Cyclodestructive procedures for non-refractory glaucoma

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.

• They included all types of lasers (for example, Nd: YAG, diode), routes of administration (transpupillary, transvitreal, non-contact and contact transscleral, and endoscopic), and laser settings (including power, number of applications, extent of treatment).
• They included trials in which CPC was performed alone or in combination with another procedure.
• They excluded trials in which endoscopic CPC was compared with non-cyclodestructive glaucoma treatments,

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