Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Iridotomía para desacelerar la evolución de la pérdida del campo visual en el glaucoma de ángulo cerrado

Esta versión no es la más reciente

ver la versión actual 09 enero 2023

Información

DOI:
https://doi.org/10.1002/14651858.CD012270.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 13 junio 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.

Cifras del artículo

Altmetric:

Citado por:

Citado 0 veces por enlace Crossref Cited-by

Contraer

Autores

  • Jimmy T Lea

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

    [email protected]

    Joint first author

  • Benjamin Rousea

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

    Joint first author

  • Gus Gazzard

    NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK

    UCL Institute of Ophthalmology, London, UK

Contributions of authors

JL, BR, and GG designed and wrote the protocol.

JL and BR screened studies for inclusion.

JL and BR extracted data from studies.

JL, BR, and GG drafted the final review and will be responsible for updates.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Cochrane Eyes and Vision US Project, supported by cooperative agreement 1 U01 EY020522, National Eye Institute, National Institutes of Health, USA.

  • Epidemiology and Biostatistics of Aging Training Program, T32 AG000247, National Institute on Aging, National Institutes of Health, USA.

    • JL is a doctoral candidate supported by the Epidemiology and Biostatistics of Aging Training Program.

  • 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 expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the Department of Health.

Declarations of interest

JL: none known.
BR: none known.
GG has received travel funding and both educational and unrestricted research funding from pharmaceutical and equipment manufacturers that are involved in the treatment of glaucoma; however none of the funding is otherwise related to (or competing with) the subject of this review.

Acknowledgements

We thank Kristina Lindsley, Tianjing Li, Barbara Hawkins, Sonal Singh, Andrew Law, Anupa Shah, Xuan Hui, Jennifer Evans and other members of Cochrane Eyes and Vision (CEV) for their comments and suggestions during title registration and writing the review. We thank our peer reviewers for providing comments to the review manuscript. We are also grateful to Amanda Bicket who provided feedback on the background of our review. Our protocol was adapted from a previous (withdrawn) protocol by Aravind Reddy and Sandra M Johnson for a Cochrane Review that was could not be completed.

We thank Lori Rosman, Information Specialist for CEV for devising and executing the electronic search strategies. We thank the methodologists and staff at CEV for assistance with full‐text screening of non‐English articles.

Version history

Published

Title

Stage

Authors

Version

2023 Jan 09

Iridotomy to slow progression of visual field loss in angle‐closure glaucoma

Review

Benjamin Rouse, Jimmy T Le, Gus Gazzard

https://doi.org/10.1002/14651858.CD012270.pub3

2018 Jun 13

Iridotomy to slow progression of visual field loss in angle‐closure glaucoma

Review

Jimmy T Le, Benjamin Rouse, Gus Gazzard

https://doi.org/10.1002/14651858.CD012270.pub2

2016 Jun 29

Iridotomy to slow progression of angle‐closure glaucoma

Protocol

Jimmy T Le, Benjamin Rouse, Gus Gazzard

https://doi.org/10.1002/14651858.CD012270

Differences between protocol and review

We added methods for assessing the certainty of the evidence and presenting outcomes in a 'Summary of findings' table in accordance with revised Cochrane standards and GRADE. We revised our background to be more concise and clarified that comparator (observation) refers to no iridotomy. For our secondary outcomes, we also considered data for longer‐term follow‐up closest to one year if trials did not report outcomes at one year.

Methods not implemented

We did not conduct a meta‐analysis as planned because data are not available for all outcomes and the full reports of the trials are still under preparation. Accordingly, we did not perform assessment of reporting biases, subgroup analyses and sensitivity analyses.

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.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

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

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Iridotomy vs No treatment, Outcome 1 Angle Width.
Figuras y tablas -
Analysis 1.1

Comparison 1 Iridotomy vs No treatment, Outcome 1 Angle Width.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Iridotomy vs No treatment, Outcome 2 Adverse events.
Figuras y tablas -
Analysis 1.2

Comparison 1 Iridotomy vs No treatment, Outcome 2 Adverse events.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. Iridotomy compared to no iridotomy for patients with primary angle‐closure suspect, primary angle closure, or primary angle‐closure glaucoma

Iridotomy compared to no iridotomy for patients with primary angle‐closure suspect, primary angle closure, or primary angle‐closure glaucoma

Patient or population: patients with primary angle‐closure suspect, primary angle closure, or primary angle‐closure glaucoma
Setting: hospital or out‐patient
Intervention: iridotomy
Comparison: no iridotomy

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of eyes
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with no iridotomy

Risk with Iridotomy

Proportion of progressive visual field loss at 1 year

Not reported

Not reported

‐

‐

‐

Intraocular pressure: mean IOP at 1 year

Not reported

Not reported

‐

‐

‐

Gonioscopic findings: mean angle width at 1 year

The mean angle width was 11.3° in the no iridotomy group

The mean angle width in the iridotomy group was 12.7° higher
(12.06° higher to 13.34° higher)

MD 12.7
(12.06 to 13.34)

1550
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

Participants in the study were primary angle‐closure suspects. Data were only available at 18 months.

Need for additional surgery: proportion of participants who received additional surgery to control IOP at 1 year

Not reported

Not reported

‐

‐

‐

Medications: mean number of medications used to control IOP at 1 year

Not reported

Not reported

‐

‐

‐

Quality of life measures

Not reported

Not reported

‐

‐

‐

Adverse events ‒ IOP spike (rise greater than or equal to 8 mmHg) at 1 hour

4 per 1000

98 per 1000
(31 to 310)

RR 24.00
(7.60 to 75.83)

1468
(1 RCT)

⊕⊕⊝⊝
LOW 1 2

Participants in the study were primary angle‐closure suspects.

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; MD: Mean difference; IOP: Intraocular pressure

GRADE Working Group grades of evidence
High‐certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate‐certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low‐certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low‐certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded by one level for risk of bias, as the study is at unclear risk of bias for incomplete outcome data, selective outcome reporting, and other sources of bias due to the lack of availability of a full trial report.

2 Downgraded by one level for imprecision, as the confidence interval of the risk ratio between the groups is wide.

Figuras y tablas -
Summary of findings for the main comparison. Iridotomy compared to no iridotomy for patients with primary angle‐closure suspect, primary angle closure, or primary angle‐closure glaucoma
Ir a la tabla de la revisión
Table 1. AAO summary of clinical findings defining angle‐closure diseases

Primary angle‐closure suspect (PACS)

Primary angle closure (PAC)

Primary angle‐closure glaucoma (PACG)

Iridotrabecular contact greater than or equal to 180°

X

X

X

Elevated intraocular pressure OR peripheral anterior synechiae

X

X

Optic nerve damage

X
Figuras y tablas -
Table 1. AAO summary of clinical findings defining angle‐closure diseases
Ir a la tabla de la revisión
Comparison 1. Iridotomy vs No treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Angle Width Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 IOP spike (rise greater than or equal to 8 mmHg) at 1 hour

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 1. Iridotomy vs No treatment
Ir a la tabla de la revisión