical techniques. Also there should be further investigation in to the effectiveness of laser trabeculoplasty in specific racial groups, specific diagnostic groups, such as pseudoexfoliation and pigmentary glaucoma and different stages of OAG. More research is also required determining cost-effectiveness of laser trabeculoplasty in the management of glaucoma.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Laser trabeculoplasty for open angle glaucoma

Glaucoma is a chronic progressive disease of the optic nerve which, if not treated, leads to visual field decay and blindness at end stages. Intraocular pressure (IOP) decreasing is shown to diminish the progression of the disease, and could be achieved by the chronic use of hypotensive eyedrops, incisional surgery or laser trabeculoplasty. There is still great controversy about where in the treatment scale laser trabeculoplasty is positioned, although this technique has already been described three decades ago. This treatment consists of application of laser spots in the trabecular meshwork, the structure responsible for the aqueous humor drainage, leading to an increase in the outflow facility through it and in consequence, decreasing IOP. It is an interesting form of treatment since it does not depend on chronic instillation of eyedrops, as does medical treatment, and also does not have too many complications, as does incisional surgery. This review included 19 trials (2137 participants). One trial compared laser trabeculoplasty associated with a hypotensive eyedrop with no intervention, and at six years of follow up the risk of visual field decay was greater in non treated participants. Three trials compared hypotensive eyedrops with trabeculoplasty, and the risk of uncontrolled IOP was greater at two years in the laser group. It is necessary to mention that the eyedrops used in these trials differ significantly from the ones used currently, since these trials were developed a decade ago. Three other trials compared trabeculoplasty with trabeculectomy and the risk of uncontrolled IOP was higher in the laser group at six months of follow up. There is some evidence showing that diode laser and selective trabeculoplasty have similar effect in controlling IOP when compared to argon laser trabeculoplasty. Comparisons of different lasers and different techniques of application were done in the remaining trials, but there is still not enough evidence to determine which is the best treatment protocol. Further research is necessary to compare trabeculoplasty with new hypotensive eyedrops and also the results of laser therapy in people of different ethnicities, since some studies suggest that they have a different response to this kind of laser therapy. More research is required to analyse cost-effectiveness of these interventions.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

雷射小樑成型術用於隅角開放型青光眼

研究背景

在全世界,隅角開放型青光眼(Open angle glaucoma (OAG))是造成失明的重要原因之一。雷射小樑成型術是一種治療方式,但是其治療結果仍未有清楚的定位。

研究目的

這篇回顧的目的為研究雷射小樑成型術對於隅角開放型青光眼的效果。

检索方法

我們從Cochrane Library中的CENTRAL、以及MEDLINE、 EMBASE、LILACS和手查過程中尋找臨床試驗。我們也連絡了該領域的研究者。

纳入标准

我們納入了將有雷射小樑成型術與無介入措施、內科治療或手術相比較的隨機對照臨床試驗。我們也納入了比較各種技術模式的雷射小樑成型術的試驗。

数据收集与分析

兩名作者分別獨立評估試驗品質並摘錄資料。我們聯絡試驗研究者以了解遺漏的資訊。

主要结果

這篇回顧納入19篇試驗,包含2137名研究對象。只有五篇研究完全符合方法學品質良好的標準。一篇試驗是比較雷射小樑成型術與局部的β阻斷劑對照無介入措施用於治療早期青光眼。六年追蹤期間,對照組發展成青光眼的風險較高(risk ratio (RR)為0.71,95% confidence interval (CI)為0.53 至0.95)。兩組的健康相關生活品質沒有顯著差異。三篇試驗比較雷射小樑成型術與藥物(1990年代以前使用的方案)用於治療新診斷為隅角開放型青光眼的病患。在六個月與兩年的追蹤期間,相較於雷射小樑成型術,藥物組眼壓失控(intraocular pressure (IOP))的風險較高。三篇試驗比較雷射小樑成型術與小樑切除術。六個月時小樑成型術組其眼壓失控的風險顯著較高,但兩年時則沒有觀察到顯著的差質。三篇試驗比較半導體與選擇性雷射對照氬氣雷射小樑成型術,有些證據顯示在六個月與一年的追蹤時其控制眼壓的效果相同。

作者结论

證據顯示在新診斷為隅角開放型青光眼的病患中,追蹤兩年時,與雷射小樑成型術相比較,在1990年代之前使用藥物治療者中,其眼壓失控的風險較高。在六個月與兩年的追蹤期間,小樑成型術對於控制眼壓並沒有比小樑切除術有效。將不同的雷射技術與模式與傳統的雷射小樑成型術相比較,則須要有更多的證據以確定他們的效果是否相同。將雷射小樑成型術與現代藥物(前列腺素衍生物,局部的脫水酵素抑制劑與α2致效劑)及現代手術技術相比較,亦無證據足以確定其效果。另外也應進一步研究雷射小樑成型術對於特定種族族群,特定診斷族群,如假性剝落與色素性青光眼與不同階段隅角開放型青光眼的效果。另外也需要更多的研究以決定雷射小樑成型術對於處理青光眼的成本效果。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

雷射小樑成型術用於隅角開放型青光眼

雷射小樑成型術用於廣效型青光眼。青光眼是一種慢性進展的視神經疾病,如果沒有加以治療將導致視野衰退,最終失明。顯示減少眼壓(IOP)可以降低疾病的進展,且可以經由長期使用低壓的眼睛滴劑,切口手術或雷射小樑成型術來達成。雖然雷射小樑成型技術在三十年前就已經被描述過,但目前對於此種技術在治療位階中的地位仍有許多爭議。這種治療包括在眼小樑網絡上使用雷射光點,其網絡負責水狀液引流的結構,使液體得以通過而增加外流與結果以降低眼壓。它是一種有趣的治療方式,因為它不像藥物治療需要依賴長期的眼睛滴劑,而且也不像切口手術有太多的併發症。這篇回顧納入19篇試驗(2137名研究對象)。一篇試驗比較雷射小樑切除術與低壓的眼睛滴劑對照無介入措施,在六年的追蹤期間,無治療的研究對象其視野退化的風險較高。三篇試驗比較低壓的眼睛滴劑與小樑成型術,在兩年追蹤時雷射組其眼壓失控的風險較高。有必要說明在這些試驗中所使用的眼睛滴劑與目前所使用的眼睛滴劑有很大的不同,因為這些試驗是在十年前進行的。三篇其它的試驗比較小樑成型術與小樑切除術,在六個月追蹤時雷射組其眼壓失控的風險較高。有一些證據顯示相較於氬氣雷射小樑成型術,半導體雷射與選擇性小樑成型術對於控制眼壓具有相同的效果。其餘試驗已完成不同的雷射與技術的比較,但仍然沒有足夠的證據可以決定最佳的治療方案。進一步的研究需要去比較小樑成型術與新的低壓眼睛滴劑,以及雷射療法對於不同種族的結果,因為有些研究認為這種雷射療法對他們會有不同的反應。需要更多的研究去分析這些介入措施的成本效果。

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