Methodological quality of the review: High confidence
Authors: Michelessi M, Bicket AK, Lindsley K
Region: Ghana
Sector: Glaucoma
Sub-sector: None
Equity focus: None specified
Review type: Intervention review
Quantitative synthesis method, if applicable: Not applicable
Qualitative synthesis method, if applicable: Not applicable
Background:
Intraocular pressure (IOP) is the main treatable risk factor for glaucoma. The ciliary body epithelium produces fluid that builds up pressure in the eye. It is thought that procedures that destroy the ciliary body epithelium, known as cyclodestructive procedures, may reduce IOP as a treatment for glaucoma. Different methods of cyclodestructive procedures are available; the most common is laser. The purpose of this review was to assess laser treatments that destroy the ciliary body epithelium. The review focused on the effectiveness and safety of the included procedures by assessing IOP control, vision, pain control, and side effects.
Objectives:
To assess the effectiveness and safety of cyclodestructive procedures for the management of non-refractory glaucoma (that is, glaucoma in an eye that has not undergone incisional glaucoma surgery). The authors also aimed to compare the effect of different routes of administration, laser delivery instruments, and parameters of cyclophotocoagulation (CPC) with respect to IOP control, visual acuity, pain control, and adverse events.
Main findings:
The authors included only head-to-head trials that evaluated CPC using different types of lasers, delivery methods, parameters, or a combination of these factors.
The main outcomes for this review include: Control of IOP at one year, defined as a decrease in IOP by 15% from baseline value (or by another percentage of IOP reduction, as reported by included trials), Mean change in IOP measurements (by any recording device; contact or non-contact tonometry) collected prior to intervention and at one year.
Methodology:
The Cochrane Eyes and Vision Information Specialist conducted systematic searches in the following databases for randomized controlled trials and controlled clinical trials. There were no language or publication year restrictions. The authors then grouped the reports by study and each review author assessed each study as ‘include, ‘exclude’ or ‘unsure’.
Applicability/external validity: The authors make clear that only one study was considered appropriate for inclusion, limiting its external validity.
Geographic focus: None specified
Summary of quality assessment: High confidence
Publication source: Michelessi M, Bicket AK, Lindsley K. Cyclodestructive procedures for non-refractory glaucoma (2018) Cochrane Database of Systematic Reviews (4)