Management and outcomes of primary open-angle glaucoma.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 42483376 · doi:10.4103/jfmpc.jfmpc_23_26
What was done
Authors conducted a systematic review and meta-analysis of 80 randomized controlled trials evaluating patients with primary open-angle glaucoma (POAG) treated with medical therapy (e.g., prostaglandin analogs, beta-blockers), surgical intervention (e.g., trabeculectomy, minimally invasive glaucoma surgery), or combination therapy. Primary outcomes assessed were intraocular pressure (IOP) reduction of ≥20%, mean IOP reduction, and visual field progression across diverse patient cohorts and follow-up periods.
What was found
No statistically significant difference in achieving ≥20% IOP reduction was found between medical, surgical, and combination treatments (P = 0.5301). Surgical procedures showed the greatest mean IOP decrease, followed by medical and combination therapies, but the difference among treatment arms was not statistically significant (P = 0.8493). Adverse effects (predominantly ocular pain, hyperemia, and blurred vision) occurred across all treatments. Specific effect sizes, confidence intervals, and visual field metrics were not reported in the abstract.
Why it matters
This review suggests that medical, surgical, and combination approaches offer broadly comparable IOP-lowering efficacy in POAG. Clinicians can tailor therapy based on individual disease severity, safety profiles, and patient preferences rather than presumed superiority of a single intervention category.
Limits
The abstract lacks total participant counts, exact point estimates, confidence intervals, and heterogeneity statistics. Grouping disparate surgical techniques and medication classes across varying study durations introduces clinical heterogeneity, and secondary outcomes such as visual field progression and quality of life lack quantitative reporting in the abstract.
Cited by
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