Surgical treatment of neovascular glaucoma: a systematic review and meta-analysis
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Abstract
Purpose
This literature review and meta-analysis aims to compare intraocular pressure (IOP) lowering efficacy, failure rates and loss of light perception (LP) rates 6 months after an IOP-lowering surgical procedure in neovascular glaucoma (NVG) eyes.
Methods
MEDLINE and EMBASE were used as data sources. Only studies including NVG patients who underwent two different surgical approaches were considered. The treatment effect measures were (i) weighted mean difference (WMD) for IOP reduction, (ii) risk ratio (RR) for failure rates and (iii) risk difference (RD) for loss of LP. Outcome measures were reported with a 95% confidence interval (CI) and P < 0.05 was considered statistically significant. Analysis was performed using RevMan v5.0.
Results
No RCT were retrieved. Seven comparative non-randomised studies were eligible. In glaucoma drainage devices (GDDs) vs cyclophotocoagulation arm, there was no statistical difference in IOP-lowering efficacy (WMD = − 3.63; CI [− 8.69, 1.43], P = 0.16), although failure rates and loss of LP were lower in the GDDs group (RR = 0.64, CI [0.41, 0.99], P = 0.05; and RD = − 0.15, CI [− 0.25, − 0.05], P = 0.004, respectively). In the Ahmed glaucoma valve (AGV) vs trabeculectomy arm, there was no statistical difference in IOP-lowering efficacy and loss of LP (WMD = 0.78, CI [− 2.29, 3.85], P = 0.62 and RD of 0.04, CI [− 0.05, 0.14], P = 0.34, respectively), but failure rates were lower in trabeculectomy group (RR of 2.25, CI [1.14, 3.71], P = 0.02).
Conclusions
There is lack of high-quality evidence on the subject as no RCT were retrieved comparing two different IOP-lowering procedures in NVG patients. Our findings are based, therefore, on non-RCT studies and should be interpreted with caution. There appears to be no difference in IOP-lowering efficacy between GDDs and cyclophotocoagulation, although GDDs appear to be safer. AGV and trabeculectomy also seem to provide similar IOP-lowering results with trabeculectomy showing lower failure rates.
Keywords
Neovascular glaucoma Glaucoma drainage devices Trabeculectomy CyclophotocoagulationAbbreviations
- IOP
intraocular pressure
- LP
light perception
- NVG
neovascular glaucoma
- WMD
weighted mean difference
- RR
risk ratio
- RD
risk difference
- CI
confidence interval
- GDDs
glaucoma drainage devices
- AGV
Ahmed glaucoma valve
- VEGF
vascular endothelial growth factor
- AH
aqueous humour
- RCTs
randomised clinical trials
- MMC
mitomycin C
Notes
Acknowledgments
We thank Joana Alarcão MD for her contribution in elaborating the search strategy for this review. We also thank Filipe Rodrigues MD for assistance in the electronic search.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors.
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