Methods

Allocation: randomised, centralised, stratified list generated by a formal procedure, assigned the eye to one of the two surgical sequences. Both eyes could be enrolled if they both met inclusion criteria at the same time and they were randomised separately
Masking: evaluator (whenever possible). If the evaluator gained knowledge of the treatment assigned, they noted this on the examination form
Follow up: 5 years
Centres: 11

Participants

N = 591 participants (789 eyes)
Diagnosis:
1. POAG in a phakic eye
2. OAG in a phakic eye four weeks or more after laser iridotomy, provided the eye is not inflamed, steroid medication has not been used for a week, and less of one twelfth of the trabecular meshwork circumference is blocked by PAS
3. study eye on maximal medical therapy tolerated
4. at least 1 visual field test before the eligibility test
5. study eye meets at least 1 of the 9 combinations of criteria for consistent elevated IOP, glaucomatous visual field defect and optic disk rim deterioration specified in the study
6. visual acuity of 20/80 or better (Snellen)
7. visual field score at least 1 and not more than 16
8. study eye treatable with either with trabeculoplasty or trabeculectomy
9. patients able to cooperate
10. patients sign consent form
Age: 35 to 80 years old (median 67 year old)
Gender: 46% male; 54% female
Race: 42% white, 56% black, 2% other
History: hereditary 38% (first degree), hypertension 50%, vascular disorder 20%, diabetes 20%

Interventions

1. ALT + trabeculectomy + trabeculectomy (n = 404)
2. Trabeculectomy + ALT + trabeculectomy (n = 385)

Outcomes

Early failure (6 weeks): IOP > initial levels, SVFD
Late failure (more than 6 weeks): when met again the eligibility criteria with maximal medical therapy (eligibility criteria are explicited in the AGIS protocol and combines visual field severity with IOP levels)

Notes

Considering this study has three interventions in each group, we will consider the results just of the first intervention, which were obtained by personal contact

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Allocation: randomised
Masking: not mentioned
Follow up: 24 months
Centres: 1
ITT analysis: not mentioned

Participants

N = 82 participants (82 eyes)
Diagnosis:
1. newly diagnosed simple or capsular glaucoma
2. untreated mean daytime IOP between 25 and 50 mmHg
3. trabecular meshwork visible at least 3/4 at gonioscopy
4. reproducible visual field defect at automated perimetry (Competer 350, threshold program 30 degrees) or Goldmann perimetry.
Eye included: the worse, but fellow eye received the same therapy if necessary
Exclusion criteria: participants with other causes of visual field loss, participants that could not cooperate with a reliable visual field examination, gonioscopy or fundus examination, severe visual field in one eye (PV less than 100), visual acuity less than 0.3 at Snellen's fraction, refractive errors greater than + ‐ 5.00, aphakia or pseudophakia, ocular inflammation, corneal disease, age below 50 years
Age: at least 50 years old (70.8)
Sex: not mentioned
Race: all Caucasian
History: all phakic, 29 participants had bilateral glaucomatous damage, no description of concomitant pathologies

Interventions

1. ALT (n = 40). 2 sessions 1 month apart (randomly assigned superiorly or inferiorly). 50 spots, 50 micra, 0.1 seconds. No postoperative steroids were used
2. Ocular hypotensive medication (pilocarpine 4%, 3 times daily) (n = 42). Extra medications were not mentioned in the first publication. Stepped medication described in 1992: 1. beta‐blocker; 2. oral acetazolamide; 3. ALT; 4. surgery

Outcomes

Failure:
1. 2 daily IOP curve > 26 mmHg 1 week apart
2. IOP reduction < 4 mmHg on 2 following IOP curves (1 week apart)
3. clinically evident visual field decay
4. adverse reaction that necessitates change in medication
Success: no indication for additional therapy
Continuous data of pressure for superior or inferior trabeculoplasty
Optic nerve progression (documented with stereophotographs analysed by a 2 masked examiners, projected simultaneously)

Notes

1 participant deceased after 10 months of treatment

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Allocation: randomised (table of random numbers)
Masking: not mentioned
Follow up: 14 months
ITT analysis: not mentioned

Participants

N = 40 participants (40 eyes)
Diagnosis:
1. POAG for which maximum medical therapy had failed to control IOP at less than 22 mmHg. Maximum therapy for this study was topical timolol 0.25% twice daily and pilocarpine 2% 4 times a day
2. no evidence of pseudoexfoliation or pigment dispersion syndrome
3. the absence of corneal opacities which might preclude view of the trabecular meshwork
4. no previous surgery or trabecular photocoagulation
5. the participant should be willing and capable of giving informed consent to the treatment and able to complete follow‐up visits
Age: mean 65.8 years in DLT group and 67.8 years in ALT group
Sex: not mentioned
History: not mentioned

Interventions

1. DLT (n = 20)
2. ALT (n = 20)

Outcomes

Failure:
1. IOP > or equal 22 mmHg
2. PAS formation
3. Continuous IOP data

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Allocation: randomised
Masking: evaluator masked for gonioscopy and tonometry.
Follow up: 12 months (7 to 20)
ITT analysis: not mentioned (describe one loss of follow up). We used all randomised to analyse failure

Participants

N = 20 participants
Diagnosis: OAG (excluded eyes with closed angles, aphakic and pseudophakic, juvenile glaucoma and miopia over 3 diopters)
Age: not mentioned
Race: not mentioned
Sex: not mentioned

Interventions

1. DLT (n =10)
2. ALT (n =10)

Outcomes

Failure: less of 20% IOP reduction or need of changing in medication

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Allocation: randomised, by a third person, random numbers table. If the patient had both eyes to be treated they were randomised separately.
Masking: until patient signed informed consent
Follow up: 5 years
Centres: 1
ITT analysis: not mentioned

Participants

N = 46 participants (50 eyes)
Diagnosis: OAG with maximally tolerated medical therapy. Included POAG, pseudoexfoliation syndrome, pigmentary glaucoma, patients with mixed mechanisms and NTG
Age: 1. 76 years old +‐ 2.8; 2. 71 years old +‐ 2.5
Race: not mentioned
History: 6 eyes in group 1 received intraocular surgeries before DLT and 5 eyes in group 2 (ALT) received previously intraocular surgeries

Interventions

1. DLT (n = 22)
2. ALT (n = 28)

Outcomes

Failure: need of trabeculectomy
Side effects: discomfort, PAS formation, inflammation

Notes

No difference of IOP between groups at any time. 4 participants had both eyes randomised

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Allocation: randomised by a blocked randomisation schedule (computered generated), third party
Masking: no
Follow up: 12 months
Centres: 1
ITT analysis: used

Participants

N = 152 participants (176 eyes). Both eyes included but correlation between eyes was accounted.
Diagnosis: OAG, primary, pigmentary or pseudoexfoliation) on maximal medical therapy or failed previous ALT (180/360, more than 6 months previously), had 2 sighted eyes. Exclusion criteria: advanced visual field defect, previous glaucoma surgery done, corneal disease, use of systemic steroids during the study
Age: 1. 69.7 years (10.52); 2. 69.5 years (11.54)
Race: not mentioned
Sex: 72 male, 104 female

Interventions

1. SLT (n = 89)
2. ALT (n = 87)

Outcomes

Primary outcome: less of 20% IOP reduction from initial values at 6 months and one year.
Secondary: anterior chamber reaction, IOP spikes at one hour post laser and PAS formation.

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Allocation: randomised, methods not specified. When both eye were eligible, one eye was randomised to each group
Masking: not specified
Follow up: 6 months
Centres: 1
ITT analysis: not mentioned

Participants

N = 34 participants (40 eyes)
Diagnosis: IOP equal or greater than 25 mmHg in a pre laser curve in a patient with POAG or capsular glaucoma; glaucomatous cupping of the optic disc and glaucomatous visual field defect; no earlier glaucoma treatment
Age: 1. 72.5 years (54 to 89); 2. 70.2 years (62 to 89)
Race: not specified
History: not specified

Interventions

1. ALT in 2 stages. Treatment of 180 degrees of trabecular meshwork in each stage (n = 19)
2. ALT in 1 stage. Treatment of 360 degrees of trabecular meshwork (n = 21)
Treatment protocol: 50 micra spot size, 0.1 seconds, 0.8 to 2.0 W

Outcomes

Failure:
IOP > 22 mmHg with hypotensive medication
Visual field deterioration (confirmed with manual perimetry)
Optic disc deterioration (detected by biomicroscopy)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Allocation: randomised (set of sequentially numbered, opaque, sealed envelopes provided by a Data centre)
Masking: computerised visual field and fundus photographs read by masked graders (Disc Photography Reading Center). IOP evaluator was also masked (and the status of collecting data was recorded at each study visit)
Follow‐up: at least 4 years
Centres: 2 clinical, 1 reading and 1 co‐ordinating
ITT analysis: used
Randomisation: January 1993 to April 1997

Participants

N = 255 participants (if possible both eyes with correction of correlation between fellow eyes)
Diagnosis: Men and women with newly diagnosed, previously untreated COAG (primary, normal tension, exfoliative glaucoma). The diagnosis required repeatable visual fields defects in at least one eye, detected by static computerised perimetry (Humphrey 24‐2 Full‐Threshold program).
Exclusion criteria included: advanced visual field defects (MD ‐16 dB or threat to fixation), visual acuity less than 0.5, mean IOP greater than 30 mmHg, lens opacities exceeding N1, C1 or P1 in the Lens Opacities Classification System II. Participants with glaucomatous visual field defect in both eyes eligible only if MD ‐10dB or better in one eye and ‐16dB in the other eye
Age: mean 68.1 years (4.9)
Race: not mentioned, but probably 100% white
History: 20% had family history of glaucoma, 38% had systemic hypertension, 6% had myocardial infarction, 4% had diabetes, 9% had vasospasm, 10% had migraine
24% had both eyes eligible

Interventions

1. No treatment (n = 126)
2. Betaxolol and ALT, performed one week after inclusion (n = 129)
Technique: full 360 degree ALT was administered
If the eligible eye achieved 25 mmHg in 2 consecutive visits or the other eye 35 mmHg in 1 visit, latanoprost 50 micrograms/ml was administered once daily

Outcomes

Primary: glaucoma progression (visual field changes or optic disk changes). Visual field progression was defined as worsening of 3 consecutive points in the Glaucoma Change Probability map, confirmed in 3 consecutive visual fields. Optic disc progression should be detected by a masking reader in a flicker chronoscopy and side by side comparison in 2 consecutive visits
Secondary: explore natural history, explore the factors that may influence progression, change in IOP over time, vision‐related quality of life

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Allocation: randomised, methods not specified
Masking: not mentioned
Follow up: 4 years (3 years and 1 year after cross over)
ITT analysis:

Participants

N = 32 participants randomised.
Diagnosis: participants with POAG: IOP greater than 22 mmHg in both eyes (mean of the 2 highest readings of the daily phasing); glaucomatous visual field defects in at least 1 eye as assessed by a computer assisted static perimetry (Octopus G1). In case of a unilateral field defect, the fellow eye had to show optic disc cupping consistent with glaucomatous optic neuropathy
Exclusion criteria: previous antiglaucoma treatment, smoking, history of allergic and respiratory disease, including asthma and atopy assessed by skin prick testing.
Participants who experienced IOP > or = 22 mmHg during follow up were excluded
Age: 44 to 67 years
Gender: 17 women and 15 men
History: not mentioned

Interventions

1. ALT (n = 16)
2.0.5% timolol twice daily (n = 16)
No other treatment was administered to these participants during the follow up. If the IOP reached 22 mmHg or more the participant was excluded

Outcomes

Primary: change in the PC20, the provocative concentration that reduced at least 20% of the forced expirated volume, presented in a logarithmic transformed value

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Allocation: randomised. Blocked on patient: 1 eye 1 intervention, fellow eye the other
Masking: IOP evaluator, visual field and optic disc reading centres
Follow up: the study was controlled for 2 years, but there was a follow up until 9 years on an observational basis (no managed treatment)
Centres: 8 clinical, 1 co‐ordinating, 1 photography reading centre, 1 visual field reading centre
ITT analysis:

Participants

N = 271 participants (542 eyes). At follow up (after 2 years) 203 participants were followed.
Diagnosis: age > or = 35 years, IOP in both eyes > or = 22 mmHg on 2 consecutive visits, IOP ratio between 0.67 and 1.5 inclusive, glaucomatous field defect in at least 1 eye or disc abnormality in the presence of extremely elevated IOP, best corrected visual acuity 20/70 or better in both eyes, informed consent
Exclusion criteria: history of glaucoma other than POAG, usage of topical or systemic antihypertensive medication within the last 6 months, severe paracentral or central field defect, contraindication for use of trial medication, previous eye surgery, goniosynechiae more than 10 degree, evidence of diabetic retinopathy, current use of corticosteroids, epinephrine or clonidine
Age: median 61 years
Race: 45% white, 43% black
History: 15% diabetes; 12% coronary disease, 10% peripheral vascular disease, 37% hypertension, 7% anemia, 4% using alfa blocker, 6% using beta blocker

Interventions

1. ALT first followed by topical medication if needed (n = 271)
2. Medication first, applied according a stepped regimen (n = 271)

Outcomes

Failure criteria:
1. Primary: prescription of more than first line medication
Reduction of IOP was considered inadequate if the measurements were of 22 mmHg or more at 2 consecutive visits 2 weeks apart or above 80% of the reference IOP. The reference IOP could change if there was a visual field decay
2. Secondary: deterioration of visual field. Visual fields were examined using Program 32 on the Octopus 201 or 2000 automated perimeter. The analysis was numerically and clinically
3. Deterioration of optic disc (subjective assessment)
4. Change in IOP
5. Deterioration of visual acuity
6. Need of further glaucoma intervention
7. Intraocular spikes observed at 4 hours of the first application (data used)
8. PAS formation at 3 months of follow up

Notes

At 2 years of follow up uncontrolled IOP was defined as need of one medication to the LF group and add a second medication to MF group.
Early IOP spikes were considered after the first laser application

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Allocation: randomised (not mentioned allocation criteria, but were stratified by race before randomisation)
Masking: not mentioned
Follow up: 90 months
Centres: 1
ITT analysis: not mentioned

Participants

N = 36 participants (45 eyes)
Diagnosis: POAG and exfoliation syndrome, no previous ocular surgery, age 50 years or older, current treatment with maximally tolerated ocular hypotensive medication
Age: 57 to 92 years (mean 75 +‐ 1.4)
Race: 27 white and 9 black
History: not mentioned

Interventions

1. ALT (100 burns, applied 360 degrees over the meshwork) (n = 15)
2. ALT (50 burns, applied over 180 degrees of the meshwork) (n = 15)
3. ALT (50 burns, applied over 360 degrees of the meshwork) (n = 15)

Outcomes

Failure criteria: further intervention required (after completion of 100 burns of ALT)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Allocation: randomised
Masking: not mentioned
Follow up: 24 months
Centres: 1
ITT analysis: not mentioned

Participants

N = 80 participants (102 eyes)
Diagnosis: POAG and exfoliative glaucoma requiring initial ALT
Age: not specified
Race: not specified
History: not specified

Interventions

1. ALT receiving 50 burns to the superior 180 degrees of the trabecular meshwork (n = 49 eyes)
2. ALT receiving 50 burns to the inferior 180 degrees of the trabecular meshwork (n = 53 eyes)

Outcomes

Failure criteria: further intervention required (either completion of ALT or filtration surgery)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Allocation: randomised (one eye allocated to receive treatment with 0.2s and the fellow eye received 0.1s)
Masking: evaluator (notes in chart)
Follow up: 6 months and posteriorly a new analysis with 24 months of follow up
Centres: 1
ITT: not mentioned

Participants

N= 33 participants randomised (64 eyes)
N=26 participants followed for 24 months
Diagnosis: POAG on topical hypotensive medication who had IOP of 21 mmHg or more and/or who showed deteriorating visual fields, using a suprathreshold static visual field analyser (Friedmann). Pseudoesfooliation, pigment dispersion syndrome and other secondary glaucomas were excluded)
Age: 73.4 (8.3) years
Race: not speciefied
History: not specified

Interventions

1. ALT with duration of 0.1 sec in OD and with 0.3 seconds each spot in OS (n=17)
2. ALT with duration of 0.2 sec in OD and with 0.1 seconds each spot in OS (n=16). All eyes received a 50 micra spot size, applied to all 360 degrees of the trabecular meshwork in one or two sessions. The power setting was started at 0.9 W

Outcomes

Failure criteria: Adverse effects: IOP spikes after one hour of laser application

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Allocation: randomised (computer selection)
Masking: not mentioned
Follow up: 6 months to 8 years
Centres: 1
ITT analysis: not mentioned (77 randomised; 44 analysed in the first publication in 1984)
The worse eye analysis was performed in cases of bilateral glaucoma or random allocation

Participants

N = 77 participants randomised (44 participants with a minimum of six months of follow up were analysed)
Diagnosis: OAG newly diagnosed
Inclusion criteria: IOP equal or greater 24 mmHg on 2 different occasions, cup to disc ratio equal or greater than 0.6 and/or notching, and/or pallor of the neuroretinal rim, glaucomatous visual field loss using the Friedmann Field Analyser
Posterior publication = 168 participants
Age: varied between 60.8 and 67.1 years
History: not mentioned
Race: not mentioned

Interventions

1. Medical treatment (pilocarpine and/or sympatomimetics and/or timolol and/or carbonic anhydrase inhibitor (n = 15). Medical regimen could have been changed to control IOP. n2 (post publication) = 56
2. Surgical treatment (trabeculectomy) (n = 15); n (post publication) = 57
3. ALT (plus pilocarpine if IOP not controlled). It was performed in 2 sessions 2 weeks apart, 50 burns over 180 degrees each session, 50 micra spot size, 0.1 seconds, 0.5‐1.0 W. 0.3% prednisolone was used 4 times a day for 4 days and pilocarpine if necessary. Pilocarpine was used 2% four times a day 1 week prior the laser treatment. Participants in this group could receive pilocarpine 2% to control their pressure during the follow up. n = 15; post publication n = 55

Outcomes

Failure criteria: IOP equal or greater than 22 mmHg after 3 months of treatment or visual field loss greater than 2% per annum

Notes

If failure occurred the second line treatment was undertaken and again randomly allocated
Success:
6 months: surgery = 100%; med = 87%; laser = 86%;
3 years: surgery = 99.9%; med = 89.2%; laser = 85%
The visual field deterioration is determined by a mean score, but is shown in Table 4 (1994). There is not an absolute number.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Allocation: randomised
Masking: not mentioned
Follow up: 12 months
Centres: 1
ITT analysis: not mentioned

Participants

N = 30 participants (48 eyes)
Diagnosis: Phakic POAG with IOP of 22 mmHg or greater despite maximal medical therapy. These participants had glaucomatous optic disc cupping and glaucomatous visual field changes on Goldmann perimetry.
In bilateral cases right eyes were randomised and left eye received the opposite.
Exclusion criteria: Developmental, aphakic, inflammatory, haemolitic and pseudo‐exfoliative types of glaucoma were not eligible.
Age: 62 years (27 to 77 years)
Race: black
History: not mentioned

Interventions

1. ALT (n = 25 eyes). Technique: 50 micra in the anterior portion of the trabecular meshwork, 0.1 sec of duration, power was adjusted to 800 to 1000mW. 50 burns placed over nasal 180 degrees at first application. If after 3 months the IOP remained high the procedure was repeated at the 180 degrees temporally. Eyes received prednisolone acetate 1% if there was uveitis
2. Full tolerable antiglaucoma medical treatment (n = 23 eyes) ‐ pilocarpine 4% and acetazolamide orally. 4 participants also used timolol

Outcomes

Success criteria: successful control: IOP < 22 mmHg
Improvement: reduction in IOP of 5 mmHg but keeping levels of more than 22 mmHg
No improvement: reduction in IOP of 4 mmHg or less but keeping levels of 22 mmHg or greater
Deterioration: rise in IOP of 5 mmHg or more

Notes

The authors describe the results of each success group

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Allocation: randomised (each eye). Methods of allocation: picking from a hat
Masking: not mentioned
Centres: 1
ITT analysis: not applied

Participants

N = 120 participants
Diagnosis: POAG (60 participants) and capsular glaucoma (60 participants). All eyes receiving maximal tolerated antiglaucoma medication insufficient to control the glaucoma
Age: 71 years (51 to 87)
Race: not mentioned
History: not mentioned

Interventions

1. ALT (n = 29), 50 micra, 0.1 sec, power level 500 mW
2. ALT, 50 micra, 0.1 sec, power level 600 mW (n = 30)
3. ALT, 50 micra, 0.1 sec, power level 600 mW (n = 30)
4. ALT, 50 micra, 0.1 sec, power level 800 mW (n = 30) .
Medication was kept unchanged. No anti‐inflammatory drugs were used

Outcomes

Failure criteria:
1. PAS formation
2. IOP > or = 21 mmHg or no decrease of IOP < 3 mmHg

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Allocation: randomised (one eye selected by computer, the other eye selected as control)
Masking: evaluator and second visual field evaluator
Follow up: 35 months (30 to 40)
Centres: 1
ITT analysis: not mentioned, but losses were described

Participants

N = 25 participants (50 eyes)
Diagnosis: bilateral POAG as judged by elevation of IOP (above 21 mmHg), glaucomatous disc change and visual field loss. No previous eye surgery or evidence of other eye disease. Patients taking in both eyes the maximum antiglaucoma medication that could be tolerated. Despite treatment IOP was consistently exceeding 21 mmHg and considered to be inadequately controlled.
Age: 72, 54 years (50 to 90)
Race: not specified
History: not mentioned

Interventions

1. ALT (n = 25) (360 degrees, 100 burns, 0.1 seconds, 150 to 350 micra size spots) continued with maximal medical therapy. The participants received topical prednisolone 1% 4 times a day for one week after the treatment
2. MMT (n = 25)

Outcomes

Success criteria: IOP decrease of 20% or more from the baseline examination; no IOP readings above 21 mmHg; stable visual fields by Goldmann perimetry

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate

Methods

Allocation: randomised
Masking: not mentioned
Follow up: 2 to 14 months (9.5 months)
Centres: 1
ITT analysis: not mentioned

Participants

N = 100 participants (100 eyes)
Diagnosis: COAG, phakic eyes, with visual field and/or optic nerve damage (not specified by which methods) and judged to be uncontrolled with maximum tolerated medical therapy
Age: 1. 64.0 years (mean); 2. 69.4 years (mean)
Race: 89% white participants, 11% black participants
History: not mentioned

Interventions

1. Bichromatic wavelength (blue‐green) ALT, performed with 80 burns over 360 degrees of the anterior portion of the trabecular meshwork (n = 50 eyes)
2. Monochromatic wavelength (green) ALT applied with the same technique (n = 50 eyes)
In both groups eyes were kept with MMT tolerated

Outcomes

Failure: need for filtering surgery

Notes

Green manufactured by MIRA; Blue‐green manufactured by Coherent Radiation Model 900

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Methods

Allocation: randomised (blocked, by a third party not involved). If a participant required a second eye to be treated this was subjected to the same randomisation procedure as the first
Masking: not mentioned
Follow up: 6 months
Centres: 2
ITT analysis: not mentioned

Participants

N = 61 participants (95 eyes)
Diagnosis: OAG classified as severe or with evidence of progression of disease or not responding to medical treatment. 7 participants had NTG, 1 was aphakic and 1 had pseudoexfoliation (2 eyes), but all had open angles
Age: 70 years (range 38 to 86 years)
Race: not mentioned
History: not mentioned
Race: not mentioned

Interventions

1. ALT (n = 46). Blue/green laser source, applied 180 degrees of the trabecular meshwork, 50 burns, 50 micra spots
2. Trabeculectomy (n = 48). Standard technique with a fornix based flap

Outcomes

Continuous data; need for medication; need for filtering surgery

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate