Topical medical therapy and ocular perfusion pressure in open angle glaucoma: a systematic review and meta-analysis

Abstract

Objective: We compared the benefits and harms of topical interventions for ocular perfusion pressure in open angle glaucoma.

Methods: We searched the databases MEDLINE, EMBASE and CENTRAL for randomized controlled trials comparing topical hypotensive agents in glaucoma. Of the 9433 citations identified, 10 randomized controlled trials were included. We summarized data using random effects meta-analysis for post-treatment mean ocular perfusion pressure and using relative risk for adverse events.

Results: Ten trials (416 patients) were included. The quality of included trials was low to moderate. There was a higher post-treatment ocular perfusion pressure with bimatoprost compared to timolol (1 trial, 32 patients, mean difference – 4.00 mmHg, 95% confidence interval –7.01 to –0.99, p = .009); heterogeneity was not significant (I² = 41%, χ² = 13.55, p = .09). Prostaglandins as a class had higher post-treatment mean ocular perfusion pressure compared to alternative interventions (5 trials, 147 patients, mean difference 2.19 mmHg, 95% confidence interval 0.67–3.70, p = .005); heterogeneity in the subgroup analysis was not significant (I² = 10%, χ² = 4.47, p = .35). Adverse events were found to be significant in only one of the studies comparing latanoprost to brimonidine, relative risk 3.67 (standard error 0.59, p = .03).

Conclusions: We identified low to moderate quality evidence describing post-intervention mean ocular perfusion pressure in open angle glaucoma. Bimatoprost increases mean ocular perfusion pressure when compared to timolol. As a class, prostaglandins increase mean ocular perfusion pressure. Prostaglandins may provide beneficial ocular perfusion pressure profiles compared to alternative agents.

Keywords:

• Glaucoma
• ocular physiological phenomena
• systematic review
• ophthalmic solutions

Transparency

Declaration of funding

This paper was not funded.

Declaration of financial/other relationships

No potential conflict of interest was reported by the authors.

A peer reviewer of this manuscript declares receiving unrestricted research fund from Senju Pharmaceutical, a distributor of bimatoprost in Japan. Other CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors acknowledge Ruth Mitchell for assistance in developing the search strategies.