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Cochrane Database of Systematic Reviews

Procedimientos ciclodestructivos para el glaucoma no refractario

Información

DOI:
https://doi.org/10.1002/14651858.CD009313.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 25 abril 2018see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Salud ocular y de la visión

Copyright:
  1. Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Manuele Michelessi

    Ophthalmology, Fondazione G.B. Bietti per lo studio e la ricerca in Oftalmolologia‐IRCCS, Rome, Italy

  • Amanda K Bicket

    Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA

  • Kristina Lindsley

    Correspondencia a: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    [email protected]

Contributions of authors

Conceiving and designing the review: MM, KL
Designing and undertaking search strategies: Iris Gordon and Lori Rosman (CEV)
Screening search results: MM, KL
Organizing retrieval of papers: KL
Screening retrieved papers against inclusion criteria: MM, KL
Appraising risk of bias: MM, KL
Extracting data from papers: MM, KL
Writing to authors of papers for additional information: KL
Entering data into RevMan: KL
Analysis of data: KL, MM
Interpretation of data: MM, AKB, KL
Providing a methodological perspective: KL, MM
Providing a clinical perspective: MM, AKB
Providing a policy perspective: MM, AKB
Providing a consumer perspective: MM, AKB
Writing the review: MM, KL, AKB

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Grant 1 U01 EY020522, National Eye Institute, National Institutes of Health, USA.

    Methodological support provided by the Cochrane Eyes and Vision US Satellite

  • National Institute for Health Research (NIHR), UK.

    • Richard Wormald, Co‐ordinating Editor for Cochrane Eyes and Vision (CEV) acknowledges financial support for his CEV research sessions from the Department of Health through the award made by the NIHR to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology.

    • This review was supported by the NIHR, via Cochrane Infrastructure funding to the CEV UK editorial base.

    The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Declarations of interest

MM reports receiving payment for educational courses on methodology and glaucoma diagnostic accuracy from Polifarma and Santen. As a member of the International Glaucoma Panel (Allergan), mentored by Prof. David Garway‐Heath, MM has received travel accommodations and meeting expenses for three ARVO meetings (2015 ‐ 2017).
AKB: None known
KL: None known

Acknowledgements

We acknowledge Leslie S Jones (LSJ), Oluwatosin Smith (OS), Salman J Yousuf (SJY), and John Kwagyan (JK) for developing the protocol for this review. We thank Iris Gordon and Lori Rosman, Cochrane Eyes and Vision (CEV) Information Specialists, for developing the search strategy and executing the electronic searches. We also acknowledge the support of the CEV editorial team during the preparation of this review and thank the peer reviewers for their comments, and Nancy Fitton for editing the Plain Language Summary.

The contribution of the IRCCS ‐ Fondazione Bietti in this paper was supported by the Italian Ministry of Health and by Fondazione Roma. The supporting organization had no role in the design or conduct of this research.

Version history

Published

Title

Stage

Authors

Version

2018 Apr 25

Cyclodestructive procedures for non‐refractory glaucoma

Review

Manuele Michelessi, Amanda K Bicket, Kristina Lindsley

https://doi.org/10.1002/14651858.CD009313.pub2

2011 Sep 07

Cyclodestructive procedures for glaucoma

Protocol

Leslie Jones, Oluwatosin Smith, Salman J Yousuf, John Kwagyan

https://doi.org/10.1002/14651858.CD009313

Differences between protocol and review

In the protocol (Jones 2011), the authors planned to include randomized and quasi‐randomized controlled trials. However, we identified no quasi‐randomized controlled trials, and will not consider quasi‐randomized controlled trials in future updates to this review.

We included a 'Summary of findings' table and GRADE assessments in this review, neither of which were required under Cochrane standards at the time of the protocol.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Summary of findings for the main comparison. Low‐ versus high‐energy diode trans‐scleral cyclophotocoagulation for non‐refractory glaucoma

Low‐ versus high‐energy diode transscleralcyclophotocoagulation for non‐refractory glaucoma

Population: people with primary open‐angle glaucoma and no previous glaucoma surgery

Settings: ophthalmology clinics

Intervention: low energy; 1.5 watts for 1.5 seconds x 20 spots over 360 ° (45.0 J)

Comparison: high energy; 1.25 watts for 2.5 seconds x 20 spots over 360 ° (62.5 J)

Outcomes*

Illustrative comparative risks** (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

High‐energy diode transscleralcyclophotocoagulation

Low‐energy diode transscleralcyclophotocoagulation

Control of intraocular pressure

462 per 1000

475 per 1000
(295 to 762)

RR 1.03 (0.64 to 1.65)

79
(1 study)

⊕⊕⊝⊝
low1, 2

Control of intraocular pressure defined as a decrease in IOP by 20% from baseline value

Mean change in intraocular pressure

On average intraocular pressure in the high energy group dropped by 3 mmHg

On average intraocular pressure in the low‐energy group was 0.5 mmHg lower than the IOP in the high‐energy group (5.79 mmHg lower to 4.79 mmHg higher)

‐

79
(1 study)

⊕⊕⊝⊝
low1, 2

‐

Decrease in visual acuity

205 per 1000

250 per 1000
(111 to 566)

RR 1.22 (0.54 to 2.76)

79
(1 study)

⊕⊕⊝⊝
low1, 2

Decrease in visual acuity defined as a decrease of 2 or more lines on the Snellen chart or one or more categories of visual acuity if unable to read the eye chart

Mean visual field

No visual field outcomes reported

‐

‐

‐

‐

‐

Number of glaucoma medications after treatment

The mean number of glaucoma medications in the high energy group was 1.3

The mean number of glaucoma medications in the low energy group was 0.10 more (0.43 fewer to 0.63 more)

‐

79
(1 study)

⊕⊕⊕⊝
moderate1

‐

Additional glaucoma surgery

231 per 1000

175 per 1000
(72 to 425)

RR 0.76 (0.31 to 1.84)

79
(1 study)

⊕⊕⊝⊝
low1, 2

Additional glaucoma surgery defined as retreatment with cyclophotocoagulation according to randomized assignment

Adverse events: atonic pupil

311 per 1000

277 per 1000
(146 to 523)

RR 0.89 (0.47 to 1.68)

92
(1 study)

⊕⊕⊝⊝
low1, 2

Atonic pupil was the only adverse event reported by treatment group. Trial authors noted that most participants had mild to moderate pain for a few days following the procedure and many also had transient conjunctival burns (number not reported). Severe iritis occurred in 2 eyes and hyphema occurred in 3 eyes. No instances of hypotony or phthisis bulbi were reported

*All outcomes are reported for participants with at least 3 months follow‐up; mean follow‐up was 13.2 months.
**The basis for the assumed risk is the risk in the comparison group. 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% CI).
J: joule; CI: confidence interval; RR: risk ratio; mmHg: millimeter of mercury

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

1Downgraded for risk of bias in the trial (unmasked outcome assessors and 14% attrition).
2Downgraded for imprecision in the effect estimate (wide confidence interval).

Figuras y tablas -
Summary of findings for the main comparison. Low‐ versus high‐energy diode trans‐scleral cyclophotocoagulation for non‐refractory glaucoma
Ir a la tabla de la revisión