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The Cochrane Database of Systematic... Mar 2023Acute primary angle closure (APAC) is a potentially blinding condition. It is one of the few ophthalmic emergencies and carries high rates of visual morbidity in the... (Review)
Review
BACKGROUND
Acute primary angle closure (APAC) is a potentially blinding condition. It is one of the few ophthalmic emergencies and carries high rates of visual morbidity in the absence of timely intervention. Laser peripheral iridotomy (LPI) has been the standard of care thus far. However, LPI does not eliminate the long-term risk of chronic angle closure glaucoma and other associated sequelae. There has been increasing interest in lens extraction as the primary treatment for the spectrum of primary angle closure disease, and it is as yet unclear whether these results can be extrapolated to APAC, and whether lens extraction provides better long-term outcomes. We therefore sought to evaluate the effectiveness of lens extraction in APAC to help inform the decision-making process. OBJECTIVES: To assess the effect of lens extraction compared to LPI in the treatment of APAC.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 1), Ovid MEDLINE, Ovid MEDLINE E-pub Ahead of Print, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to 10 January 2022), Embase (January 1947 to 10 January 2022), PubMed (1946 to 10 January 2022), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to 10 January 2022), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search. We last searched the electronic databases on 10 January 2022.
SELECTION CRITERIA
We included randomized controlled clinical trials comparing lens extraction against LPI in adult participants ( ≥ 35 years) with APAC in one or both eyes.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodology and assessed the certainty of the body of evidence for prespecified outcomes using the GRADE approach.
MAIN RESULTS
We included two studies conducted in Hong Kong and Singapore, comprising 99 eyes (99 participants) of predominantly Chinese origin. The two studies compared LPI with phacoemulsification performed by experienced surgeons. We assessed that both studies were at high risk of bias. There were no studies evaluating other types of lens extraction procedures. Phacoemulsification may result in an increased proportion of participants with intraocular pressure (IOP) control compared with LPI at 18 to 24 months (risk ratio (RR) 1.66, 95% confidence interval (CI) 1.28 to 2.15; 2 studies, n = 97; low certainty evidence) and may reduce the need for further IOP-lowering surgery within 24 months (RR 0.07, 96% CI 0.01 to 0.51; 2 studies, n = 99; very low certainty evidence). Phacoemulsification may result in a lower mean IOP at 12 months compared to LPI (mean difference (MD) -3.20, 95% CI -4.79 to -1.61; 1 study, n = 62; low certainty evidence) and a slightly lower mean number of IOP-lowering medications at 18 months (MD -0.87, 95% CI -1.28 to -0.46; 1 study, n = 60; low certainty evidence), but this may not be clinically significant. Phacoemulsification may have little to no effect on the proportion of participants with one or more recurrent APAC episodes in the same eye (RR 0.32, 95% CI 0.01 to 7.30; 1 study, n = 37; very low certainty evidence). Phacoemulsification may result in a wider iridocorneal angle assessed by Shaffer grading at six months (MD 1.15, 95% CI 0.83 to 1.47; 1 study, n = 62; very low certainty evidence). Phacoemulsification may have little to no effect on logMAR best-corrected visual acuity (BCVA) at six months (MD -0.09, 95% CI -0.20 to 0.02; 2 studies, n = 94; very low certainty evidence). There was no evidence of a difference in the extent of peripheral anterior synechiae (PAS) (clock hours) between intervention arms at 6 months (MD -1.86, 95% CI -7.03 to 3.32; 2 studies, n = 94; very low certainty evidence), although the phacoemulsification group may have less PAS (degrees) at 12 months (MD -94.20, 95% CI -140.37 to -48.03; 1 study, n = 62) and 18 months (MD -127.30, 95% CI -168.91 to -85.69; 1 study, n = 60). In one study, there were 26 adverse events in the phacoemulsification group: intraoperative corneal edema (n = 12), posterior capsular rupture (n = 1), intraoperative bleeding from iris root (n = 1), postoperative fibrinous anterior chamber reaction (n = 7), and visually significant posterior capsular opacification (n = 5), and no cases of suprachoroidal hemorrhage or endophthalmitis. There were four adverse events in the LPI group: closed iridotomy (n = 1) and small iridotomies that required supplementary laser (n = 3). In the other study, there was one adverse event in the phacoemulsification group (IOP > 30 mmHg on day 1 postoperatively (n = 1)), and no intraoperative complications. There were five adverse events in the LPI group: transient hemorrhage (n = 1), corneal burn (n = 1), and repeated LPI because of non-patency (n = 3). Neither study reported health- or vision-related quality of life measures.
AUTHORS' CONCLUSIONS
Low certainty evidence suggests that early lens extraction may produce more favorable outcomes compared to initial LPI in terms of IOP control. Evidence for other outcomes is less clear. Future high-quality and longer-term studies evaluating the effects of either intervention on the development of glaucomatous damage and visual field changes as well as health-related quality of life measures would be helpful.
Topics: Adult; Humans; Cataract Extraction; Glaucoma; Intraocular Pressure; Phacoemulsification; Quality of Life
PubMed: 36884304
DOI: 10.1002/14651858.CD015116.pub2 -
Indian Journal of Ophthalmology Feb 2023Genome-wide association studies (GWAS) have identified that single-nucleotide polymorphisms (SNPs) rs1258267 in CHAT and rs3753841 in COL11A1 are associated with primary... (Meta-Analysis)
Meta-Analysis
Genome-wide association studies (GWAS) have identified that single-nucleotide polymorphisms (SNPs) rs1258267 in CHAT and rs3753841 in COL11A1 are associated with primary angle-closure glaucoma (PACG). The purpose of the study was to evaluate the association of CHAT rs1258267 and COL11A1 rs3753841 with PACG. A comprehensive electronic database search was performed to include eligible studies, published from October 2010 to March 2022. By calculating summary odds ratios (ORs) and 95% confidence intervals (CI) under five genetic models, the risk of PACG related to these two SNPs could be estimated. Heterogeneity was measured with a Chi-square-based Q statistic test and the I statistic. By the Z test, we analyzed the overall effect of OR. We used funnel plots and Begg's funnel plots to evaluate the publication bias of included studies. The meta-analysis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. There were eighteen studies associating CHAT rs1258267 with PACG indicating evidently decreased PACG risk in five genetic models. Thirty studies were included to demonstrate a notable increase in the risk of PACG-carrying COL11A1 rs3753841 genotypes. Subgroup analyses showed that the association of CHAT rs1258267 and COL11A1 rs3753841 with PACG was obvious in Asians, while no evidence was found to confirm this connection in Caucasians. This meta-analysis suggests that CHAT rs1258267 G/A polymorphisms could bring about a decreased risk of PACG susceptibility and COL11A1 rs3753841 G/A polymorphisms could cause an increased risk. These effects mainly manifest in Asians.
Topics: Humans; Collagen Type XI; Genetic Predisposition to Disease; Genome-Wide Association Study; Genotype; Glaucoma, Angle-Closure; Polymorphism, Single Nucleotide; Choline O-Acetyltransferase
PubMed: 36727317
DOI: 10.4103/ijo.IJO_1226_22 -
The Cochrane Database of Systematic... Jan 2023Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. For example, contact between the iris and lens at... (Review)
Review
BACKGROUND
Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. For example, contact between the iris and lens at the pupillary margin creates a pupillary block that increases resistance to aqueous outflow. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual field loss. Laser peripheral iridotomy ('iridotomy') is a procedure to eliminate pupillary block by allowing aqueous humor to pass directly from the posterior to anterior chamber, which is achieved by creating a hole in the iris using laser. Iridotomy is used to treat patients with primary angle-closure glaucoma, patients with primary angle-closure (narrow angles and no signs of glaucomatous optic neuropathy), and patients who are primary angle-closure suspects (patients with reversible obstruction). However, the effectiveness of iridotomy on slowing progression of visual field loss is uncertain.
OBJECTIVES
To assess the effects of iridotomy compared with no iridotomy for primary angle-closure glaucoma, primary angle-closure, and primary angle-closure suspect.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 10), which contains the Cochrane Eyes and Vision Trials Register; MEDLINE Ovid; Embase Ovid; PubMed; LILACS; ClinicalTrials.gov; and the WHO ICTRP. The date of the most recent search was 10 October 2021.
SELECTION CRITERIA
Randomized or quasi-randomized controlled trials that compared iridotomy with no iridotomy in primary angle-closure suspects, people with primary angle-closure, or people with primary angle-closure glaucoma in one or both eyes were eligible.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodology and assessed the certainty of the body of evidence for prespecified outcomes using the GRADE approach.
MAIN RESULTS
We identified four studies (3086 eyes of 1543 participants) that compared iridotomy with no iridotomy in participants (range of mean age 59.6 to 62.9 years) who were primary angle-closure suspects from China, Singapore, or the UK. Study investigators randomized one eye of each participant to iridotomy and the other to no iridotomy. Two studies provided long-term (five or more years) results. We judged the certainty of the evidence as moderate to low across the prespecified outcomes, downgrading for high risk of bias (e.g. performance and detection biases) and imprecision of results. Meta-analyses of data from two studies suggest that iridotomy probably results in little to no difference in IOP compared with no iridotomy at one year (mean difference (MD) 0.04 mm Hg, 95% confidence interval (CI) -0.17 to 0.24; I = 65%; 2598 eyes of 1299 participants; moderate certainty evidence) and five years (MD 0.12 mm Hg, 95% CI -0.11 to 0.35; I = 0%; 2016 eyes of 1008 participants), and in best-corrected visual acuity measured as logMAR at one year (MD 0.00, 95% CI -0.01 to 0.01; I = 69%; 2596 eyes of 1298 participants; moderate certainty evidence) and five years (MD 0.01, 95% CI -0.01 to 0.03; I = 0%; 2002 eyes of 1001 participants). In terms of gonioscopic findings, eyes treated with iridotomy likely had wider angles in Shaffer grading scale (MD 4.93 units, 95% CI 4.73 to 5.12; I = 59%; 2598 eyes of 1299 participants at one year; MD 5.07, 95% CI 4.78 to 5.36; I = 97%; 2016 eyes of 1008 participants at five years; moderate certainty evidence) and experienced fewer peripheral anterior synechiae (PAS) than eyes that received no iridotomy at five years (risk ratio (RR) 0.41, 95% CI 0.24 to 0.67; I = 28%; 2 studies, 2738 eyes of 1369 participants), but the evidence was less conclusive at one year (RR 0.62, 95% CI 0.25 to 1.54; I = 57%; 3 studies, 2896 eyes of 1448 participants; low certainty evidence). No studies reported data on the proportion of participants with progressive visual field loss during follow-up (the primary outcome of this review), mean number of medications to control IOP, or quality of life outcomes. Low certainty evidence suggests that iridotomy may result in little to no difference in the incidence of acute angle-closure (RR 0.29, 95% CI 0.07 to 1.20; I = 0%; 3 studies, 3006 eyes of 1503 participants). Other ocular adverse events (e.g. eye pain, dry eye, redness of eyes, and ocular discomfort), although rare, were more common in eyes treated with iridotomy than in eyes in the control group. AUTHORS' CONCLUSIONS: We did not find sufficient evidence to draw any meaningful conclusions on the use of iridotomy for the purpose of slowing progression of visual field loss. No study reported on progressive visual field loss, the primary outcome of this review. Although there is moderate certainty evidence that iridotomy results in improved gonioscopic findings, in is unclear if these findings translate to clinically meaningful benefits.
Topics: Humans; Middle Aged; Glaucoma, Angle-Closure; Visual Fields; Quality of Life; Glaucoma; Intraocular Pressure; Vision Disorders
PubMed: 36621864
DOI: 10.1002/14651858.CD012270.pub3 -
Ophthalmology and Therapy Apr 2023Currently, there is no generally approved surgical treatment for patients with primary angle-closure glaucoma (PACG) and co-existing cataracts. The aim of this... (Review)
Review
BACKGROUND
Currently, there is no generally approved surgical treatment for patients with primary angle-closure glaucoma (PACG) and co-existing cataracts. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of phacoemulsification and phacotrabeculectomy in PACG patients with cataract.
METHODS
Diverse databases were searched, including PubMed, MEDLINE, EMBASE, Cochrane Library, Chinese Journal Full-text Database (CNKI), Wanfang database, and China Science and Technology Journal Database, for randomized controlled trials (RCTs) on phacoemulsification and phacotrabeculectomy for the treatment of PACG published up to 30 June 2021. ReviewManager (RevMan) version 5.4 software was used for the meta-analysis, and the effective quantity of measurement data was measured by the mean difference (MD) and 95% confidence interval (CI). The effect of counting data was measured by odds ratio (OR).
RESULTS
Our search of the databases identified 14 RCTs that satisfied the search criteria. Meta-analysis of these 14 RCTs showed that at the 1 month postoperative follow-up, intraocular pressure (IOP) of patients in the phacoemulsification group was higher than that of patients in the phacotrabeculectomy group (MD 2.04, 95% CI 1.42-2.65; P < 0.00001). However, the postoperative IOP was not significantly different between the two groups at the 3, 6, and 12 months postoperative follow-ups (P = 0.52, P = 0.51, and P = 0.05, respectively). More medications for IOP reduction were required by patients in the phacoemulsification group compared with those in the phacotrabeculectomy group at 3 months postoperation (MD 0.76, 95% CI 0.33-1.18; P = 0.0005), 6 months postoperation (MD 0.66, 95% CI 0.15-1.18; P = 0.01), and 12 months postoperation (MD 0.76, 95% CI 0.22-1.30; P = 0.006). Patients in the phacoemulsification group obtained better best corrected visual acuity (BCVA) than those in the phacotrabeculectomy group (MD - 0.17, 95% CI - 0.34 to - 0.01; P = 0.04) at 3 months postoperation, but there was no significant difference in BCVA between the two groups at 6 and 12 months postoperation (P = 0.33 and P = 0.56, respectively). The deepened anterior chamber was more obvious in patients in the phacoemulsification group versus those in the phacotrabeculectomy group (MD 0.61, 95% CI 0.03-1.18; P = 0.04). Patients in the phacoemulsification group experienced fewer postoperative complications than those in the phacotrabeculectomy group (OR 0.27, 95% CI 0.17-0.42; P < 0.00001).
CONCLUSION
Our results provide evidence that phacotrabeculectomy has advantages over phacoemulsification for the treatment of PACG in terms of better IOP and reduced medication need during the early stage post surgery. However, in terms of the complication risk, phacoemulsification is the more secure treatment option.
PubMed: 36580218
DOI: 10.1007/s40123-022-00639-z -
Photodiagnosis and Photodynamic Therapy Mar 2023Elevated intraocular presure secondary to angle closure in angle closure glaucoma is considered the primary mechanism in the development of optic nerve damage. There is... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Elevated intraocular presure secondary to angle closure in angle closure glaucoma is considered the primary mechanism in the development of optic nerve damage. There is evidence that vascular mechanisms may play a role in the pathogenesis of primary angle closure disease (PACD). We aimed to evaluate optic nerve head vessel density in PACD.
METHODS
PubMed, Scopus, and Web of Science were searched. Observational investigations were included. A frequentist network meta-analysis was performed. The primary outcome was circumpapillary vessel density (cpVD), and the secondary outcome was peripapillary retinal nerve fiber layer (pRNFL) thickness.
RESULTS
One thousand twenty four eyes from eleven studies were included in the study. There was no difference in cpVD between the primary angle closure glaucoma (PACG) and acute primary angle closure (APAC) group however, there was a significant decreasing in pRNFL thickness in the PACG group compared to APAC group. In the PACG and APAC group, cpVD and pRNFL thickness were decreased compared to primary angle closure (PAC), primary angle closure suspect (PACS), and control group. There was no difference in cpVD and pRNFL thickness between PAC, PACS and control group.
CONCLUSION
This study has shown that the elevated intraocular pressure is an important factor affecting optical nerve perfusion in PACD. The decreasing in cpVD and RNFL thickness was more severe in the PACG and APAC group.
Topics: Humans; Optic Disk; Glaucoma, Angle-Closure; Network Meta-Analysis; Intraocular Pressure; Photochemotherapy; Photosensitizing Agents; Tomography, Optical Coherence
PubMed: 36493693
DOI: 10.1016/j.pdpdt.2022.103209 -
PloS One 2022For primary angle-closure and angle-closure glaucoma, the fact that refractive error sometimes deviates from predictions after intraocular lens (IOL) implantation is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
For primary angle-closure and angle-closure glaucoma, the fact that refractive error sometimes deviates from predictions after intraocular lens (IOL) implantation is familiar to cataract surgeons. Since controversy remains in the accuracy of IOL power calculation formulas, both traditional and network meta-analysis on formula accuracy were conducted in patients with primary angle-closure conditions.
METHODS
A comprehensive literature search was conducted through Aug 2022, focusing on studies on intraocular lens power calculation in primary angle-closure (PAC) and primary angle-closure glaucoma (PACG). A systemic review and network meta-analysis was performed. Quality of studies were assessed. Primary outcomes were the mean absolute errors (MAE) and the percentages of eyes with a prediction error within ±0.50 diopiters (D) or ±1.00 D (% ±0.50/1.00 D) by different formulas.
RESULTS
Six retrospective studies involving 419 eyes and 8 formulas (Barrett Universal II, Kane, SRK/T, Hoffer Q, Haigis, Holladay I, RBF 3.0 and LSF) were included. SRK/T was used as a reference as it had been investigated in all the studies included. Direct comparison showed that none of the involved formula outperformed or was defeated by SRK/T significantly in terms of either MAE or % ±0.50/1.00 D (all P>0.05). Network comparison and ranking possibilities disclosed BUII, Kane, RBF 3.0 with statistically insignificant advantage. No significant publication bias was detected by network funnel plot.
CONCLUSIONS
No absolute advantage was disclosed among the formulas involved in this study for PAC/PACG eyes. Further carefully designed studies are warranted to evaluate IOL calculation formulae in this target population.
TRAIL REGISTRATION
Registration: PROSEPRO ID: CRD42022326541.
Topics: Biometry; Glaucoma, Angle-Closure; Humans; Lenses, Intraocular; Network Meta-Analysis; Optics and Photonics; Phacoemulsification; Refraction, Ocular; Retrospective Studies
PubMed: 36240196
DOI: 10.1371/journal.pone.0276286 -
Indian Journal of Ophthalmology May 2022Topiramate-induced acute angle closure (TiAAC) is a potentially vision-threatening side effect of topiramate (TPM) use. The purpose of this article is to review... (Review)
Review
Topiramate-induced acute angle closure (TiAAC) is a potentially vision-threatening side effect of topiramate (TPM) use. The purpose of this article is to review demographic characteristics, clinical features, and management options of TiAAC. A systematic literature search of all reported cases and case series of TiAAC was conducted in the following search engines: PubMed, Web of Science, Google Scholar, Elsevier, and EBSCO. Seventy-three publications describing 77 cases were included. 58 (75.3%) patients were female, and the mean age was 34.88 ± 11.21 years (range, 7-57). The most commonly reported indication of TPM use was migraine headache (59.7%), and the mean duration from starting treatment until the onset of angle closure was 14.1 ± 31.5 days. All cases were managed by immediate cessation of TPM and topical therapy. In addition, systemic medications (carbonic anhydrase inhibitors, hyperosmotic agents, and steroids) were used in 51 patients (66.2%). A laser and/or surgical intervention was performed in 10 patients (13%). After commencement of treatment, the mean duration until the resolution of TiAAC was 3.9 ± 3.6 days (range, 1-18). The findings of our study present a summary of the current body of evidence provided by case reports and case series on TiAAC. In conclusion, the onset of angle closure following TPM use peaks at 2 weeks after initiating treatment, and in most cases, successful management can be achieved by discontinuing TPM and initiating appropriate medical therapy.
Topics: Acute Disease; Adult; Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Humans; Male; Middle Aged; Migraine Disorders; Topiramate; Young Adult
PubMed: 35502014
DOI: 10.4103/ijo.IJO_2134_21 -
Klinische Monatsblatter Fur... Apr 2022We report a rare case of spontaneous suprachoroidal hemorrhage and present a systematic review of the literature using PubMed/Medline databases. Patients that developed...
We report a rare case of spontaneous suprachoroidal hemorrhage and present a systematic review of the literature using PubMed/Medline databases. Patients that developed a spontaneous suprachoroidal hemorrhage with a history of previous intraocular surgery were excluded. An 82-year-old male patient with no known ocular pathologies or surgical history was referred with acute ocular pain and decreased vision in the right eye (BCVA: 0.6 with hyperopic correction) following a Valsalva maneuver. General history included chronic heart failure and coronary artery disease, treated with anticoagulant and antihypertensive drugs. Dilated fundus examination revealed a posterior red-brown choroidal mass, with a thickness of 1.5 mm on B-scan ultrasonography. The lesion was not visible on fluorescein or indocyanine green angiography and was located under the choroid on B-scan optical coherence tomography. The diagnosis of a spontaneous suprachoroidal hemorrhage was evoked, and the patient was observed. Five months later, BCVA was 1.0 uncorrected, with a normal-appearing fundus. In a literature review, eight cases of spontaneous suprachoroidal hemorrhage following an episode of increased intrathoracic pressure were identified, including our patient. M/F ratio was 1 : 1, with a median age of 66.5 years. All cases presented systemic pathologies. All cases presented with a unilateral suprachoroidal hemorrhage. Only 2/8 patients had ocular comorbidities. Complications requiring treatment were noted in 4/8 cases, including 2 cases that resulted in the loss of the vision following an acute angle-closure glaucoma. Spontaneous resolution of the hemorrhage was observed in the other 4 patients. In 6/8 cases, vision recovered over a mean period of 10 weeks. In conclusion, spontaneous suprachoroidal hemorrhage following a Valsalva maneuver in eyes with no history of ocular surgery or trauma is rare, and has been associated with advanced age, cardiovascular disease and asthma. In severe cases (2/8) the eye was lost, while most cases (6/8) recovered, presenting a good visual outcome.
Topics: Aged; Aged, 80 and over; Anticoagulants; Choroid; Choroid Hemorrhage; Fundus Oculi; Humans; Male
PubMed: 35472806
DOI: 10.1055/a-1785-4912 -
Diet, Oxidative Stress, and Blood Serum Nutrients in Various Types of Glaucoma: A Systematic Review.Nutrients Mar 2022Glaucoma is one of the most common causes of irreversible vision loss worldwide. It is an insidious disease with a multifactorial pathogenesis. Despite progress in... (Review)
Review
Glaucoma is one of the most common causes of irreversible vision loss worldwide. It is an insidious disease with a multifactorial pathogenesis. Despite progress in treatment methods, prevention and lifestyle modifications may be useful in slowing the progression of this disease. This systematic review aimed to evaluate the influence of diet, oxidative stress, and disturbances in blood serum levels of nutrients on the incidence and severity of glaucoma based on scientific reports on the role of nutrition in the pathogenesis and course of glaucoma. This paper presents an analysis of the above issues; however, further research is required to develop this topic. Future clinical trials are needed to assess the influence of nutrition and to develop nutritional management strategies for patients with glaucoma.
Topics: Diet; Glaucoma; Glaucoma, Open-Angle; Humans; Nutrients; Oxidative Stress; Serum
PubMed: 35406033
DOI: 10.3390/nu14071421 -
Ophthalmology Aug 2022Corneal endothelial cell density (ECD) loss after glaucoma surgery with or without cataract surgery. (Meta-Analysis)
Meta-Analysis Review
TOPIC
Corneal endothelial cell density (ECD) loss after glaucoma surgery with or without cataract surgery.
CLINICAL RELEVANCE
Corneal ECD loss may occur as the result of intraoperative surgical trauma in glaucoma surgery or postoperatively with chronic endothelial cell trauma or irritation.
METHODS
Glaucoma filtration surgery or microinvasive glaucoma surgery (MIGS) in participants with ocular hypertension, primary and secondary open-angle glaucoma, normal-tension glaucoma, and angle-closure glaucoma were included. Electronic databases searched in December 2021 included MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the International Prospective Register of Systematic Reviews, Food and Drug Administration (FDA) Premarket Approval, and FDA 510(k).
RESULTS
A total of 39 studies were included in quantitative synthesis. Twelve months after suprachoroidal MIGS, mean ECD loss was 282 cells/mm (95% confidence interval [CI], 220-345; P < 0.00001; chi-square = 0.06; I = 0%; 2 studies; very low certainty). Mean ECD loss after Schlemm's canal implantable devices was 338 cells/mm (95% CI, 185-491; P < 0.0001; chi-square = 0.08; I = 0%; 2 studies; low certainty) at 12 months. Mean ECD loss was 64 cells/mm (95% CI, 21-107; P = 0.004; chi-square = 4.55; I = 0%; 6 studies; low certainty) after Schlemm's canal procedures (without implantable devices) at 12 months. At 12 months, the mean ECD loss after trabeculectomy was 33 cells/mm (95% CI, -38 to 105, P = 0.36, chi-square = 1.17; I = 0%; moderate certainty). At 12 months, mean ECD loss was 121 cells/mm (95% CI, 53-189; P = 0.0005; chi-square = 3.00; I = 0%; 5 studies; low certainty) after Express (Alcon) implantation. When compared with the control fellow eye, aqueous shunt surgery reduced ECD by 5.75% (95% CI, -0.93 to 12.43; P = 0.09, chi-square = 1.32; I = 0%; low certainty) and 8.11% ECD loss (95% CI, 0.06-16.16 P = 0.05; chi-square = 1.93; I = 48%) at 12 and 24 months, respectively.
CONCLUSIONS
Overall, there is low certainty evidence to suggest that glaucoma surgery involving long-term implants has a greater extent of ECD loss than glaucoma filtration surgeries without the use of implants. The results of this review support follow-up beyond 36 months to assess ECD loss and corneal decompensation after implantation of glaucoma drainage implants.
Topics: Cataract; Corneal Endothelial Cell Loss; Endothelial Cells; Glaucoma; Glaucoma Drainage Implants; Glaucoma, Open-Angle; Humans
PubMed: 35331751
DOI: 10.1016/j.ophtha.2022.03.015