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Clinical implication of recent randomized control trial in primary angle-closure disease management
Shefali R Parikh1, Rajul S Parikh1
1Shreeji Eye Clinic and Palak's Glaucoma Care Centre, Mumbai, Maharashtra, India.
Indian Journal of Ophthalmology
|August 3, 2022
Summary
Early intervention for primary angle-closure glaucoma (PACG) prevents blindness. This review examines recent randomized controlled trials comparing treatments like clear lens extraction (CLE) and laser peripheral iridotomy (LPI) for primary angle-closure disease (PACD).
Area of Science:
- Ophthalmology
- Glaucoma Research
- Clinical Practice Guidelines
Background:
- Primary angle-closure glaucoma (PACG) is a leading cause of preventable blindness.
- Early intervention is crucial to halt the angle-closure process.
- Treatments like laser peripheral iridotomy (LPI) and clear lens extraction (CLE) are used for primary angle-closure (PAC), PACG, and primary angle-closure suspect (PACS).
Purpose of the Study:
- To systematically review recent randomized controlled trials (RCTs) on the management of primary angle-closure disease (PACD).
- To discuss the clinical implications of these RCTs for daily practice.
- To address the ongoing debate regarding first-line treatments for PACD, particularly the role of LPI versus CLE.
Main Methods:
- A systematic review of RCTs published between January 2005 and December 2021.
- Searches were conducted in major databases: PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov.
- Keywords included various terms for angle-closure disease, surgical/laser interventions, and study designs (RCTs, meta-analyses).
Main Results:
- The review focuses on recently published RCTs within the specified 16-year period.
- Findings from these RCTs inform the comparative effectiveness of different PACD management strategies.
- The EAGLE study's findings on CLE versus LPI are a key point of discussion.
Conclusions:
- Recent RCTs provide robust evidence for managing PACD.
- Clinical practice guidelines can be informed by high-quality evidence from systematic reviews of RCTs.
- The optimal first-line treatment for PACD continues to be refined based on emerging research.
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