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Eye (London, England) Apr 2023The XEN45 Gel Stent is a subconjunctival filtering device that has demonstrated promising efficacy. This meta-analysis quantitatively evaluates reported complications... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The XEN45 Gel Stent is a subconjunctival filtering device that has demonstrated promising efficacy. This meta-analysis quantitatively evaluates reported complications and interventions after XEN45 implantation in the treatment of open angle glaucoma (OAG).
METHODS
Pilot, cohort, observational studies, and randomised controlled trials that included at least ten patients undergoing ab interno or externo XEN45 surgery, with or without phacoemulsification were deemed eligible for inclusion. A meta-analysis of proportions with random-effect models was performed using the meta routine in R version 3.2.1. Outcomes included the rate of complications and post-operative interventions.
RESULTS
One hundred and fifty-two studies were identified on initial literature search and 33 were included in final analysis. Numerical hypotony was the most common post-operative complication, involving 20% of patients (95% CI: 10-31%). Post-operative gross hyphema occurred in 14% (95% CI: 7-22%) and transient intra-ocular pressure (IOP) spikes (>30 mmHg) in 13% (95% CI: 4-27%). Stent exposure occurred in 1% (95% CI: 0-2%). Stent migration occurred in 1% (95% CI: 0-3%). XEN45 revision and/or a second XEN45 implantation was performed in 5% of patients (95% CI: 3-7%). Stent relocation was performed in 3% (95% CI: 1-7%). A second glaucoma procedure was performed in 11% (95% CI: 8-15%). 26% underwent one (95% CI: 17-36%), 13% underwent two (95% CI: 5-24%) while 4% underwent three (95% CI: 2-6%) bleb needling procedures. 35% of patients (95% CI: 29-40%) required at least one needling. The average rate of needling per patient was 0.38 (95% CI: 0.20-0.59). However, there is a lack of high-quality data, with 8 of the 33 studies assessed to have a moderate to high risk of bias.
CONCLUSIONS
While literature suggests that XEN45 Gel Stent implantation is safe in the treatment of OAG, the overall current level of evidence is low and further studies are needed. More than a third of patients require at least one post-operative bleb needling procedure.
Topics: Humans; Glaucoma, Open-Angle; Blister; Treatment Outcome; Glaucoma; Intraocular Pressure; Glaucoma Drainage Implants; Stents; Retrospective Studies
PubMed: 35347294
DOI: 10.1038/s41433-022-02022-5 -
Ophthalmic Research 2022Pathophysiological overlaps exist between diabetes and primary open-angle glaucoma (POAG) and presence of diabetes increases the risk of POAG. Considering that diabetic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pathophysiological overlaps exist between diabetes and primary open-angle glaucoma (POAG) and presence of diabetes increases the risk of POAG. Considering that diabetic retinopathy (DR) is an ocular complication of diabetes, one could speculate that DR as a severity measure may associate with or even predict POAG. Given that POAG is asymptomatic in early stages, an association to DR may prove clinically important and facilitate an earlier diagnosis of POAG.
OBJECTIVES
The aim of the study was to investigate if DR is associated with and predictive of POAG.
METHOD
We systematically searched 11 literature databases on May 12, 2021. We screened a total of 1,535 records and found six studies eligible for qualitative and quantitative analysis. Two independent authors reviewed the studies, extracted data, and evaluated risk of bias within individual studies. Studies were reviewed qualitatively, and meta-analyses were made based on the odds ratios (ORs) with 95% confidence intervals (CI) of the association between DR and POAG using the random-effects model. Subgroup analyses were made on the association between subtypes of DR and POAG.
RESULTS
Six studies (two longitudinal and four cross-sectional) were eligible for review with a total of 255,614 patients with diabetes, of which 20,483 patients had any degree of DR and 5,258 had POAG. All studies were based on patients with type 2 diabetes except one with both type 1 and type 2 patients. Any DR was not associated with POAG (OR 1.17; 95% CI: 0.58-2.35; p = 0.65). Further stratification revealed that neither cross-sectional (OR 1.00; 95% CI: 0.56-1.81, p = 0.99) nor longitudinal studies (OR 1.47; 95% CI: 0.57-3.78, p = 0.43) demonstrated an association between DR and POAG.
CONCLUSIONS
We did not find convincing evidence of an associations between DR and prevalent or incident POAG.
Topics: Cross-Sectional Studies; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Glaucoma, Open-Angle; Humans; Polymorphism, Genetic
PubMed: 35313300
DOI: 10.1159/000523940 -
Frontiers in Medicine 2022XEN gel stents are used for the treatment of open-angle glaucoma (OAG), including primary and secondary glaucoma that are uncontrolled by previous medical therapy and...
PURPOSE
XEN gel stents are used for the treatment of open-angle glaucoma (OAG), including primary and secondary glaucoma that are uncontrolled by previous medical therapy and cases with previous failed surgery. Our aim was to systematically review of the clinical data of currently published ab-interno XEN gel stents with an emphasis on intraocular pressure (IOP), antiglaucoma medication outcomes, and safety profiles.
METHODS
We analyzed all of the publications (MEDLINE, EMBASE, Cochrane Library) on the ab-interno XEN gel stent to evaluate the reduction in IOP and antiglaucoma medications following the procedure. The primary outcomes measured for the meta-analysis were reduction in IOP and anti-glaucoma medications. The secondary outcome were adverse events. For each study, we used a random effects analysis model to calculate the mean difference and 95% confidence intervals for the continuous results (reduction in IOP and antiglaucoma medications) using the inverse variance statistical method.
RESULTS
Five hundred twenty-seven articles were checked and 56 studies were found to be relevant with a total of 4,410 eyes. There was a significant reduction in IOP as well as in the number of medications required in patients treated with ab-interno XEN implant either alone or combined with cataract surgery. This new treatment for various types of glaucoma reduced the IOP by 35% to a final average close to 15 mmHg. This reduction was accompanied by a decrease in the number of antiglaucoma medications in all the studies, approximately 2 classes of medication at the price of more needlings. The overall complete success rate was 21.0-70.8% after 2 years using strict criteria originally designed to record success rate in filtration surgery. The incidence of complications vision-threatening was low at <1%.
CONCLUSIONS
XEN gel stent was effective and safe for primary and secondary OAG. Further studies should be performed to investigate the impact of ethnicity on the success and failure rate after XEN implantation.
PubMed: 35186992
DOI: 10.3389/fmed.2022.804847 -
Repeat Selective Laser Trabeculoplasty for Glaucoma Patients: A Systematic Review and Meta-analysis.Journal of Current Glaucoma Practice 2021To evaluate repeat selective laser trabeculoplasty (SLT) for treating primary open-angle glaucoma (POAG).
AIM AND OBJECTIVE
To evaluate repeat selective laser trabeculoplasty (SLT) for treating primary open-angle glaucoma (POAG).
MATERIALS AND METHODS
PubMed, CINAHL, and EMBASE were systematically searched along with grey literature. All English articles that measured intraocular pressure (IOP) before and after repeat SLT on adult patients with POAG were included. Studies were not filtered by location or publication date. Covidence was used to screen imported articles. Risk of bias assessment and data extraction was performed after screening. Meta-analysis was performed using STATA 16.0. Fixed-effect or random-effects models were developed depending on the presence of heterogeneity.
RESULTS
Database and grey literature search identified 512 unique studies. After duplicate removal and screening, 12 articles were included and data from included studies were synthesized. Nine articles were included in the meta-analysis. Three studies were prospective observational studies, and nine studies were retrospective chart reviews. Due to the presence of heterogeneity, a random-effects model has been utilized that suggested significant IOP reduction (IOPR) by repeat SLT at 24 months follow-up.
CONCLUSION
Based on our results, repeat SLT could be an effective procedure in reducing IOP for patients with glaucoma for up to 24 months. Efficacy of third, fourth, or further SLT remains to be verified. More data from long-term, high-quality randomized-controlled trials (RCTs) are required to make conclusions.
CLINICAL SIGNIFICANCE
Repeat SLT may be an effective treatment for lowering IOP with minimal complications or safety issues. This may allow the use of SLT as a primary treatment for POGA, allowing the discontinuation of medications or eye drops and lead to additional benefits.
HOW TO CITE THIS ARTICLE
Jang HJ, Yu B, Hodge W, Repeat Selective Laser Trabeculoplasty for Glaucoma Patients: A Systematic Review and Meta-analysis. J Curr Glaucoma Pract 2021;15(3):117-124.
PubMed: 35173393
DOI: 10.5005/jp-journals-10078-1302 -
BMC Ophthalmology Feb 2022β-Zone parapapillary atrophy (β-PPA) is a common sign in patients with open-angle glaucoma (OAG). Some studies have suggested that β-PPA can aid in the diagnosis of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
β-Zone parapapillary atrophy (β-PPA) is a common sign in patients with open-angle glaucoma (OAG). Some studies have suggested that β-PPA can aid in the diagnosis of OAG. We performed a systematic review and meta-analysis of the prevalence and diagnostic ability of β-PPA in OAG.
METHODS
We performed a literature search in PubMed, Web of Science, Embase and Google Scholar from inception to 1st November, 2021. Both hospital-based and population-based studies that reported details of β-PPA in OAG were included.
RESULTS
We screened 1404 articles from these databases and ultimately included 24 articles in our meta-analysis. The prevalence of β-PPA in OAG was 0.73 (95% CI 0.67 to 0.78). The results of subgroup analysis by country revealed prevalence rates of 0.83 (95% CI 0.78 to 0.88) in Japan, 0.85 (95% CI 0.64 to 0.97) in Korea, 0.64 (95% CI 0.55 to 0.73) in the USA, 0.61 (95% CI 0.58 to 0.63) in Germany and 0.57 (95% CI 0.39 to 0.74) in China. Fundus photography, Heidelberg retina tomography (HRT), Heidelberg retina angiography (HRA) + indocyanine green angiography (ICGA), Spectral domain optical coherence tomography (SD-OCT)and Swept source optical coherence tomography(SS-OCT) values were 0.65 (95% CI 0.58 to 0.71), 0.70 (95% CI 0.50 to 0.86), 0.78 (95% CI 0.61 to 0.91), 0.77 (95% CI 0.65 to 0.88) and 0.99(95% CI 0.87 to 1.00) respectively. The sensitivity and specificity of β-PPA as a diagnostic marker were 0.78 (95% CI 0.68 to 0.85) and 0.63 (95% CI 0.51 to 0.73), respectively.
CONCLUSIONS
β-PPA is a potential diagnostic marker for OAG. However, a more detailed understanding of β-PPA characteristics is needed to improve the ability to predict OAG.
Topics: Atrophy; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Optic Atrophy; Optic Disk; Prevalence; Tomography, Optical Coherence
PubMed: 35151269
DOI: 10.1186/s12886-022-02282-5 -
Ophthalmology Jun 2022This systematic review and meta-analysis summarizes the existing evidence for the association of alcohol use with intraocular pressure (IOP) and open-angle glaucoma... (Meta-Analysis)
Meta-Analysis Review
TOPIC
This systematic review and meta-analysis summarizes the existing evidence for the association of alcohol use with intraocular pressure (IOP) and open-angle glaucoma (OAG).
CLINICAL RELEVANCE
Understanding and quantifying these associations may aid clinical guidelines or treatment strategies and shed light on disease pathogenesis. The role of alcohol, a modifiable factor, in determining IOP and OAG risk also may be of interest from an individual or public health perspective.
METHODS
The study protocol was preregistered in the Open Science Framework Registries (https://osf.io/z7yeg). Eligible articles (as of May 14, 2021) from 3 databases (PubMed, Embase, Scopus) were independently screened and quality assessed by 2 reviewers. All case-control, cross-sectional, and cohort studies reporting a quantitative effect estimate and 95% confidence interval (CI) for the association between alcohol use and either IOP or OAG were included. The evidence for the associations with both IOP and OAG was qualitatively summarized. Effect estimates for the association with OAG were pooled using random effects meta-analysis. Studies not meeting formal inclusion criteria for systematic review, but with pertinent results, were also appraised and discussed. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS
Thirty-four studies were included in the systematic review. Evidence from 10 studies reporting an association with IOP suggests that habitual alcohol use is associated with higher IOP and prevalence of ocular hypertension (IOP > 21 mmHg), although absolute effect sizes were small. Eleven of 26 studies, comprising 173 058 participants, that tested for an association with OAG met inclusion criteria for meta-analysis. Pooled effect estimates indicated a positive association between any use of alcohol and OAG (1.18; 95% confidence interval [CI], 1.02-1.36; P = 0.03; I = 40.5%), with similar estimates for both prevalent and incident OAG. The overall GRADE certainty of evidence was very low.
CONCLUSIONS
Although this meta-analysis suggests a harmful association between alcohol use and OAG, our results should be interpreted cautiously given the weakness and heterogeneity of the underlying evidence base, the small absolute effect size, and the borderline statistical significance. Nonetheless, these findings may be clinically relevant, and future research should focus on improving the quality of evidence.
Topics: Cross-Sectional Studies; Ethanol; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension; Tonometry, Ocular
PubMed: 35101531
DOI: 10.1016/j.ophtha.2022.01.023 -
Ophthalmic Research 2022Previous studies identified myopia as a risk factor for primary open-angle glaucoma (POAG). However, recent studies have shown different results, and the definitive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies identified myopia as a risk factor for primary open-angle glaucoma (POAG). However, recent studies have shown different results, and the definitive relationship between myopia and POAG remains controversial.
OBJECTIVES
The aim of this study was to investigate the relationship between myopia and POAG.
METHODS
Published articles were searched from PubMed, Embase, and Scopus databases between 1970 and 2020. A pooled analysis of the odds ratios (ORs) was performed using a random-effects model.
RESULTS
Data on the association between myopia and POAG were obtained from 16 cross-sectional studies, and the pooled OR was 2.26 (95% confidence interval [CI], 1.77-2.89, p < 0.001) in random-effects model (I2 = 86%; p < 0.01). For the relationship of myopia and POAG progression, data from 7 longitudinal cohort studies were included, and the pooled OR was 0.85 (95% CI, 0.73-0.99, p = 0.042) in the random-effects model (I2 = 88%; p < 0.01).
CONCLUSION
Our findings demonstrated that myopia may be a risk factor associated with POAG and a possible protective factor for POAG progression. It may be due to myopia with the presence of a lamina cribrosa defect, slowing down the visual field loss and also POAG progression. Further research for underlying mechanisms is still needed.
Topics: Cross-Sectional Studies; Glaucoma, Open-Angle; Humans; Longitudinal Studies; Myopia; Visual Field Tests
PubMed: 34883495
DOI: 10.1159/000520468 -
Frontiers in Medicine 2021To explore the associations between refractive errors and multiple eye health outcomes. This is an umbrella review based on systematic reviews with meta-analyses. In...
To explore the associations between refractive errors and multiple eye health outcomes. This is an umbrella review based on systematic reviews with meta-analyses. In our study, refractive errors included myopia, hyperopia, astigmatism, and anisometropia. We reconducted the meta-analyses whose primary data were available in sufficient detail by random effect model. Heterogeneity was assessed by . The main outcomes included myopic macular degeneration (MMD), retinal detachment (RD), cataract, open-angle glaucoma (OAG), strabismus, age-related macular degeneration (AMD), and diabetic retinopathy (DR). Myopia was associated with increased risk of MMD (relative risk = 102.11, 95% CI 52.6-198.22), RD (3.45, 1.08-11.00), nuclear cataract (2.15, 1.53-3.03), posterior subcapsular (PSC) cataract (1.74, 1.41-2.15), OAG (1.95, 1.74-2.19), exotropia (5.23, 2.26-12.09), but decreased risk of DR (0.83, 0.66-1.04), and early AMD (0.80, 0.67-0.94). From mild-to-high myopia, the association strengthened for MMD, RD, nuclear cataract, PSC cataract, OAG, and DR. Hyperopia was associated with an increased risk of early AMD (1.09, 1.01-1.18) and esotropia (22.94, 10.20-51.62). Astigmatism and anisometropia were associated with increased risk of both exotropia and esotropia. Myopia, especially high myopia, demonstrated the highest risk for eye health outcomes, such as MMD, RD, OAG, nuclear and PSC cataracts, and exotropia. However, myopia was associated with a lower risk of early AMD and DR. Individuals with hyperopia are more likely to suffer early AMD and esotropia. Astigmatism and anisometropia predispose to strabismus. A lot of research studies on the mechanism of the associations are needed. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=239744; identifier: 239744.
PubMed: 34805225
DOI: 10.3389/fmed.2021.759767 -
International Ophthalmology Feb 2022To provide an overview of the ocular features of rheumatoid arthritis (RA) and of the ophthalmic adverse drug reactions (ADRs) that may be associated with the... (Review)
Review
PURPOSE
To provide an overview of the ocular features of rheumatoid arthritis (RA) and of the ophthalmic adverse drug reactions (ADRs) that may be associated with the administration of antirheumatic drugs.
METHODS
A systematic literature search was performed using the PubMed, MEDLINE, and EMBASE databases. In addition, a cohort of 489 RA patients who attended the Authors' departments were examined.
RESULTS
Keratoconjunctivitis sicca, episcleritis, scleritis, peripheral ulcerative keratitis (PUK), and anterior uveitis were diagnosed in 29%, 6%, 5%, 2%, and 10%, respectively, of the mentioned cohort. Ocular ADRs to non-steroidal anti-inflammatory drugs are rarely reported and include subconjunctival hemorrhages and hemorrhagic retinopathy. In patients taking indomethacin, whorl-like corneal deposits and pigmentary retinopathy have been observed. Glucocorticoids are frequently responsible for posterior subcapsular cataracts and open-angle glaucoma. Methotrexate, the prototype of disease-modifying antirheumatic drugs (DMARDs), has been associated with the onset of ischemic optic neuropathy, retinal cotton-wool spots, and orbital non-Hodgkin's lymphoma. Mild cystoid macular edema and punctate keratitis in patients treated with leflunomide have been occasionally reported. The most frequently occurring ADR of hydroxychloroquine is vortex keratopathy, which may progress to "bull's eye" maculopathy. Patients taking tofacitinib, a synthetic DMARD, more frequently suffer herpes zoster virus (HZV) reactivation, including ophthalmic HZ. Tumor necrosis factor inhibitors have been associated with the paradoxical onset or recurrence of uveitis or sarcoidosis, as well as optic neuritis, demyelinating optic neuropathy, chiasmopathy, and oculomotor palsy. Recurrent episodes of PUK, multiple cotton-wool spots, and retinal hemorrhages have occasionally been reported in patients given tocilizumab, that may also be associated with HZV reactivation, possibly involving the eye. Finally, rituximab, an anti-CD20 monoclonal antibody, has rarely been associated with necrotizing scleritis, macular edema, and visual impairment.
CONCLUSION
The level of evidence for most of the drug reactions described herein is restricted to the "likely" or "possible" rather than to the "certain" category. However, the lack of biomarkers indicative of the potential risk of ocular ADRs hinders their prevention and emphasizes the need for an accurate risk vs. benefit assessment of these therapies for each patient.
Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Glaucoma, Open-Angle; Humans; Iatrogenic Disease; Rituximab
PubMed: 34802085
DOI: 10.1007/s10792-021-02058-8 -
Korean Journal of Ophthalmology : KJO Feb 2022Investigation of myopic open-angle glaucoma (OAG) prevalence in Northeast Asia by systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
PURPOSE
Investigation of myopic open-angle glaucoma (OAG) prevalence in Northeast Asia by systematic review and meta-analysis.
METHODS
Systematic PubMed, Embase and Cochrane database searches for Northeast Asian population-based studies published up to 30 November 2020 and reporting on myopia and OAG diagnosis. By random-effect models, pooled OAG prevalence in a myopic population and pooled myopic OAG prevalence in a general population were generated, with 95% confidence intervals (CIs).
RESULTS
The meta-analysis encompassed five population-based studies in four countries (12,830 individuals, including 7,723 patients with myopia and 1,112 patients with OAG). In a myopic population, OAG prevalence was 4.10% (95% CI, 3.00-5.70; I2 = 93%); in a general population, myopic OAG prevalence was 1.10% (95% CI, 0.60-1.70; I2 = 94%). A visual examination of funnel plot symmetry raised a suspicion of publication bias. Notwithstanding, Begg and Mazumbar's adjusted rank correlation test showed no such evidence (p = 0.6242).
CONCLUSIONS
Our systematic review and meta-analysis returned an estimate of OAG prevalence in a myopic Northeast Asian population. Our findings will inform future glaucoma studies as well as public health guidelines for Northeast Asian populations.
Topics: Asia; Glaucoma, Open-Angle; Humans; Myopia; Prevalence
PubMed: 34743493
DOI: 10.3341/kjo.2021.0089