Efficacy and Safety of Different Types of Intraocular Pressure-Lowering Surgeries in Patients with Primary Angle Closure (PAC) or PAC Glaucoma: Systematic Review and Network Meta-Analysis of Randomized Clinical Trials

ABSTRACTABSTRACTObjective To compare the intraocular pressure (IOP)-lowering effect of different types of surgery available in the literature using a network meta-analysis (NMA) based on a systematic review.Methods PubMed and the Cochrane database were searched. Randomized clinical trials involving surgical interventions for high IOP for PAC (primary angle closure) or PACG (primary angle closure glaucoma) were included. Descriptive statistics and outcomes were extracted. Bayesian NMA was performed to compare the IOP-lowering effect and the change in the number of antiglaucoma drugs required between baseline and endpoint, as well as success rates.Results This NMA included 21 articles with 1237 eyes with PAC or PACG. Interventions were characterised as phacoemulsification (phaco), trabeculectomy, goniosynechialysis (GSL) with viscoelastic or blunt device, goniosurgery (GS) (trabeculotomy or goniotomy), micro-bypass stent (Istent®), endocyclophotocoagulation (ECPL) or various combinations of these procedures. Phaco+GSL [−1.73 (95%CrI: −3.53 to −0.13)] and phaco+GSL+GS [−3.92 (95%CrI: −6.91 to −1.31)] provided better IOP lowering effects than phaco alone. Phaco+trabeculectomy [−3.11 (95%CrI: −5.82 to −0.44)] was inferior to phaco+GSL+GS. Phaco+trabeculectomy [−0.45 (95%CrI: −0.81 to −0.13)] provided a better outcome in terms of reducing the need for antiglaucoma drug compared to phaco alone. There were no differences between the other surgeries in terms of reduction of antiglaucoma drug number and IOP lowering effect. Success rates were similar for all surgical procedures.Conclusions Phaco+GSL+GS showed the most promising results for lowering IOP. Phaco+trabeculectomy resulted in a significant reduction in the number of antiglaucoma drugs compared to phaco alone.KEYWORDS: Angle closureglaucomagoniosynechialysisphacoemulsificationtrabeculectomy ACKNOWLEDGMENTSAyse B. G. Sener thanks the "Republic of Turkey Higher Education Council" for the 100-2000 program scholarship for Ph.D.ABBREVIATIONS AND ACRONYMS CINeMA(Confidence In Network Meta-Analysis)PAC(primary angle closure)PACG(angle-closure glaucoma)IOP(intraocular pressure)PRISMA(Preferred Reporting Items notification checklist for Systematic Review and Meta-Analyses)RCT(Randomized Clinical Trial)RoB2(Risk of Bias 2)ROB-MEN(Risk Of Bias due to Missing Evidence in Network meta-analysis)NMA(Network Meta-Analysis)SUCRA(Surface Under the Cumulative Ranking Curve)CrI(Credibility Intervals)CI(Confidence Intervals)Phaco(Phacoemulsification)GSL(Goniosynechialysis)GS(Goniosurgery)PAS(Peripheral Anterior Synechia).DISCLOSURE STATEMENTNo potential conflict of interest was reported by the authors.SUPPLEMENTARY MATERIALSupplemental data for this article can be accessed online at https://doi.org/10.1080/08820538.2023.2223292DATA AVAILABILITY STATEMENTThe datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.Additional informationFundingThe authors declare that no funds, grants, or other forms of support were received during the preparation of this manuscript. The authors have no relevant financial interests to disclose.