Meta-analysis of Medical Intervention for Normal Tension Glaucoma
Received 12 August 2008; received in revised form 14 January 2009; accepted 23 January 2009. published online 18 May 2009.
Objective
To evaluate the intraocular pressure (IOP) reduction achieved by the most frequently prescribed antiglaucoma drugs in patients with normal tension glaucoma (NTG).
Design
Systematic review and meta-analysis.
Participants
Fifteen randomized clinical trials reported 25 arms for peak IOP reduction, 16 arms for trough IOP reduction, and 13 arms for diurnal curve IOP reduction.
Methods
Pertinent publications were identified through systematic searches of PubMed, EMBASE, and the Cochrane Controlled Trials Register. The patients had to be diagnosed as having NTG. Methodological quality was assessed by the Delphi list on a scale from 0 to 18. The pooled 1-month IOP-lowering effects were calculated using the 2-step DerSimonian and Laird estimate method of the random effects model.
Main Outcome Measures
Absolute and relative reductions in IOP from baseline for peak and trough moments.
Results
Quality scores of included studies were generally high, with a mean quality score of 12.7 (range, 9–16). Relative IOP reductions were peak, 15% (12%–18%), and trough, 18% (8%–27%) for timolol; peak, 14% (8%–19%), and trough, 12% (−7% to 31%) for dorzolamide; peak, 24% (17%–31%), and trough, 11% (7%–14%) for brimonidine; peak, 20% (17%–24%), and trough, 20% (18%–23%) for latanoprost; peak, 21% (16%–25%), and trough, 18% (14%–22%) for bimatoprost. The differences in absolute IOP reductions between prostaglandin analogues and timolol varied from 0.9 to 1.0 mmHg at peak and −0.1 to 0.2 mmHg at trough.
Conclusions
Latanoprost, bimatoprost, and timolol are the most effective IOP-lowering agents in patients with NTG.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Available online: May 17, 2009.
Department of Ophthalmology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
Correspondence: Rui-Li Wei, MD, Department of Ophthalmology, Shanghai Changzheng Hospital, 415 Fengyang Road, Shanghai 200003, China
Manuscript no. 2008-967.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
ABSTRACT