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Surgical treatment of neovascular glaucoma: a systematic review and meta-analysis

  • Zakhar Shchomak
  • David Cordeiro Sousa
  • Inês Leal
  • Luís Abegão PintoEmail author
Review Article
  • 39 Downloads

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 Cyclophotocoagulation 

Abbreviations

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Zakhar Shchomak
    • 1
  • David Cordeiro Sousa
    • 2
  • Inês Leal
    • 2
  • Luís Abegão Pinto
    • 2
    Email author
  1. 1.Faculdade de Medicina da Universidade de LisboaLisbonPortugal
  2. 2.Department of OphthalmologyHospital Santa MariaLisbonPortugal

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