A Meta-analysis of Topical Prostaglandin Analogs in the Treatment of Chronic Angle-closure Glaucoma

Objective: To evaluate the intraocular pressure (IOP)-lowering efficacy of prostaglandin analogs topical medications in patients with chronic angle-closure glaucoma (CACG). Methods: Pertinent publications were identified through systematic searches of PubMed, EM BASE, KoreaMed. Chinese Biomedicine Database, and the Cochrane-Controlled Trials Register. Randomized clinical trials involving CACG patients treated with latanoprost, bimatoprost, or travoprost monotherapy were selected. Methodologic quality was assessed by a Delphi list with additions and scored out of a maximum of 18. The outcome measures were absolute and relative reduction in IOP from baseline, for diurnal Curve, peak, and trough. The pooled effects were calculated using 2-step DerSimonian and Laird estimate method of the random effects model. Results: Nine randomized clinical trials enrolling a total of 1,090 patients were included in the meta-analysis. Quality scores of included studies were generally high, a mean of 14.9 (range, 12-18). The difference in absolute IOP reduction between prostaglandin analogs and timolol varied from 0.4 to 1.6 mm Hg at diurnal curve, 0.9 to 2.3 mm Hg at peak, and 1.3 to 2.4 mm Hg at trough. Relative IOP reduction were diurnal curve, 31% (95% confidence interval, 27% to 34%), peak, 34% (31% to 37%), and trough 31% (28% to 35%) for latanoprost; diurnal curve, 26% (21% to 30%) peak, 28% (24% to 32%), and trough 27% (23% to 30%) for bimatoprost; diurnal curve, 28% (20% to 36%), peak, 32% (31% to 34%), and trough 31% (29% to 33%) for travoprost: and diurnal curve, 23% (19% to 27%), peak, 24% (20% to 29%), and trough 21% (19% to 24%) for timolol. Conclusions: Latanoprost, travoprost, and bimatoprost provide significant IOP-lowering efficacy in eyes with CACG; and the 3 prostaglandin analogs are associated with at least as effective as timolol.