Elsevier

Ophthalmology

Volume 116, Issue 7, July 2009, Pages 1243-1249
Ophthalmology

Original article
Meta-analysis of Medical Intervention for Normal Tension Glaucoma

https://doi.org/10.1016/j.ophtha.2009.01.036Get rights and content

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.

Section snippets

Materials and Methods

This meta-analysis was performed according to a predetermined protocol describing complete and detailed methods, which followed a previous publication.8

Results

The selection flow of studies is summarized in Figure 1. The literature search identified 420 articles; including 35 randomized clinical trials that evaluate medical intervention in the treatment of NTG. Twenty randomized clinical trials were excluded for reasons that included 9 duplicate publications, 1 meeting abstract, 1 treated with latanoprost 0.006% twice daily, 4 without measure outcomes, and 5 with follow-up more than 3 months. Thus, 15 randomized clinical trials that met our inclusion

Discussion

This meta-analysis confirmed that latanoprost, bimatoprost, timolol, and brimonidine significantly reduced IOP in patients with NTG. The highest reduction in IOP at peak was achieved by brimonidine (24%), followed by bimatoprost, latanoprost, timolol, dorzolamide, brinzolamide, and betaxolol (12%). At trough, the order is latanoprost (20%), bimatoprost, timolol, dorzolamide, and brimonidine (11%). The order at diurnal curve is latanoprost (20%), bimatoprost, timolol, and brimonidine (16%).

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    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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