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Derivaciones del humor acuoso para el glaucoma

Appendices

Appendix 1. CENTRAL search strategy

#1 MeSH descriptor: [Glaucoma] explode all trees
#2 MeSH descriptor: [Ocular Hypertension] explode all trees
#3 MeSH descriptor: [Intraocular Pressure] explode all trees
#4 glaucom*
#5 ((intra*ocular or ocular*) near/3 (hypertension* or tension* or pressur*))
#6 IOP
#7 MeSH descriptor: [Filtering Surgery] explode all trees
#8 MeSH descriptor: [Cataract Extraction] explode all trees
#9 (cataract* near/3 (extract* or surg* or operat* or remov*))
#10 {or #1‐#9}
#11 MeSH descriptor: [Glaucoma Drainage Implants] explode all trees
#12 (Baerveldt* or Krupin* or Ahmed* or Molteno* or Schocket* or Joseph* or Optimed* or White or Hunan*)
#13 glaucom* and (Devic* or implant* or shunt* or valve* or tube* or drain* or seton*)
#14 {or #11‐#13}
#15 #10 and #14

Appendix 2. MEDLINE Ovid search strategy

1. Randomized Controlled Trial.pt.
2. Controlled Clinical Trial.pt.
3. (randomized or randomised).ab,ti.
4. placebo.ab,ti.
5. drug therapy.fs.
6. randomly.ab,ti.
7. trial.ab,ti.
8. groups.ab,ti.
9. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8
10. exp animals/ not humans.sh.
11. 9 not 10
12. exp Glaucoma/
13. exp ocular hypertension/
14. exp intraocular pressure/
15. glaucom*.tw.
16. ((intra?ocular or ocular*) adj3 (hypertension* or tension* or pressur*)).tw.
17. IOP.tw.
18. exp filtering surgery/
19. exp Cataract Extraction/
20. (cataract* adj3 (extract* or surg* or operat* or remov*)).tw.
21. or/12‐20
22. exp Glaucoma Drainage Implants/
23. (Baerveldt* or Krupin* or Ahmed* or Molteno* or Schocket* or Joseph* or Optimed* or White or Hunan*).tw.
24. (glaucom* and (Devic* or implant* or shunt* or valve* or tube* or drain* or seton*)).tw.
25. or/22‐24
26. 21 and 25
27. 11 and 26

The search filter for trials at the beginning of the MEDLINE strategy is from the published paper by Glanville 2006.

Appendix 3. Embase.com search strategy

1. 'randomized controlled trial'/exp
2. 'randomization'/exp
3. 'double blind procedure'/exp
4. 'single blind procedure'/exp
5. random*:ab,ti
6. 1 OR 2 OR 3 OR 4 OR 5
7. 'animal'/exp OR 'animal experiment'/exp
8. 'human'/exp
9. 7 AND 8
10. 7 NOT 9
11. 6 NOT 10
12. 'clinical trial'/exp
13. (clin* NEAR/3 trial*):ab,ti
14. ((singl* OR doubl* OR trebl* OR tripl*) NEAR/3 (blind* OR mask*)):ab,ti
15. 'placebo'/exp
16. placebo*:ab,ti
17. random*:ab,ti
18. 'experimental design'/exp
19. 'crossover procedure'/exp
20. 'control group'/exp
21. 'latin square design'/exp
22. 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20 OR 21
23. 22 NOT 10
24. 23 NOT 11
25. 'comparative study'/exp
26. 'evaluation'/exp
27. 'prospective study'/exp
28. control*:ab,ti OR prospectiv*:ab,ti OR volunteer*:ab,ti
29. 25 OR 26 OR 27 OR 28
30. 29 NOT 10
31. 30 NOT (11 OR 23)
32. 11 OR 24 OR 31
33. 'glaucoma'/exp
34. 'intraocular pressure'/exp
35. 'intraocular pressure abnormality'/de
36. 'ocular ischemic syndrome'/exp
37. glaucom*:ab,ti
38. ((intra*ocular OR ocular*) NEAR/3 (hypertension* OR tension* OR pressur*)):ab,ti
39. iop:ab,ti
40. 'filtering operation'/exp
41. 'cataract extraction'/exp
42. (cataract* NEAR/3 (extract* OR surg* OR operat* OR remov*)):ab,ti
43. #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42
44. 'glaucoma drainage implant'/exp
45. baerveldt*:ab,ti OR krupin*:ab,ti OR ahmed*:ab,ti OR molteno*:ab,ti OR schocket*:ab,ti OR joseph*:ab,ti OR optimed*:ab,ti OR white:ab,ti OR hunan*:ab,ti
46. glaucom*:ab,ti AND (devic*:ab,ti OR implant*:ab,ti OR shunt*:ab,ti OR valve*:ab,ti OR tube*:ab,ti OR drain*:ab,ti OR seton*:ab,ti)
47. #44 OR #45 OR #46
48. #43 AND #47
49. #32 AND #48

Appendix 4. PubMed search strategy

#1 ((randomized controlled trial[pt]) OR (controlled clinical trial[pt]) OR (randomised[tiab] OR randomized[tiab]) OR (placebo[tiab]) OR (drug therapy[sh]) OR (randomly[tiab]) OR (trial[tiab]) OR (groups[tiab])) NOT (animals[mh] NOT humans[mh])
#2 Glaucom*[tw] NOT MEDLINE[sb]
#3 ((intraocular[tw] OR ocular*[tw]) AND (hypertension*[tw] OR tension*[tw] OR pressur*[tw])) NOT MEDLINE[sb]
#4 IOP[tw] NOT MEDLINE[sb]
#5 (cataract*[tw] AND (extract*[tw] OR surg*[tw] OR operat*[tw] OR remov*[tw])) NOT MEDLINE[sb]
#6 #2 OR #3 OR #4 OR #5
#7 (Baerveldt*[tw] OR Krupin*[tw] OR Molteno*[tw] OR Molteno*[tw] OR Schocket*[tw] OR Joseph*[tw] OR Optimed*[tw] OR White[tw] OR Hunan*[tw]) NOT MEDLINE[sb]
#8 Glaucom*[tw] AND (Devic*[tw] OR implant*[tw] OR shunt*[tw] OR valve*[tw] OR tube*[tw] OR drain*[tw] OR seton*[tw]) NOT MEDLINE[sb]
#9 #7 OR #8
#10 #6 AND #9
#11 #1 AND #10

Appendix 5. LILACS search strategy

(MH:C11.525$ OR glaucoma$ OR "Ocular Hypertension" OR "Hipertensión Ocular" OR "Hipertensão Ocular" OR MH:G14.440$ OR ((intraocular OR "intra‐ocular" OR ocular$) AND (hypertension$ OR tension$ OR pressur$)) OR "Presión Intraocular" OR "Pressão Intraocular" OR IOP OR MH:E04.540.450$ OR MH:E04.540.825.249$ OR ((cataract$ OR Catarata OR MH:C11.510.245$) AND (extract$ OR surg$ OR operat$ OR remov$))) AND (MH:E07.695.250$ OR "Implantes de Drenaje de Glaucoma" OR "Implantes para Drenagem de Glaucoma" OR Baerveldt$ OR Krupin$ OR Ahmed$ OR Molteno$ OR Schocket$ OR Joseph$ OR Optimed$ OR White OR Hunan$ OR Device$ OR implant$ OR shunt$ OR valve$ OR tube$ OR drain$ OR seton$)

Appendix 6. ClinicalTrials.gov search strategy

(glaucoma OR hypertension OR intraocular pressure) AND (device OR implant OR implants OR shunt OR valve OR tube OR drain OR drainage OR seton OR Baerveldt OR Krupin OR Ahmed OR Molteno OR Schocket OR Joseph OR Optimed OR White OR Hunan)

Appendix 7. ICTRP search strategy

Glaucoma AND device OR Glaucoma AND implant OR Glaucoma AND implants OR Glaucoma AND shunt OR Glaucoma AND valve OR Glaucoma AND tube OR Glaucoma AND drain OR Glaucoma AND drainage OR Glaucoma AND seton OR Glaucoma AND Baerveldt OR Glaucoma AND Krupin OR Glaucoma AND Ahmed OR Glaucoma AND Molteno OR Glaucoma AND Schocket OR Glaucoma AND Joseph OR Glaucoma AND Optimed OR Glaucoma AND White OR Glaucoma AND Hunan OR Hypertension AND device OR Hypertension AND implant OR Hypertension AND implants OR Hypertension AND shunt OR Hypertension AND valve OR Hypertension AND tube OR Hypertension AND drain OR Hypertension AND drainage OR Hypertension AND seton OR Hypertension AND Baerveldt OR Hypertension AND Krupin OR Hypertension AND Ahmed OR Hypertension AND Molteno OR Hypertension AND Schocket OR Hypertension AND Joseph OR Hypertension AND Optimed OR Hypertension AND White OR Hypertension AND Hunan

Intraocular pressure AND device OR Intraocular pressure AND implant OR Intraocular pressure AND implants OR Intraocular pressure AND shunt OR Intraocular pressure AND valve OR Intraocular pressure AND tube OR Intraocular pressure AND drain OR Intraocular pressure AND drainage OR Intraocular pressure AND seton OR Intraocular pressure AND Baerveldt OR Intraocular pressure AND Krupin OR Intraocular pressure AND Ahmed OR Intraocular pressure AND Molteno OR Intraocular pressure AND Schocket OR Intraocular pressure AND Joseph OR Intraocular pressure AND Optimed OR Intraocular pressure AND White OR Intraocular pressure AND Hunan

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 1 Mean intraocular pressure.
Figures and Tables -
Analysis 1.1

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 1 Mean intraocular pressure.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 2 Intraocular pressure outcomes at 1 year follow‐up.
Figures and Tables -
Analysis 1.2

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 2 Intraocular pressure outcomes at 1 year follow‐up.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 3 Intraocular pressure outcomes at 3 years follow‐up.
Figures and Tables -
Analysis 1.3

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 3 Intraocular pressure outcomes at 3 years follow‐up.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 4 Intraocular pressure outcomes at 5 years follow‐up.
Figures and Tables -
Analysis 1.4

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 4 Intraocular pressure outcomes at 5 years follow‐up.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 5 Mean difference in logMAR visual acuity.
Figures and Tables -
Analysis 1.5

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 5 Mean difference in logMAR visual acuity.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 6 Mean change in visual field.
Figures and Tables -
Analysis 1.6

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 6 Mean change in visual field.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 7 Mean antiglaucoma medications.
Figures and Tables -
Analysis 1.7

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 7 Mean antiglaucoma medications.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 8 Need for reoperation to control glaucoma progression.
Figures and Tables -
Analysis 1.8

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 8 Need for reoperation to control glaucoma progression.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 9 Complications at 1 year follow‐up.
Figures and Tables -
Analysis 1.9

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 9 Complications at 1 year follow‐up.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 10 Complications at 3 years follow‐up.
Figures and Tables -
Analysis 1.10

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 10 Complications at 3 years follow‐up.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 11 Complications at 4 years follow‐up.
Figures and Tables -
Analysis 1.11

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 11 Complications at 4 years follow‐up.

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 12 Complications at 5 years follow‐up.
Figures and Tables -
Analysis 1.12

Comparison 1 Aqueous shunts versus trabeculectomy for glaucoma, Outcome 12 Complications at 5 years follow‐up.

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 1 Mean intraocular pressure.
Figures and Tables -
Analysis 2.1

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 1 Mean intraocular pressure.

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 2 Mean logMAR visual acuity.
Figures and Tables -
Analysis 2.2

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 2 Mean logMAR visual acuity.

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 3 Mean number of antiglaucoma medications.
Figures and Tables -
Analysis 2.3

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 3 Mean number of antiglaucoma medications.

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 4 Need for reoperation to control glaucoma progression.
Figures and Tables -
Analysis 2.4

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 4 Need for reoperation to control glaucoma progression.

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 5 Complications at 1 year follow‐up.
Figures and Tables -
Analysis 2.5

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 5 Complications at 1 year follow‐up.

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 6 Complications at 3 years follow‐up.
Figures and Tables -
Analysis 2.6

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 6 Complications at 3 years follow‐up.

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 7 Complications at 5 years follow‐up.
Figures and Tables -
Analysis 2.7

Comparison 2 Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma, Outcome 7 Complications at 5 years follow‐up.

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 1 Mean intraocular pressure at 2 years follow‐up.
Figures and Tables -
Analysis 3.1

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 1 Mean intraocular pressure at 2 years follow‐up.

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 2 Intraocular pressure outcomes at 2 years follow‐up.
Figures and Tables -
Analysis 3.2

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 2 Intraocular pressure outcomes at 2 years follow‐up.

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 3 Mean logMAR visual acuity at 2 years follow‐up.
Figures and Tables -
Analysis 3.3

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 3 Mean logMAR visual acuity at 2 years follow‐up.

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 4 Visual field mean deviation at 2 years follow‐up.
Figures and Tables -
Analysis 3.4

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 4 Visual field mean deviation at 2 years follow‐up.

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 5 Mean number of antiglaucoma medications at 2 years follow‐up.
Figures and Tables -
Analysis 3.5

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 5 Mean number of antiglaucoma medications at 2 years follow‐up.

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 6 Complications at 2 years follow‐up.
Figures and Tables -
Analysis 3.6

Comparison 3 Ahmed implant versus single‐plate Molteno implant for glaucoma, Outcome 6 Complications at 2 years follow‐up.

Comparison 4 Double‐plate Molteno implant versus Schocket shunt for glaucoma, Outcome 1 Mean intraocular pressure at 6 months follow‐up.
Figures and Tables -
Analysis 4.1

Comparison 4 Double‐plate Molteno implant versus Schocket shunt for glaucoma, Outcome 1 Mean intraocular pressure at 6 months follow‐up.

Comparison 4 Double‐plate Molteno implant versus Schocket shunt for glaucoma, Outcome 2 Complications at 6 to 12 months follow‐up.
Figures and Tables -
Analysis 4.2

Comparison 4 Double‐plate Molteno implant versus Schocket shunt for glaucoma, Outcome 2 Complications at 6 to 12 months follow‐up.

Comparison 5 Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma, Outcome 1 Mean intraocular pressure.
Figures and Tables -
Analysis 5.1

Comparison 5 Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma, Outcome 1 Mean intraocular pressure.

Comparison 5 Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma, Outcome 2 Mean logMAR visual acuity.
Figures and Tables -
Analysis 5.2

Comparison 5 Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma, Outcome 2 Mean logMAR visual acuity.

Comparison 5 Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma, Outcome 3 Mean antiglaucoma medications.
Figures and Tables -
Analysis 5.3

Comparison 5 Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma, Outcome 3 Mean antiglaucoma medications.

Comparison 6 Ahmed implant with anti‐VEGF versus Ahmed implant alone for glaucoma, Outcome 1 Mean intraocular pressure.
Figures and Tables -
Analysis 6.1

Comparison 6 Ahmed implant with anti‐VEGF versus Ahmed implant alone for glaucoma, Outcome 1 Mean intraocular pressure.

Comparison 6 Ahmed implant with anti‐VEGF versus Ahmed implant alone for glaucoma, Outcome 2 Mean antiglaucoma medications.
Figures and Tables -
Analysis 6.2

Comparison 6 Ahmed implant with anti‐VEGF versus Ahmed implant alone for glaucoma, Outcome 2 Mean antiglaucoma medications.

Comparison 7 Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma, Outcome 1 Mean intraocular pressure at 1 year follow‐up.
Figures and Tables -
Analysis 7.1

Comparison 7 Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma, Outcome 1 Mean intraocular pressure at 1 year follow‐up.

Comparison 7 Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma, Outcome 2 Complete success at 1 year follow‐up.
Figures and Tables -
Analysis 7.2

Comparison 7 Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma, Outcome 2 Complete success at 1 year follow‐up.

Comparison 7 Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma, Outcome 3 Mean antiglaucoma medications at 1 year follow‐up.
Figures and Tables -
Analysis 7.3

Comparison 7 Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma, Outcome 3 Mean antiglaucoma medications at 1 year follow‐up.

Comparison 7 Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma, Outcome 4 Complications at 1 year follow‐up.
Figures and Tables -
Analysis 7.4

Comparison 7 Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma, Outcome 4 Complications at 1 year follow‐up.

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 1 Mean intraocular pressure.
Figures and Tables -
Analysis 8.1

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 1 Mean intraocular pressure.

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 2 Intraocular pressure outcomes at 6 months follow‐up.
Figures and Tables -
Analysis 8.2

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 2 Intraocular pressure outcomes at 6 months follow‐up.

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 3 Intraocular pressure outcomes at 1 year follow‐up.
Figures and Tables -
Analysis 8.3

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 3 Intraocular pressure outcomes at 1 year follow‐up.

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 4 Postoperative hypertensive phase.
Figures and Tables -
Analysis 8.4

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 4 Postoperative hypertensive phase.

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 5 Mean antiglaucoma medications at 6 months follow‐up.
Figures and Tables -
Analysis 8.5

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 5 Mean antiglaucoma medications at 6 months follow‐up.

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 6 Complications at 6 months follow‐up.
Figures and Tables -
Analysis 8.6

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 6 Complications at 6 months follow‐up.

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 7 Complications at 1 year follow‐up.
Figures and Tables -
Analysis 8.7

Comparison 8 Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma, Outcome 7 Complications at 1 year follow‐up.

Comparison 9 Ahmed implant with partial tube ligation versus Ahmed implant with no ligation for glaucoma, Outcome 1 Mean intraocular pressure at 6 months follow‐up.
Figures and Tables -
Analysis 9.1

Comparison 9 Ahmed implant with partial tube ligation versus Ahmed implant with no ligation for glaucoma, Outcome 1 Mean intraocular pressure at 6 months follow‐up.

Comparison 9 Ahmed implant with partial tube ligation versus Ahmed implant with no ligation for glaucoma, Outcome 2 Intraocular pressure outcomes at 6 months follow‐up.
Figures and Tables -
Analysis 9.2

Comparison 9 Ahmed implant with partial tube ligation versus Ahmed implant with no ligation for glaucoma, Outcome 2 Intraocular pressure outcomes at 6 months follow‐up.

Comparison 9 Ahmed implant with partial tube ligation versus Ahmed implant with no ligation for glaucoma, Outcome 3 Complications at 6 months follow‐up.
Figures and Tables -
Analysis 9.3

Comparison 9 Ahmed implant with partial tube ligation versus Ahmed implant with no ligation for glaucoma, Outcome 3 Complications at 6 months follow‐up.

Comparison 10 Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty, Outcome 1 Mean intraocular pressure at 2 years follow‐up.
Figures and Tables -
Analysis 10.1

Comparison 10 Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty, Outcome 1 Mean intraocular pressure at 2 years follow‐up.

Comparison 10 Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty, Outcome 2 Intraocular pressure outcomes at 2 years follow‐up.
Figures and Tables -
Analysis 10.2

Comparison 10 Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty, Outcome 2 Intraocular pressure outcomes at 2 years follow‐up.

Comparison 10 Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty, Outcome 3 Visual acuity improvement of 2 lines or more on Snellen chart at 2 years follow‐up.
Figures and Tables -
Analysis 10.3

Comparison 10 Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty, Outcome 3 Visual acuity improvement of 2 lines or more on Snellen chart at 2 years follow‐up.

Comparison 10 Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty, Outcome 4 Complications at 2 years follow‐up.
Figures and Tables -
Analysis 10.4

Comparison 10 Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty, Outcome 4 Complications at 2 years follow‐up.

Comparison 11 Ahmed model M4 versus Ahmed model S2 for neovascular glaucoma, Outcome 1 Mean intraocular pressure at 1 year follow‐up.
Figures and Tables -
Analysis 11.1

Comparison 11 Ahmed model M4 versus Ahmed model S2 for neovascular glaucoma, Outcome 1 Mean intraocular pressure at 1 year follow‐up.

Comparison 11 Ahmed model M4 versus Ahmed model S2 for neovascular glaucoma, Outcome 2 Visual acuity between 20/20 and 20/100 at 1 year follow‐up.
Figures and Tables -
Analysis 11.2

Comparison 11 Ahmed model M4 versus Ahmed model S2 for neovascular glaucoma, Outcome 2 Visual acuity between 20/20 and 20/100 at 1 year follow‐up.

Comparison 11 Ahmed model M4 versus Ahmed model S2 for neovascular glaucoma, Outcome 3 Complications 1 day after surgery.
Figures and Tables -
Analysis 11.3

Comparison 11 Ahmed model M4 versus Ahmed model S2 for neovascular glaucoma, Outcome 3 Complications 1 day after surgery.

Comparison 12 500 mm2 Baerveldt implant versus 350 mm2 Baerveldt implant for non‐neovascular glaucoma, Outcome 1 Mean intraocular pressure.
Figures and Tables -
Analysis 12.1

Comparison 12 500 mm2 Baerveldt implant versus 350 mm2 Baerveldt implant for non‐neovascular glaucoma, Outcome 1 Mean intraocular pressure.

Comparison 12 500 mm2 Baerveldt implant versus 350 mm2 Baerveldt implant for non‐neovascular glaucoma, Outcome 2 Intraocular pressure outcomes.
Figures and Tables -
Analysis 12.2

Comparison 12 500 mm2 Baerveldt implant versus 350 mm2 Baerveldt implant for non‐neovascular glaucoma, Outcome 2 Intraocular pressure outcomes.

Comparison 12 500 mm2 Baerveldt implant versus 350 mm2 Baerveldt implant for non‐neovascular glaucoma, Outcome 3 Complications at 5 years follow‐up.
Figures and Tables -
Analysis 12.3

Comparison 12 500 mm2 Baerveldt implant versus 350 mm2 Baerveldt implant for non‐neovascular glaucoma, Outcome 3 Complications at 5 years follow‐up.

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 1 Mean intraocular pressure at 6 months follow‐up.
Figures and Tables -
Analysis 13.1

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 1 Mean intraocular pressure at 6 months follow‐up.

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 2 Intraocular pressure outcomes at 6 months follow‐up.
Figures and Tables -
Analysis 13.2

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 2 Intraocular pressure outcomes at 6 months follow‐up.

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 3 Visual acuity within 1 Snellen line or improved at 6 months follow‐up.
Figures and Tables -
Analysis 13.3

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 3 Visual acuity within 1 Snellen line or improved at 6 months follow‐up.

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 4 Mean antiglaucoma medications at 6 months follow‐up.
Figures and Tables -
Analysis 13.4

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 4 Mean antiglaucoma medications at 6 months follow‐up.

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 5 Need for reoperation to control glaucoma progression.
Figures and Tables -
Analysis 13.5

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 5 Need for reoperation to control glaucoma progression.

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 6 Complications at 6 months follow‐up.
Figures and Tables -
Analysis 13.6

Comparison 13 Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma, Outcome 6 Complications at 6 months follow‐up.

Summary of findings for the main comparison. Aqueous shunts versus trabeculectomy

Aqueous shunts compared with trabeculectomy for glaucoma

Population: People with glaucoma

Settings: Glaucoma surgery

Intervention: Aqueous shunt (Ahmed or Baerveldt)

Comparison: Trabeculectomy

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk:
Trabeculectomy

Corresponding risk:
Aqueous shunt

Mean IOP at 1‐year follow‐up

The mean IOP ranged across trabeculectomy groups from 11.4 mmHg to 13.8 mmHg.

The mean IOP in the aqueous shunt groups was 2.55 mmHg higher (0.78 lower to 5.87 mmHg higher).

MD 2.55 mmHg
(‐0.78 mmHg to 5.87 mmHg)

380

(3 studies)

⊕⊝⊝⊝
very low1,2,3

Mean logMAR visual acuity at 1‐year follow‐up

The mean change in logMAR visual acuity ranged across trabeculectomy groups from ‐0.29 units to 5.77 units.

The mean logMAR visual acuity in the aqueous shunt groups was 0.12 units higher (0.07 units lower to 0.31 units higher).

MD 0.12 units
(‐0.07 units to 0.31 units)

380

(3 studies)

⊕⊝⊝⊝
very low1,2,3

Mean change in visual field score from baseline at 1‐year follow‐up

The mean change in visual field score ranged across trabeculectomy groups from 0.09 to 1.09.

The mean change in visual field score in the aqueous shunt groups was 0.25 lower (1.91 lower to 1.40 higher).

MD ‐0.25
(‐1.91 to 1.40)

196

(2 studies)

⊕⊝⊝⊝
very low1,3,4

1 trial did not report visual field outcomes.

Mean number of antiglaucoma medications at 1‐year follow‐up

The mean number of antiglaucoma medications in the trabeculectomy group was 0.5.

The mean number of antiglaucoma medications in the aqueous shunt group was 0.80 higher (0.48 to 1.12 higher).

MD 0.80
(0.48 to 1.12)

184

(1 study)

⊕⊕⊝⊝
low1,4

2 trials reported that the mean number of antiglaucoma medications was higher in the aqueous shunt group than in the trabeculectomy group, but reported insufficient data for analysis.

Proportion needing additional glaucoma surgery at 1‐year follow‐up

36 per 1000

9 per 1000
(1 to 49)

RR 0.24
(0.04 to 1.36)

329

(2 studies)

⊕⊝⊝⊝
very low1,2,3

1 trial reported reoperation data at 4 years' follow‐up only.

Adverse events up to 1‐year follow‐up

571 per 1000

337 per 1000
(246 to 463)

RR 0.59
(0.43 to 0.81)

212

(1 study)

⊕⊝⊝⊝
very low1,2,3

2 trials reported specific adverse events (e.g. flat anterior chamber, choroidal effusion, hyphema), but not overall number of adverse events.

Quality of life at 1‐year follow‐up

Not reported

Not reported

*The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% confidence interval).
CI: confidence interval; IOP: intraocular pressure; MD: mean difference; RR: risk ratio

GRADE Working Group grades of evidence
High certainty: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: We are very uncertain about the estimate.

1Downgraded (‐1) for high or unclear risk of bias among included trials.
2Downgraded (‐1) for heterogeneity or inconsistency across trials.
3Downgraded (‐1) for imprecision of results (wide confidence intervals).
4Downgraded (‐1) for high probability of publication bias (selectively not reported from included trials).

Figures and Tables -
Summary of findings for the main comparison. Aqueous shunts versus trabeculectomy
Summary of findings 2. Ahmed implant versus Baerveldt implant

Ahmed implant compared with Baerveldt implant for glaucoma

Population: People with glaucoma

Settings: Glaucoma surgery

Intervention: Ahmed implant

Comparison: Baerveldt implant (350 mm2)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk: Baerveldt implant

Corresponding risk: Ahmed implant

Mean IOP at 1‐year follow‐up

The mean IOP ranged across Baerveldt implant groups from 13.2 mmHg to 13.6 mmHg.

The mean IOP in the Ahmed implant groups was 2.60 mmHg higher (1.58 mmHg to 3.62 mmHg higher).

MD 2.60 mmHg
(1.58 mmHg to 3.62 mmHg)

464

(2 studies)

⊕⊕⊕⊝
moderate1

Mean logMAR visual acuity at 1‐year follow‐up

The mean logMAR visual acuity ranged across Baerveldt implant groups from 1.23 to 1.5 logMAR units.

The mean logMAR visual acuity in the Ahmed implant groups was 0.07 units lower (0.27 units lower to 0.13 units higher).

MD ‐0.07 units
(‐0.27 units to 0.13 units)

501

(2 studies)

⊕⊕⊝⊝
low1,2

Mean change in visual field score from baseline at 1‐year follow‐up

Not reported

Not reported

Mean number of antiglaucoma medications at 1‐year follow‐up

The mean number of antiglaucoma medications ranged across Baerveldt implant groups from 1.2 to 1.5.

The mean number of antiglaucoma medications in the Ahmed implant groups was 0.35 higher (0.11 to 0.59 higher).

MD 0.35
(0.11 to 0.59)

464

(2 studies)

⊕⊕⊕⊝
moderate1

Proportion needing additional glaucoma surgery at 1‐year follow‐up

20 per 1000

56 per 1000
(21 to 153)

RR 2.77
(1.02 to 7.54)

514
(2 studies)

⊕⊕⊕⊝
moderate1

Adverse events up to 1‐year follow‐up

See comment

See comment

The 2 trials reported specific adverse events (e.g. flat anterior chamber, choroidal effusion, hyphema), but not overall number of adverse events.

Quality of life at 1‐year follow‐up

Not reported

Not reported

*The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% confidence interval).
CI: confidence interval; IOP: intraocular pressure; MD: mean difference; RR: risk ratio

GRADE Working Group grades of evidence
High certainty: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: We are very uncertain about the estimate.

1Downgraded (‐1) for high or unclear risk of bias among included trials.
2Downgraded (‐1) for imprecision of results (wide confidence intervals).

Figures and Tables -
Summary of findings 2. Ahmed implant versus Baerveldt implant
Summary of findings 3. Ahmed implant versus Molteno implant

Ahmed implant compared with Molteno implant for glaucoma

Population: People with glaucoma

Settings: Glaucoma surgery

Intervention: Ahmed implant

Comparison: Molteno implant (single‐plate)

Outcomes*

Illustrative comparative risks** (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk: Molteno implant

Corresponding risk: Ahmed implant

Mean IOP at 1‐year follow‐up

The mean IOP in the Molteno implant group was 15.36 mmHg.

The mean IOP in the Ahmed implant group was 1.64 mmHg higher (0.85 mmHg to 2.43 mmHg higher).

MD 1.64 mmHg
(0.85 mmHg to 2.43 mmHg)

57 (1 study)

⊕⊕⊝⊝
low1,2

Mean logMAR visual acuity at 1‐year follow‐up

The mean logMAR visual acuity in the Molteno implant group was 0.7 units.

The mean logMAR visual acuity in the Ahmed implant group was 0.08 units higher (0.24 units lower to 0.40 units higher).

MD 0.08 units
(‐0.24 units to 0.40 units)

57 (1 study)

⊕⊝⊝⊝
very low1,2,3

Mean change in visual field score from baseline at 1‐year follow‐up

The mean deviation in Humphrey visual fields in the Molteno implant group was ‐19.49 dB.

The mean deviation in Humphrey visual fields in the Ahmed implant group was 0.18 dB lower (3.13 dB lower to 2.77 dB higher).

MD ‐0.18 dB
(‐3.13 dB to 2.77 dB)

57 (1 study)

⊕⊝⊝⊝
very low1,2,3

Mean number of antiglaucoma medications at 1‐year follow‐up

The mean number of antiglaucoma medications in the Molteno implant group was 1.41.

The mean number of antiglaucoma medications in the Ahmed implant group was 0.38 lower (1.03 lower to 0.27 higher).

MD ‐0.38
(‐1.03 to 0.27)

57 (1 study)

⊕⊕⊝⊝
low1,2

Proportion needing additional glaucoma surgery at 1‐year follow‐up

Not reported

Not reported

Adverse events up to 1‐year follow‐up

See comment

See comment

The trial reported specific adverse events (e.g. flat anterior chamber, choroidal effusion, hyphema), but not overall number of adverse events.

Quality of life at 1‐year follow‐up

Not reported

Not reported

*The primary follow‐up time for this review was 1 year, however the trial comparing Ahmed versus Molteno implants reported data at 2 years only.
**The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% confidence interval).
CI: confidence interval; IOP: intraocular pressure; MD: mean difference

GRADE Working Group grades of evidence
High certainty: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: We are very uncertain about the estimate.

1Downgraded (‐1) for high or unclear risk of bias among included trials.
2Downgraded (‐1) for indirectness (follow‐up time was 2 years).
3Downgraded (‐1) for imprecision (wide confidence intervals).

Figures and Tables -
Summary of findings 3. Ahmed implant versus Molteno implant
Summary of findings 4. Molteno implant versus Schocket shunt

Molteno implant compared with Schocket shunt for glaucoma

Population: People with glaucoma

Settings: Glaucoma surgery

Intervention: Molteno implant (double‐plate)

Comparison: Schocket shunt

Outcomes*

Illustrative comparative risks** (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk: Schocket shunt

Corresponding risk: Molteno implant

Mean IOP at 1‐year follow‐up

The mean IOP in the Schocket shunt group was 18.9 mmHg.

The mean IOP in the Molteno implant group was 2.50 mmHg lower (4.60 mmHg to 0.40 mmHg lower).

MD ‐2.50 mmHg
(‐4.60 mmHg to ‐0.40 mmHg)

115

(1 study)

⊕⊕⊝⊝
low1,2

Another trial reported mean IOP for 40 participants (19 in the Molteno group and 21 in the Schocket shunt group), but did not report the follow‐up time at which data were collected.

Mean logMAR visual acuity at 1‐year follow‐up

Not reported

Not reported

Mean change in visual field score from baseline at 1‐year follow‐up

Not reported

Not reported

Mean number of antiglaucoma medications at 1‐year follow‐up

See comment

See comment

1 trial reported the number of antiglaucoma medications for 40 participants (19 in the Molteno group and 21 in the Schocket shunt group), but did not report the follow‐up time at which data were collected. Another trial did not report this outcome.

Proportion needing additional glaucoma surgery at 1‐year follow‐up

Not reported

Not reported

Adverse events up to 1‐year follow‐up

See comment

See comment

1 trial reported specific adverse events (e.g. flat anterior chamber, choroidal effusion, hyphema), but not overall number of adverse events. Another trial did not report adverse events.

Quality of life at 1‐year follow‐up

Not reported

Not reported

*The primary follow‐up time for this review was 1 year, however the trial comparing Molteno implant versus Schocket shunt reported data at 6 months only.
**The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% confidence interval).
CI: confidence interval; IOP: intraocular pressure; MD: mean difference

GRADE Working Group grades of evidence
High certainty: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: We are very uncertain about the estimate.

1Downgraded (‐1) for high or unclear risk of bias among included trials.
2Downgraded (‐1) for indirectness (follow‐up time was 6 months).

Figures and Tables -
Summary of findings 4. Molteno implant versus Schocket shunt
Table 1. Interventions evaluated in trials included in this review

Author year

Comparison and population

Number of eyes per group experimental/control

Maximum follow‐up time point reported

Aqueous shunts compared with trabeculectomy with or without MMC (4 trials)

Wilson 2000

Ahmed implant versus trabeculectomy with or without MMC for primary open‐ or closed‐angle glaucoma

55/62

1 year (11 to 13 months)

Wilson 2003

Ahmed implant versus trabeculectomy with or without MMC for primary open‐ or closed‐angle glaucoma

59/64

4 years (50 to 52 months)

Pakravan 2007

Ahmed implant with MMC versus trabeculectomy with MMC for pediatric aphakic glaucoma

15/15

Not reported

TVT 2009

Baerveldt 350 mm2 implant versus trabeculectomy with MMC for glaucoma with previous trabeculectomy or cataract surgery

107/105

5 years

Aqueous shunts compared with other aqueous shunts (5 trials)

ABC 2011

Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma

143/133

5 years

AVB 2011

Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma

124/114

3 years

Nassiri 2010

Ahmed implant versus single‐plate Molteno implant for glaucoma

46/46

2 years

Smith 1992

Double‐plate Molteno versus Schocket shunt for glaucoma

19/21

Not reported

Wilson 1992

Double‐plate Molteno versus Schocket shunt for glaucoma

65/53

6 months

Aqueous shunts compared with and without modification (18 trials)

Law 2016

Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma

26/26

2 years

Pakravan 2014

Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma

47/47

1 year

Desai 2013

Ahmed implant with intravitreal ranibizumab versus Ahmed implant alone for open‐angle glaucoma

6/5

6 months

Arcieri 2015

Ahmed implant with intravitreal bevacizumab versus Ahmed implant alone for neovascular glaucoma

20/20

2 years

Mahdy 2013

Ahmed implant with intravitreal bevacizumab and panretinal photocoagulation versus Ahmed implant with panretinal photocoagulation for neovascular glaucoma

20/20

18 months

Rojo‐Arnao 2011

Ahmed implant with subconjunctival bevacizumab versus Ahmed implant alone for glaucoma

7/6

3 months

Teixeira 2012

Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma

22/27

1 year

Yuen 2011

Ahmed implant with topical dexamethasone versus Ahmed implant with topical ketorolac for glaucoma

15/13

12 weeks

Yazdani 2016

Ahmed implant with amniotic membrane versus Ahmed implant alone for glaucoma

20/23

1 year

Rho 2015

Ahmed implant with biodegradable collagen matrix versus Ahmed implant alone for glaucoma

22/21

6 months

Hwang 2004

Ahmed implant with pericardium versus Ahmed implant alone for glaucoma

10/10

6 months

Kee 2001

Ahmed implant with partial tube ligation versus Ahmed implant with no ligation for glaucoma

16/16

6 months

Parihar 2016

Pars plana Ahmed implant versus conventional Ahmed implant for glaucoma with penetrating keratoplasty

29/29

2 years

Gil‐Carrasco 2016

Ahmed implant model M4 versus Ahmed implant model S2 for neovascular glaucoma

21/21

1 year

Britt 1999

500 mm2 Baerveldt implant versus 350 mm2 Baerveldt implant for non‐neovascular glaucoma

52/55

5 years

Valimaki 1999

Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant without oral corticosteroids for glaucoma

11/11

6 months

Heuer 1992

Double‐plate Molteno implant versus single‐plate Molteno implant for non‐neovascular glaucoma

66/66

Not reported

Gerber 1997

Pressure‐ridge Molteno implant versus standard Molteno implant with tube ligation for glaucoma

15/15

12 weeks

MMC: mitomycin C

Figures and Tables -
Table 1. Interventions evaluated in trials included in this review
Comparison 1. Aqueous shunts versus trabeculectomy for glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 At 6 months follow‐up

1

195

Mean Difference (IV, Random, 95% CI)

0.70 [‐0.75, 2.15]

1.2 At 1 year follow‐up

3

380

Mean Difference (IV, Random, 95% CI)

2.55 [‐0.78, 5.87]

1.3 At 3 years follow‐up

1

141

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐2.27, 1.67]

1.4 At 4 years follow‐up

1

110

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.5 At 5 years follow‐up

1

124

Mean Difference (IV, Random, 95% CI)

1.80 [‐0.46, 4.06]

2 Intraocular pressure outcomes at 1 year follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Qualified or complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Intraocular pressure outcomes at 3 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Qualified or complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Intraocular pressure outcomes at 5 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Qualified or complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Mean difference in logMAR visual acuity Show forest plot

3

Mean Difference (Random, 95% CI)

Subtotals only

5.1 At 1 year follow‐up

3

380

Mean Difference (Random, 95% CI)

0.12 [‐0.07, 0.31]

5.2 At 3 years follow‐up

1

157

Mean Difference (Random, 95% CI)

0.04 [‐0.17, 0.25]

5.3 At 4 years follow‐up

1

110

Mean Difference (Random, 95% CI)

‐0.88 [‐2.17, 0.41]

5.4 At 5 years follow‐up

1

143

Mean Difference (Random, 95% CI)

0.2 [‐0.08, 0.48]

6 Mean change in visual field Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 At 1 year follow‐up

2

196

Mean Difference (IV, Fixed, 95% CI)

‐0.25 [‐1.91, 1.40]

6.2 At 4 years follow‐up

1

110

Mean Difference (IV, Fixed, 95% CI)

‐5.02 [‐5.65, ‐4.39]

7 Mean antiglaucoma medications Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7.1 At 6 months follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 At 1 year follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 At 3 years follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.4 At 5 years follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Need for reoperation to control glaucoma progression Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 At 1 year follow‐up

2

329

Risk Ratio (M‐H, Fixed, 95% CI)

0.24 [0.04, 1.36]

8.2 At 3 years follow‐up

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.49 [0.19, 1.26]

8.3 At 4 years follow‐up

1

123

Risk Ratio (M‐H, Fixed, 95% CI)

2.17 [0.41, 11.41]

8.4 At 5 years follow‐up

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.44 [0.20, 0.96]

9 Complications at 1 year follow‐up Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Total participants with complications

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.43, 0.81]

9.2 Flat anterior chamber

2

329

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.62, 1.79]

9.3 Choroidal effusion

2

329

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [0.89, 3.14]

9.4 Hyphema

1

117

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.45, 2.80]

9.5 Persistent corneal edema

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

2.29 [0.61, 8.62]

9.6 Cystoid macular edema

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

1.47 [0.25, 8.63]

9.7 Bleb leak

2

329

Risk Ratio (M‐H, Fixed, 95% CI)

0.19 [0.03, 1.06]

9.8 Encapsulated bleb

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.07, 1.58]

9.9 Endophthalmitis/blebitis

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.03, 3.09]

9.10 Chronic/recurrent iritis

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

1.96 [0.18, 21.32]

9.11 Corneal ulcer

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.94]

9.12 Infection

1

117

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.13 Dysesthesia

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.02, 1.12]

9.14 Persistent diplopia

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

10.80 [0.60, 192.83]

9.15 Hypotony

1

117

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.07, 17.60]

9.16 Hypotony maculopathy

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.03, 3.09]

9.17 Implant exposure

1

117

Risk Ratio (M‐H, Fixed, 95% CI)

5.63 [0.28, 114.68]

9.18 Tube misdirection

1

117

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.19 Retinal detachment

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

2.94 [0.12, 71.47]

9.20 Suprachoroidal hemorrhage

1

117

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Complications at 3 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

10.1 Total participants with complications

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.2 Flat anterior chamber

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.3 Choroidal effusion

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.4 Persistent corneal edema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.5 Cystoid macular edema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.6 Bleb leak

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.7 Encapsulated bleb

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.8 Endophthalmitis/blebitis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.9 Chronic/recurrent iritis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.10 Corneal ulcer

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.11 Dysesthesia

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.12 Persistent diplopia

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.13 Hypotony maculopathy

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.14 Retinal detachment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Complications at 4 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

11.1 Flat anterior chamber

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 Hyphema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.3 Bleb leak

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.4 Endophthalmitis/blebitis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.5 Corneal ulcer

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.6 Implant exposure

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.7 Tube misdirection

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.8 Suprachoroidal hemorrhage

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Complications at 5 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

12.1 Flat anterior chamber

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.2 Choroidal effusion

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.3 Persistent corneal edema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.4 Cystoid macular edema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.5 Bleb leak

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.6 Encapsulated bleb

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.7 Endophthalmitis/blebitis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.8 Chronic/recurrent iritis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.9 Corneal ulcer

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.10 Dysesthesia

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.11 Persistent diplopia

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.12 Hypotony maculopathy

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.13 Retinal detachment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Aqueous shunts versus trabeculectomy for glaucoma
Comparison 2. Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 At 6 months follow‐up

2

494

Mean Difference (IV, Fixed, 95% CI)

1.31 [0.25, 2.36]

1.2 At 1 year follow‐up

2

464

Mean Difference (IV, Fixed, 95% CI)

2.60 [1.58, 3.62]

1.3 At 3 years follow‐up

2

397

Mean Difference (IV, Fixed, 95% CI)

1.24 [0.31, 2.18]

1.4 At 5 years follow‐up

1

174

Mean Difference (IV, Fixed, 95% CI)

2.0 [0.68, 3.32]

2 Mean logMAR visual acuity Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 At 1 year follow‐up

2

501

Mean Difference (IV, Fixed, 95% CI)

‐0.07 [‐0.27, 0.13]

2.2 At 3 years follow‐up

2

396

Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.25, 0.22]

2.3 At 5 years follow‐up

1

173

Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐0.39, 0.37]

3 Mean number of antiglaucoma medications Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 At 6 months follow‐up

2

494

Mean Difference (IV, Fixed, 95% CI)

0.50 [0.27, 0.73]

3.2 At 1 year follow‐up

2

464

Mean Difference (IV, Fixed, 95% CI)

0.35 [0.11, 0.59]

3.3 At 3 years follow‐up

2

397

Mean Difference (IV, Fixed, 95% CI)

0.60 [0.33, 0.87]

3.4 At 5 years follow‐up

1

174

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.03, 0.83]

4 Need for reoperation to control glaucoma progression Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 At 1 year follow‐up

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

2.77 [1.02, 7.54]

4.2 At 3 years follow‐up

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

1.98 [1.08, 3.65]

4.3 At 5 years follow‐up

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

2.67 [1.24, 5.77]

5 Complications at 1 year follow‐up Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Shallow anterior chamber

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.67, 1.38]

5.2 Choroidal effusion

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.73, 1.76]

5.3 Iritis

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.25, 1.23]

5.4 Corneal edema

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.31, 0.69]

5.5 Encapsulated bleb

1

238

Risk Ratio (M‐H, Fixed, 95% CI)

4.29 [1.27, 14.54]

5.6 Tube obstruction

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.17, 0.77]

5.7 Tube malposition

1

238

Risk Ratio (M‐H, Fixed, 95% CI)

1.84 [0.34, 9.85]

5.8 Tube erosion

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

2.77 [0.56, 13.61]

5.9 Motility disorder/diplopia

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

1.39 [0.82, 2.37]

5.10 Hyphema

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.34, 1.01]

5.11 Hypotony maculopathy

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.40, 4.84]

5.12 Malignant glaucoma

1

238

Risk Ratio (M‐H, Fixed, 95% CI)

1.84 [0.17, 20.01]

5.13 Suprachoroidal hemorrhage

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.02, 1.27]

5.14 Retinal/choroidal detachment

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.16, 3.08]

5.15 Endophthalmitis/episcleritis

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.16, 3.09]

5.16 Cystoid macular edema

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.71 [0.65, 4.48]

6 Complications at 3 years follow‐up Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Shallow anterior chamber

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.64, 1.29]

6.2 Choroidal effusion

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.73, 1.76]

6.3 Iritis

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.37, 1.53]

6.4 Corneal edema

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.43, 0.88]

6.5 Encapsulated bleb

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

4.08 [1.31, 12.72]

6.6 Tube obstruction

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.21 [0.07, 0.59]

6.7 Tube erosion

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.11, 1.51]

6.8 Motility disorder/diplopia

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.76, 2.02]

6.9 Hyphema

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.33, 0.97]

6.10 Hypotony maculopathy

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.40, 4.84]

6.11 Malignant glaucoma

1

238

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.13, 6.42]

6.12 Suprachoroidal hemorrhage

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.02, 1.27]

6.13 Retinal/choroidal detachment

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.13, 2.30]

6.14 Endophthalmitis/episcleritis

2

514

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.16, 3.09]

6.15 Cystoid macular edema

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.73 [0.71, 4.20]

7 Complications at 5 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Shallow anterior chamber

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.60, 1.44]

7.2 Choroidal effusion

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.36 [0.74, 2.52]

7.3 Iritis

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.37, 3.15]

7.4 Corneal edema

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.48, 1.00]

7.5 Encapsulated bleb

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

2.79 [0.11, 67.94]

7.6 Tube obstruction

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.21 [0.07, 0.59]

7.7 Tube erosion

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.16, 1.77]

7.8 Motility disorder/diplopia

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.65, 1.88]

7.9 Hyphema

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.31, 1.01]

7.10 Hypotony maculopathy

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.40, 4.84]

7.11 Retinal/choroidal detachment

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.13, 6.51]

7.12 Endophthalmitis

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.13 [0.01, 2.55]

7.13 Cystoid macular edema

1

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [0.65, 3.23]

Figures and Tables -
Comparison 2. Ahmed implant versus 350 mm2 Baerveldt implant for glaucoma
Comparison 3. Ahmed implant versus single‐plate Molteno implant for glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure at 2 years follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Intraocular pressure outcomes at 2 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Qualified or complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Mean logMAR visual acuity at 2 years follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Visual field mean deviation at 2 years follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Mean number of antiglaucoma medications at 2 years follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6 Complications at 2 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 Hyphema >1mm

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 Wound dehiscence

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Choroidal effusion

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.4 Choroidal maculopathy

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.5 Flat anterior chamber

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.6 Tube obstruction

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.7 Tenon cyst

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.8 Cataract formation

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 3. Ahmed implant versus single‐plate Molteno implant for glaucoma
Comparison 4. Double‐plate Molteno implant versus Schocket shunt for glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure at 6 months follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Complications at 6 to 12 months follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Choroidal detachment with shallow anterior chamber

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Tube obstruction

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Chronic uveitis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.4 Hyphema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.5 Sterile endophthalmitis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.6 Chronic hypotony

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.7 Suprachoroidal hemorrhage

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.8 Malignant glaucoma

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. Double‐plate Molteno implant versus Schocket shunt for glaucoma
Comparison 5. Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 At 6 months follow‐up

2

141

Mean Difference (IV, Fixed, 95% CI)

‐4.02 [‐5.51, ‐2.53]

1.2 At 1 year follow‐up

1

39

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐3.45, 3.05]

2 Mean logMAR visual acuity Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 At 1 year follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Mean antiglaucoma medications Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 At 6 months follow‐up

2

141

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐0.02, 0.63]

3.2 At 1 year follow‐up

1

39

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.56, 0.56]

Figures and Tables -
Comparison 5. Ahmed implant with early aqueous suppression versus Ahmed implant with standard medication regimen for glaucoma
Comparison 6. Ahmed implant with anti‐VEGF versus Ahmed implant alone for glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 At 6 months follow‐up

3

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 At 1 year follow‐up

2

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Mean antiglaucoma medications Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 At 6 months follow‐up

2

44

Mean Difference (IV, Fixed, 95% CI)

0.00 [‐0.63, 0.64]

2.2 At 1 year follow‐up

1

30

Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.65, 0.71]

Figures and Tables -
Comparison 6. Ahmed implant with anti‐VEGF versus Ahmed implant alone for glaucoma
Comparison 7. Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure at 1 year follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Complete success at 1 year follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Mean antiglaucoma medications at 1 year follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Complications at 1 year follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Loss of light perception

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Phthisis bulbi

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Corneal decompensation

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.4 Hemorrhagic choroidal detachment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.5 Hyphema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.6 Serous choroidal detachment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.7 Tube obstruction

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.8 Aqueous misdirection

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 7. Ahmed implant with intravitreal triamcinolone versus Ahmed implant alone for neovascular glaucoma
Comparison 8. Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 At 6 months follow‐up

3

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 At 1 year follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Intraocular pressure outcomes at 6 months follow‐up Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Complete success

2

63

Risk Ratio (M‐H, Fixed, 95% CI)

1.50 [0.88, 2.55]

2.2 Qualified or complete success

2

63

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.88, 1.19]

3 Intraocular pressure outcomes at 1 year follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Qualified or complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Postoperative hypertensive phase Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5 Mean antiglaucoma medications at 6 months follow‐up Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6 Complications at 6 months follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 Early hypotony

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 Hyphema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Choroidal effusion

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.4 Tube exposure

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.5 Endophthalmitis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.6 Wound leak

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Complications at 1 year follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

7.1 Hyphema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.2 Choroidal effusion

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Tube exposure

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.4 Tube obstruction

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.5 Malignant glaucoma

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 8. Ahmed implant with shunt augmentation versus Ahmed implant without shunt augmentation for glaucoma
Comparison 9. Ahmed implant with partial tube ligation versus Ahmed implant with no ligation for glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure at 6 months follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Intraocular pressure outcomes at 6 months follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Qualified or complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Complications at 6 months follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Hyphema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Shallow anterior chamber

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Hypotony

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.4 Choroidal effusion/detachment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.5 Tube obstruction

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 9. Ahmed implant with partial tube ligation versus Ahmed implant with no ligation for glaucoma
Comparison 10. Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure at 2 years follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Intraocular pressure outcomes at 2 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Qualified or complete success

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Visual acuity improvement of 2 lines or more on Snellen chart at 2 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4 Complications at 2 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Tube‐graft touch

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Shallow anterior chamber

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Choroidal detachment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.4 Vitreous hemorrhage

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.5 Tube exposure

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.6 Hyphema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 10. Pars plana versus conventional Ahmed implant for glaucoma with penetrating keratoplasty
Comparison 11. Ahmed model M4 versus Ahmed model S2 for neovascular glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure at 1 year follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 At 6 months follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 At 1 year follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Visual acuity between 20/20 and 20/100 at 1 year follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Complications 1 day after surgery Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Total complications

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Hyphema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Hyphema, tube obstruction

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.4 DC

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.5 Contact with the iris

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.6 Flat grade 1 chamber

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 11. Ahmed model M4 versus Ahmed model S2 for neovascular glaucoma
Comparison 12. 500 mm2 Baerveldt implant versus 350 mm2 Baerveldt implant for non‐neovascular glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 At 1 year follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 At 3 years follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 At 5 years follow‐up

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Intraocular pressure outcomes Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 At 6‐18 months follow‐up

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 At 5 years follow‐up

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Complications at 5 years follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Diplopia/strabismus

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Anterior uveitis

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Retinal detachment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.4 Tube obstruction

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.5 Choroidal effusion/detachment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 12. 500 mm2 Baerveldt implant versus 350 mm2 Baerveldt implant for non‐neovascular glaucoma
Comparison 13. Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean intraocular pressure at 6 months follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Intraocular pressure outcomes at 6 months follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Visual acuity within 1 Snellen line or improved at 6 months follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4 Mean antiglaucoma medications at 6 months follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Need for reoperation to control glaucoma progression Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6 Complications at 6 months follow‐up Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 Hyphema

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 Tube exposure

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Choroidal detachment

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.4 Strabismus/motility disorder

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 13. Single‐plate Molteno implant with oral corticosteroids versus single‐plate Molteno implant alone for glaucoma