Nine RCTs (n=387) and 24 non-randomised clinical trials and case series (n=1,707) were included in the review.
AAC or AAC glaucoma.
One RCT compared laser peripheral iridotomy (LPI) with surgical peripheral iridectomy (SPI) and found no significant difference in visual acuity or IOP. One RCT compared four different types of laser treatment and found that IOP of less than 22 mmHg, with or without medication, ranged from 17 to 33% of patients treated with one of three lasers, while visual field loss progression ranged from 77.8 to 41.7% of patients treated with one of two lasers. One CCT also found no significant difference in visual acuity between LPI and SPI. Two retrospective case series found that 36.6 to 44% of patients with AAC or AAC glaucoma did not require long-term medication or additional surgery following treatment with peripheral iridectomy. One non-controlled study evaluated bilateral LPI and found that 63.4% of patients required additional long-term surgical treatment. One non-controlled study evaluated long- and short-burn LPI and found that IOP was controlled in 92.1% and 87.5% of the patients, respectively.
No study evaluated the efficacy of medical therapy. One RCT evaluated mode of delivery. No significant difference in percentage decrease in IOP was found between Ocusert Pilo-40 compared with either intensive pilocarpine or low-dose pilocarpine.
No RCT evaluated the effectiveness of non-filtering surgery or trabeculectomy for AAC or AAC glaucoma. One retrospective case series of 32 patients with AAC who did not respond to medical treatment and underwent trabeculectomy found that 56.2% had a successful long-term IOP without antiglaucoma treatment.
PAC or PAC glaucoma.
One RCT compared two types of LPI and found no difference in the mean IOP. One CCT compared LPI with SPI and found an overall reduction in IOP of 1.72 mmHg for both groups combined. One prospective non-controlled trial and one retrospective case series found that 51.3% and 81.9% of the patients, respectively, required further medication and 29.5% and 53% required surgery following treatment with LPI. One retrospective case series found that IOP was successfully controlled in 75.3% of the patients treated with LPI and 76.4% of those treated with SPI.
One RCT found that latanoprost was associated with a significant reduction in IOP compared with timolol in patients with PAC glaucoma. One RCT compared timolol with no treatment and found no significant difference in IOP, visual field loss or progression to PAC glaucoma.
No RCT evaluated the effectiveness of surgery for PAC or PAC glaucoma. One CCT found that trabeculectomy was associated with a greater overall success compared with goniosynechialysis in patients with PAC glaucoma. One case series found that combined phaco-goniosynechialysis treatment in patients with PAC glaucoma was associated with a 90% success rate in maintaining an IOP of less than 20 mmHg without medication, improved or unchanged visual acuity, and a reduction in peripheral anterior synechiae. One case series evaluated cataract extraction and found that IOP was controlled without medication in 40% of the patients.
Contralateral eye prophylaxis.
Two RCTs compared the effectiveness of prophylactic LPI with SPI in the contralateral eye of patients with AAC and found no significant difference in visual acuity or IOP. One case series found that 88.8% of patients with AAC had successful long-term control of IOP with no additional glaucoma treatment, and no new cases of AAC glaucoma were observed.
One RCT compared two types of LPI and found no significant difference in IOP. Five non-controlled trials and three retrospective case series evaluated different types of LPI. No conclusive evidence was presented.