There are several divergences in the literature regarding the safety and effectiveness of selective laser trabeculoplasty application at 360° vs. 180°. This systematic review and meta-analysis aimed to compare the efficacy and safety of selective laser trabeculoplasty at 180° and 360° in open-angle glaucoma and ocular hypertension. This systematic review and meta-analysis, registered with International Prospective Register of Systematic Reviews (CRD42024501311), conducted searches in PubMed, Embase, Web of Science, and Cochrane Library from inception to January 2024. The protocol is registered in International Prospective Register of Systematic Reviews under the same registration number. Primary outcomes included mean intraocular pressure change at 1, 6, 12, and 24 months, success ratio, and adverse events. Statistical analysis utilized R version 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). The meta-analysis included nine studies, involving 1065 eyes. Compared to 180° selective laser trabeculoplasty, 360° selective laser trabeculoplasty demonstrated superior success ratios (odds ratio 1.63; p = .002) and intraocular pressure reduction at 1 (mean difference -0.99; p < .01), 6 (mean difference -1.37; p < .01), and 12 (mean difference -1.41; p < .01) months. Although the intraocular pressure difference at 24 months was not statistically significant, a subgroup analysis showed that one study influenced heterogeneity and effect size. Adverse event rates did not significantly differ between the groups. 360° selective laser trabeculoplasty is preferred for initial laser therapy in open-angle glaucoma and ocular hypertension. It achieves maximal intraocular pressure reduction while maintaining an excellent safety profile.