Purpose: To verify the efficacy of repeat SLT.
Study design: Systematic review and meta-analysis
Methods: Database search was performed on PubMed, Scopus, Web of Science, CINAHL, and MEDLINE. Grey literature and conference abstracts from ARVO and AAO. Studies were included if they involved 1) repeat SLT, 2) patients with primary open-angle glaucoma, and 3) measurement of IOP before and after initial and repeat SLT. Data on average IOP, measurement intervals, number of eyes, number of patients, average age of patients, sex proportions, and proportions of patients with primary open-angle glaucoma were extracted from the articles. Meta-analysis was performed with STATA 15.0.
Results: Screening process resulted in 12 studies to be synthesized; 8 studies were included for meta-analysis. Meta-analysis indicated that repeat SLT significantly decreases IOP at all follow-up periods studied. SMD (95% CI) were -1.30 (-1.83, -0.77), -1.48 (-2.29, -0.66), -1.25 (-2.20, -0.30), -0.62 (-0.83, -0.40), -0.83 (-1.32, -0.35), -0.61 (-0.96, -0.25) at 1-month, less than 6-months, less than 12 months, 12-15 months, 18 months, and 24 months respectively. While the effects of repeat SLT remained significant, it nevertheless diminished with time.  No major complications were noted. 
Conclusions: Repeat SLT is effective in lowering IOP for at least 24 months. Efficacy of third, fourth or further SLT remains to be verified. More data from high-quality randomized control trials and long-term follow-up are required.

Repeat selective laser trabeculoplasty for glaucoma patients: A systematic review

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