Efficacy and safety of selective laser trabeculoplasty in steroid-induced ocular hypertension and glaucoma: a systematic review

Selective laser trabeculoplasty (SLT) offers a noninvasive therapeutic option to various types of glaucoma and ocular hypertension, yet its specific efficacy and safety in steroid-induced cases require a comprehensive evaluation. This systematic review assessed the SLT effectiveness in reducing the intraocular pressure (IOP) and medication dependence, alongside its safety profile in steroid-induced glaucoma (SIG) and steroid-induced ocular hypertension (SIOHT) patients. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance and registered in PROSPERO (CRD420251126072). PubMed, Google Scholar, ProQuest, EBSCO, Wiley Online Library, and ScienceDirect were searched from each database inception to July 13, 2025. The eligible studies included adults with SIOHT or SIG treated with SLT and reporting at least one of the following outcomes: IOP, use of IOP-lowering medication, treatment success, or adverse events. The risk of bias was assessed with the Joanna Briggs Institute checklist for case series and Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) for nonrandomized interventional studies. The study included seven studies comprising 154 eyes. The follow-up duration ranged from 6 to 24 months. SLT consistently lowered the IOP, with mean reductions ranging from 30 to 52% from baseline. A significant decrease in antiglaucoma medication use was also observed. The success rates varied considerably (46-91.7%). SLT was generally safe, showing minimal, transient complications. High heterogeneity in SLT protocols (pretreatment, laser devices, energy, and postoperative management) was noted, contributing to the outcome variability. The current evidence suggests that SLT may reduce the IOP and medication burden in selected patients with SIOHT or SIG. However, confidence in these findings is limited by the small sample sizes, retrospective designs, inconsistent treatment protocols, and substantial risk of bias. Larger prospective studies with standardized outcome definitions are needed to better define the role of SLT in this setting.