Evidence Table Systematic review evidence I



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Evidence Table 1. Systematic review evidence I

Study

KQs

Aims of the study

Conclusions


Types of participants

Types of interventions

OAG

OHT

ACG

NTG

Other




Aptel

20081





3,6



“This systematic meta-analysis was performed to evaluate the intraocular pressure (IOP) lowering effects and tolerability
of latanoprost, bimatoprost, and travoprost."



“The findings suggest a greater efficacy of bimatoprost compared with latanoprost and travoprost, although the incidence of hyperemia was lower with the latter 2 agents.

Y


Y


N


N


POAG or OHT in at least 90% of trial participants

Latanoprost, travopost, or brimatoprost monotherapy


Burr

20042





1,2,3,4,6

"To study the relative efficacy of medical and surgical treatment
for OAG in terms of measures of glaucoma progression and adverse
effects of treatment."

"Evidence from one trial suggests, for mild OAG, that VF deterioration up to five-years is not significantly different whether treatment
is initiated with medication or trabeculectomy. Reduced vision, cataract and eye discomfort are more likely with trabeculectomy. There
is some evidence, for more severe OAG, that initial medication (pilocarpine, now rarely used as first line medication) is associated with
greater VF deterioration than surgery. In general, surgery lowers IOP more than medication."


Y

N

N

N




IOP lowering meds compared with trabeculectomy w/ or w/o use of anti-scarring agents; non-penetrating trabeculectomy w/ or w/o use of antiscarring agents; any other antiglaucomatous surgery

Chai

20103





3,6

Compare the efficacy and safety profile of viscocanalostomy

"Trabeculectomy was found to have a greater pressure lowering effect compared with viscocanalostomy. However, viscocanalostomy
had a significantly better risk profile."

NR

NR

NR

NR

1.7% of participants with primary chronic angle closure glaucoma


Viscocanalostomy versus trabeculectomy

Cheng 20084



3,6

"To
evaluate the efficacy and tolerability of bimatoprost
compared with latanoprost in reducing intraocular
pressure."

"Bimatoprost was associated with significantly
greater efficacy in lowering morning IOP
than latanoprost at all time points. Comparable proportions
of patients reached the IOP target with bimatoprost
and latanoprost. Both agents were well
tolerated, although bimatoprost was associated with a
significantly greater frequency of conjunctival hyperemia
than latanoprost."


NR

Y

NR

NR

Glaucoma

Bimatoprost versus latanoprost

Cheng 20095



3,6

"The aim of this study was to evaluate the effi cacy and tolerability of latanoprost, compared with the combination of dorzolamide and timolol, in the treatment of patients with elevated intraocular pressure."

"Latanoprost was associated with significantly greater effi cacy in lowering diurnal mean IOP than combined dorzolamide and timolol in patients with IOP insuffi ciently controlled by timolol alone, and latanoprost was as effective as combined dorzolamide and timolol in patients without baseline timolol treatment. The combination of dorzolamide and timolol was less tolerated than latanoprost."


Y

Y

Y

N

Pigmentary, mixed glaucoma as well as 1 trial with chronic angle closure glaucoma participants

Latanoprost versus combined dorzolaminde and timolol (concomitant administration or fixed combination)

Cheng 20106



3,6

"To evaluate the efficacy and tolerability of nonpenetrating
filtering surgery in the treatment of patients with
open-angle glaucoma."

"Viscocanalostomy and deep sclerectomy were
less effective than trabeculectomy in the treatment of open angle
glaucoma, and deep sclerectomy plus mitomycin C (MMC) was also less effective than trabeculectomy plus MMC. However, viscocanalostomy
and deep sclerectomy were associated with
fewer complications than trabeculectomy."


Y

N

N

N




Viscocanalostomy versus trabeculectomy with or without antimetabolite; deep sclerectomy versus trabeculectomy with or without mitomycin C

Cox 20087



3,6

"To evaluate the efficacy of the fixed combination
ocular hypotensive therapies compared with their nonfixed
components used concomitantly for lowering
intraocular pressure in glaucoma and ocular
hypertension."


"Fixed combination therapies are equally
safe and effective at lowering IOP as their non-fixed
components administered concomitantly."

NR

Y

NR

NR

Glaucoma

Fixed combination medications compared with non-fixed components used (concomitant) (travoprost, brimonidine, dorzolamide, bimatoprost) and a beta blocker

Eyawo 20098



3,6

"To identify randomized trials evaluating
the head-to-head effectiveness of prostaglandin analogs in the treatment
of POAG and ocular hypertension and to conduct a
meta-analysis of their results to improve understanding of
the drugs’ relative efficacy."


"Randomized head-to-head evaluations of prostaglandin therapy demonstrate
similar efficacy effects, but differing hyperemia effects."

Y

Y

N

N

Other types of chronic open angle glaucoma

Travoprost versus latanoprost or bimatoprost; latanoprost versus bimatoprost

Fung 20079



3,6

"To compare the efficacy and tolerability of latanoprost versus brimonidine in the treatment of open angle
glaucoma, ocular hypertension or normal-tension glaucoma."


"Latanoprost is more effective than brimonidine as monotherapy in lowering IOP. Brimonidine is
associated with a higher rate of fatigue."

Y

Y

N

Y

Mixed glaucoma

Latanoprost versus brimonidine

Hodge 200810



3,6

"To systematically review the literature on the
efficacy and harm of prostaglandin analogues compared to brimonidine and dorzolamide in treating
elevated intraocular pressure."

"Latanoprost was found to be significantly
superior to dorzolamide but not brimonidine. However,
ocular adverse events were significantly fewer in
latanoprost users than in brimonide users. Neither
travoprost nor bimatoprost was compared to dorzolamide
or brimonidine in the present literature."


N

Y

N

N




Latanoprost versus dorzolamide and brimonidine

Honrubia 200911



6

"To conduct a meta-analysis of randomised clinical
trials to evaluate the development of
conjunctival hyperaemia after the use of latanoprost
versus travoprost and bimatoprost, in patients with ocular
hypertension or glaucoma."

"According to available data, the use of
latanoprost is associated with a lower incidence of
conjunctival hyperaemia when compared with travoprost
and bimatoprost in the treatment of patients with ocular
hypertension or glaucoma."


NR

Y

NR

NR

Glaucoma

Latanoprost versus travoprost and bimatoprost

Jampel 200312



3,4,6

"The objectives of this evidence report were to: identify the most important questions pertinent to treatment of patients with coexisting cataract and glaucoma; assess the published literature with respect to quality and content regarding these questions; and to inform clinical practitioners and identify areas where future research is needed, based on the literature findings"


"The literature does not point to one optimal strategy for controlling IOP in patients with coexisting cataract and glaucoma needing surgery. Therefore, there is a continued need for high quality studies with greater duration and more information on optic nerve and visual field findings."

Y

N

Y

N

OAG or ACG with coexisting cataract

Laser treatment, filtration surgery, endoscopic cyclophotocoagulation, nonpenetrating surgeries. Clear corneal and scleral cataract incision and nuclear expression/phacoemulsification

Kirwan 200913



3,6

"To assess the effectiveness of beta radiation during glaucoma surgery (trabeculectomy)."

"Trabeculectomy with beta irradiation has a lower risk of surgical failure compared to trabeculectomy alone. A trial of beta irradiation
versus anti-metabolite is warranted."

Y

Y

Y

Y

1st surgical procedure; no simultaneous bilateral surgery; all types of glaucoma included in review inclusion criteria, but included studies enrolled participants with OAG





Li 200614



3,6

"To evaluate
the incidence of reported side-effects and intraocular pressure-lowering effect of travoprost versus other
prostaglandin analogues (latanaprost, bimatoprost, unoprostone)
or timolol."

"Travoprost is more
effective than timolol in lowering IOP in patients with openangle
glaucoma or ocular hypertension. Compared with
other prostaglandin analogues, travoprost appears to be
equivalent to bimatoprost and latanoprost. Although a limited
number of local side-effects were reported, no serious
treatment-related side-effects were reported."


Y

Y

N

N




Travoprost compared with other prostagladin analogs or timolol

Liu 201015



1,3,6

"This meta-analysis
evaluated the efficacy and tolerability of one-site versus two-site phacotrabeculectomy in the treatment of patients with
coexisting cataract and glaucoma."

"Two-site phacotrabeculectomy is superior to one-site phacotrabeculectomy in reducing IOP, but other
post-operative effects are similar. One-site and two-site phacotrabeculectomies have similar adverse event rates."


NR

NR

NR

NR

Coexisting cataract and glaucoma

Phacotrabeculectomy (1 site versus 2 site)

Loon 200816



3,6

"To compare the efficacy and tolerability of
timolol versus brimonidine in the treatment of glaucoma."


"Both drugs are effective in lowering IOP. Brimonidine is associated with a
higher rate of allergy."

Y

Y

NR

NR

Other glaucoma (2%)

Timolol versus brimonidine

Maier 200517



4

"To summarize the evidence of the effectiveness of introacular pressure lowering treatment to 1) delay OAG among those with OHT ocular hypertension 2) delay progression of OAG"



"Lowering intraocular pressure in patients with
ocular hypertension or manifest glaucoma is beneficial in
reducing the risk of visual field loss in the long term."

Y

Y

N

Y




Medical and/or surgical treatment (timolol, betaxolol, various medications, laser trabeculoplasty, betaxolol, and latanoprost versus concurrent untreated control group (Includes OHTS, EMGT, CNGTS)


Minckler 200618



1,3,6

"This review compares aqueous shunts for IOP control and safety."

"Relatively few randomized trials have been published on aqueous shunts and methodology and data quality among them is poor. To
date there is no evidence of superiority of one shunt over another."

Y

NR

Y

NR

Glaucoma patients irrespective of lens status; %OAG unknown


Aqueous shunts versus standard surgery or cyclodestruction

Rolim de Moura 200719

2,3,4,6

"To study the effects of laser trabeculoplasty for OAG"

"Evidence suggests that, in people with newly diagnosed OAG, the risk of uncontrolled IOP is higher in people treated with medication
used before the 1990s when compared to laser trabeculoplasty at two years followup.Trabeculoplasty is less effective than trabeculectomy
in controlling IOP at six months and two years follow up. Different laser technology and protocol modalities were compared to the traditional laser trabeculoplasty and more evidence is necessary to determine if they are equivalent or not. There is no evidence to
determine the effectiveness of laser trabeculoplasty compared to contemporary medication (prostaglandin analogues, topical anhydrase
inhibitors and alpha2-agonists) and also with contemporary surgical techniques."


Y

N

N

N




Argon laser trabeculoplasty versus medication, trabeculectomy, diode laser trabeculoplasty or ND: Yag laser; Laser
trabeculoplasty,
betaxolol, and
latanoprost versus observation for POAG or NTG (Includes EMGT)

Vass 200720



4,6

"To assess and compare the effectiveness of topical pharmacological treatment for POAG or OHT to prevent progression or onset of
glaucomatous optic neuropathy."

"The results of this review support the current practice of IOP lowering treatment of OHT. A visual field protective effect has been
clearly demonstrated for medical IOP lowering treatment. Positive but weak evidence for a beneficial effect of the class of beta-blockers
has been shown.
Direct comparisons of prostaglandins or brimonidine to placebo are not available and the comparison of dorzolamide to placebo failed
to demonstrate a protective effect. However, absence of data or failure to prove effectiveness should not be interpreted as proof of
absence of any effect. The decision to treat a patient or not, as well as the decision regarding the drug with which to start treatment,
should remain individualised, taking in to account the amount of damage, the level of IOP, age and other patient characteristics."


Y

Y

N

N




Topical medications versus placebo or untreated control group; head to head comparisons of medications; unspecified medications versus untreated control group (Includes OHTS)

Wilkins 200521



3,6

"To assess the effects of intraoperative mitomycin C compared to placebo in trabeculectomy."

"Intraoperative mitomycin C reduces the risk of surgical failure in eyes that have undergone no previous surgery and in eyes at high risk of failure.
Compared to placebo it reduces mean IOP at 12 months in all groups of participants in this review. Apart from an increase in cataract
formation following MMC, there was insufficient power to detect any increase in other serious side effects such as endophthalmitis."

NR

NR

NR

NR

Glaucoma; Two included studies enrolled participants with ACG; Unsure if two additional included studies enrolled ACG participants


Intraoperative mitomycin C versus placebo or control

Wormald 200122



3,6

"To assess the effects of postoperative injections of 5-FU in eyes of people undergoing surgery for glaucoma."

"Postoperative injections of 5-FU are now rarely used as a planned series but are increasingly used on an ad hoc basis. This presumably
reflects an aspect of the treatment that is unacceptable to both patients and doctors. None of the trials reported on the participants’
perspective of care which constitutes a serious omission for an invasive treatment such as this."

NR

NR

NR

NR

People undergoing glaucoma surgery (high risk of failure, combined glaucoma and cataract surgery, and primary trabeculectomy; At least one included study enrolled participants with ACG

Post-operative injection of 5-FU (any dose) versus placebo or no injection

Zhang 200123



3,6

"To evaluate the comparative efficacy
and tolerance of latanoprost versus
timolol through a meta-analysis of randomised
controlled trials."

"This meta-analysis suggests
that latanoprost is more effective than
timolol in lowering IOP. However, it often
causes iris pigmentation. While current
evidence suggests that this pigmentation
is benign, careful lifetime evaluation of
patients is still justified."


Y

Y

N

N




Latanoprost versus timolol






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