Randomized Clinical Trials on Medical Treatment of Glaucoma

Rossetti, Luca

doi:10.1001/archopht.1993.01090010100034

Cited by 81 publications

(21 citation statements)

References 108 publications

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“…Previous studies and reviews summarized that industrial funding may have influence on conclusions of clinical trials, and ophthalmologists should carefully determine if results from other clinical trials could guide their clinical practice (Rossetti et al. 1993; Alasbali et al. 2009).…”

Section: Limitationsmentioning

confidence: 99%

Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Huang

Zhang

2017

Acta Ophthalmologica

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PurposeTo assess the efficacy and safety of different regimens, including monotherapy and double therapy, for primary open‐angle glaucoma (POAG) or ocular hypertension.MethodsWe searched PubMed, EMBASE and clinicaltrials.gov for studies that fit our inclusion criteria in this network meta‐analysis. Randomized controlled trials that report data on efficacy and safety of medications for POAG or ocular hypertension are included. Data on intra‐ocular pressure (IOP) lowering effect and incidence of adverse events including hyperaemia and ocular discomfort were extracted and used in mixed‐comparison analysis.ResultsThis study includes 72 randomized trials. Data were available on 12 medical treatments of POAG or ocular hypertension. Of 66 possible comparisons of outcome efficacy, 15 treatments were compared directly. Compared to prostaglandin analogues (PGA), beta‐blockers (BB) showed relatively weaker ability to lower IOP, followed by α2‐adrenergic agonists (AA) and carbonic anhydrase inhibitors (CAI). For dual therapy, regimens composed of a combination of PGA with another treatment demonstrated more powerful IOP lowering efficacy, while the combination of two non‐PGA drugs had lower efficacy in controlling IOP than PGA alone. There was no statistical significance in combinations that did not include PGA on efficacy of IOP control. In terms of tolerance, PGA alone leads to more severe hyperaemia than any other monotherapy regimen, while BBs have the lowest effect on the incidence of hyperaemia. Most dual therapy regimens containing PGA also lead to serious hyperaemia, with the exception of PGA + AA. Compared to regimens containing PGA, those with BB are less likely to cause hyperaemia.ConclusionOur network meta‐analysis showed that PGAs provide best IOP lowering effect among all the monotherapy regimen. Combination of PGA and other category of drugs leads to better IOP decrease. Combination of BB and another non‐PGA drug may have less ocular side‐effects than PGA alone.

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Section: Limitationsmentioning

confidence: 99%

Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Huang

Zhang

2017

Acta Ophthalmologica

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“…[4849] Besides, glaucomatous changes have been observed in individuals with normal IOP. This suggests a critical role of other factors in the initiation and progression of glaucomatous changes.…”

Section: Multifactorial Pathogenesis Of Glaucomamentioning

confidence: 99%

Current concepts in the pathophysiology of glaucoma

Agarwal

Gupta

Agarwal

et al. 2009

Indian J Ophthalmol

183

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Glaucoma, the second leading cause of blindness, is characterized by changes in the optic disc and visual field defects. The elevated intraocular pressure was considered the prime factor responsible for the glaucomatous optic neuropathy involving death of retinal ganglion cells and their axons. Extensive investigations into the pathophysiology of glaucoma now reveal the role of multiple factors in the development of retinal ganglion cell death. A better understanding of the pathophysiological mechanisms involved in the onset and progression of glaucomatous optic neuropathy is crucial in the development of better therapeutic options. This review is an effort to summarize the current concepts in the pathophysiology of glaucoma so that newer therapeutic targets can be recognized.The literature available in the National Medical Library and online Pubmed search engine was used for literature review.

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“…However, the more frequent examinations (every second month) in our study would partly compensate for that. The follow-up is also acceptable compared with most other glaucoma studies on medical treatment, less than 10% exceeding 1 year (Rossetti et al 1993).…”

Section: Discussionmentioning

confidence: 89%

Primary argon laser trabeculoplasty vs pilocarpine II: Long‐term effects on intraocular pressure and facility of outflow

Bergeå

Bodin

Svedbergh

1994

Acta Ophthalmologica

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In a prospective study 82 patients recently diagnosed with simple or capsular glaucoma were randomized to receive primary argon laser trabeculoplasty or pilocarpine treatment. A 2-year follow-up showed a better success rate in the laser group, with less need for additional therapy. The average intraocular pressure and peak pressure was lower and the daytime pressure variation was significantly less in the laser group. The better increase in facility of outflow in the laser group was not statistically significant. In capsular glaucoma, laser treatment resulted in a significantly lower average pressure than with medication. In simple glaucoma the effect was about the same in the two treatment groups. Increase in facility of outflow was significantly better in simple glaucoma than in capsular glaucoma. High initial intraocular pressure gave a significantly lower success rate. Primary argon laser trabeculoplasty as a single glaucoma treatment seems advantageous in comparison to medication with pilocarpine for regulating intraocular pressure.

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Randomized Clinical Trials on Medical Treatment of Glaucoma

Cited by 81 publications

References 108 publications

Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Efficacy and safety of different regimens for primary open‐angle glaucoma or ocular hypertension: a systematic review and network meta‐analysis

Current concepts in the pathophysiology of glaucoma

Primary argon laser trabeculoplasty vs pilocarpine II: Long‐term effects on intraocular pressure and facility of outflow

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