目的：前列腺素类似物（PGAs）是高眼压（OHT）和开角型青光眼（OAG）的一线治疗方法。然而,频繁的副作用和高昂的费用阻碍了患者的依从性，导致疾病进展。有证据表明，选择性激光小梁成形术（SLT）由于其安全性，可以被认为是OHT和OAG的一线治疗方法。轻微的副作用,并降低成本。考虑到PGA和SLT共享行动机制，假设先前的PGA治疗可能会影响随后的SLT疗效.因此,我们分析了PGA是否降低SLT疗效。
方法：进行了一项基于证据的综述，以评估SLT在先前接受过PGAs治疗的患者中的安全性和有效性。为此,我们使用美国国家医学图书馆的PubMed和GoogleScholar数据库对2021年5月之前发表的所有英文文章进行了广泛的文献检索.
结果：有证据表明，对于OHT和OAG，PGAs治疗与SLT相比没有优势。一个多中心，随机化，未经治疗的OHT和OAG患者的观察者掩蔽临床试验(RCT)得出结论,SLT应作为这些患者的一线治疗.这项研究得到了一项随机对照试验的荟萃分析的支持，比较SLT疗效与仅抗青光眼药物，具有SLT的优点，不良反应发生率较低。
结论：成本效益，患者依从性,和抗青光眼药物的副作用，包括更高的手术失败，支持考虑将SLT作为OAG和OHT的一线治疗。此外，SLT疗效似乎不受先前PGA给药的影响；然而，更大的队列，比较,多中心RCT是必要的，以回答这个问题。
OBJECTIVE: Prostaglandin analogs (PGAs) are first-line treatments for ocular hypertension (OHT) and open-angle glaucoma (OAG). However, frequent side effects and high costs hinder patient\'s compliance resulting in disease progression. Evidence suggests selective laser trabeculoplasty (SLT) may be considered a first-line treatment for OHT and OAG due to its safety profile, minor side effects, and reduced costs. Considering that PGAs and SLT share action mechanisms, it is hypothesized that previous PGA therapy may affect subsequent SLT efficacy. Therefore, we analyzed if PGAs reduce SLT efficacy.
METHODS: An evidence-based
review was performed to assess the safety and efficacy of SLT in patients previously treated with PGAs. For this purpose, we performed an extensive literature search using the National Library of Medicine\'s PubMed and Google Scholar database for all English language articles published until May 2021.
RESULTS: There is evidence of non-superiority of PGAs therapy versus SLT for OHT and OAG. A multicenter, randomized, observer-masked clinical trial (RCT) of untreated OHT and OAG patients concluded that SLT should be offered as the first-line treatment for these patients. This study was supported by a meta-analysis of RCTs, comparing SLT efficacy versus antiglaucoma drugs only, with the advantage of an SLT lower rate of adverse effects.
CONCLUSIONS: Cost-effectiveness, patient compliance, and antiglaucoma drugs\' side effects, including higher surgical failure, favor consideration of SLT as first-line therapy for OAG and OHT. Furthermore, SLT efficacy does not seem to be affected by prior PGA administration; however, larger cohort, comparative, multicenter RCTs are necessary to answer this question.
