Efficacy and tolerability of nonpenetrating filtering surgery with and without implant in treatment of open angle glaucoma: a quantitative evaluation of the evidence.

OBJECTIVE

To evaluate the efficacy and tolerability of nonpenetrating filtering surgery augmented with implant (NPFSI) compared with nonpenetrating filtering surgery without implant (NPFS) in the treatment of patients with open angle glaucoma.

METHODS

Pertinent studies were selected through extensive searches of the Cochrane Library, PubMed, Embase, and American Association of Ophthalmology (AAO) and Association for Research in Vision and Ophthalmology (ARVO) meeting abstracts. Seven controlled clinical trials meeting the predefined criteria were systematically reviewed by meta-analysis. The main outcome measures were percentage intraocular pressure (IOP) reduction, complete success rates, and qualified success rates. The pooled estimates were carried out in RevMan version 4.2 software.

RESULTS

The weighted mean difference of the percentage IOP reduction from baseline were 6.7% (95% confidence intervals: -3.8 to 17.2) when comparing NPFSI with NPFS. NPFSI was associated with numerically greater, but nonsignificant, IOP lowering efficacy than NPFS. The pooled risk differences comparing NPFSI with NPFS were 0.13 (-0.02 to 0.28) in complete success rate and 0.09 (-0.04 to 0.21) in qualified success rate. Numerically greater, but nonsignificant, proportions of NPFSI patients than NPFS patients achieved the target end point IOP. NPFSI resulted in the same incidences of postoperative complications as NPFS.

CONCLUSIONS

NPFSI was associated with equivalent efficacy to standard NPFS in lowering IOP. Comparable proportions of patients reached the IOP target with NPFSI and NPFS. Both surgeries were well tolerated.