Objective To evaluate the intraocular pressure (IOP) lowering efficacy of prostaglandin analogues topical medications in patients with chronic angle closure glaucoma (CACG) uncontrolled by peripheral iridotomy.
Methods Pertinent publications were identified through systematic searches of PubMed, EMBASE, Chinese Biomedicine Database, and the Cochrane Controlled Trials Register. Randomized clinical trials involving CACG patients treated with latanoprost, bimatoprost or travoprost monotherapy were selected. Methodological quality was assessed by aDelphilist with additions and scored out of a maximum of eighteen. The outcome measures were absolute and relative reduction in IOP from baseline, for diurnal curve, peak and trough. The pooled effects were calculated using two-step DerSimonian and Laird estimate method of the random effects model.
Results Nine randomized clinical trials enrolling a total of 1090 patients were included in the meta-analysis. Quality scores of included studies were generally high, a mean of 14.9 (range, 12 to 18). The difference in absolute IOP reduction between prostaglandin analogues and timolol varied from 0.4 to 1.6 mmHg at diurnal curve, 0.9 to 2.3 mmHg at peak and 1.3 to 2.4 mmHg at trough. Relative IOP reduction were diurnal curve, 31% (95% confidence interval, 27% to 34%), peak, 34% (31% to 37%), and trough 31% (28% to 35%) for latanoprost; diurnal curve, 26% (21% to 30%), peak, 28% (24% to 32%), and trough 27% (23% to 30%) for bimatoprost; diurnal curve, 28% (20% to 36%), peak, 32% (31% to 34%), and trough 31% (29% to 33%) for travoprost; diurnal curve, 23% (19% to 27%), peak, 24% (20% to 29%), and trough 21% (19% to 24%) for timolol.
Conclusions Latanoprost travoprost, bimatoprost, and timolol can significantly lower IOP in CACG patients who were inadequately treated by peripheral iridotomy; and the three prostaglandin analogues are associated with at least as effective as timolol. |
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