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Study flow diagram.
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Figure 1

Study flow diagram.

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

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

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

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

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Comparison 1 Iridotomy vs No treatment, Outcome 1 Angle Width.
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Analysis 1.1

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

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Comparison 1 Iridotomy vs No treatment, Outcome 2 Adverse events.
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Analysis 1.2

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

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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.

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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
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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
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Table 1. AAO summary of clinical findings defining angle‐closure diseases
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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]
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Comparison 1. Iridotomy vs No treatment
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