Summary of findings 1. Anti‐VEGF versus no anti‐VEGF for neovascular glaucoma.
| Anti‐VEGF medication compared with no anti‐VEGF medication for neovascular glaucoma | ||||||
| Patient or population: people with neovascular glaucoma Setting: ophthalmology hospital or clinic Intervention: intravitreal anti‐VEGF medication injection Comparison: no anti‐VEGF medication | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no anti‐VEGF | Risk with anti‐VEGF | |||||
| Proportion of participants with IOP ≤ 21 mmHg, with or without ocular hypotensive medications, 4 to 6 weeks follow‐up |
723 per 1000 | 954 per 1000 (795 to 1150) | RR 1.32 (95% CI 1.10 to 1.59) | 93 (1) | ⊕⊕⊝⊝ Lowa,b | None |
| Mean IOP, 4 to 6 weeks follow‐up | The mean IOP in the no anti‐VEGF group was 24.2 mm Hg, ranged from 23.6 to 24.8 mm Hg |
The mean IOP in the anti‐VEGF group was 17.8 mm Hg, ranged from 14.1 to 21.6 mm Hg |
MD ‐6.37 (95% CI ‐10.09 to ‐2.65) | 173 (3) | ⊕⊝⊝⊝ Very lowa,b,c | None |
| Proportion of participants with improvement in visual acuity of 2 ETDRS lines or 0.2 logMAR units, 4 to 6 weeks follow‐up | 298 per 1000 | 760 per 1000 (477 to 1216) | RR 2.55 (95% CI 1.60 to 4.08) | 93 (1) | ⊕⊝⊝⊝ Very lowa,b,d | The trial did not clearly specify a definition of the improvement in visual acuity |
| Proportion of participants with complete regression of new iris vessels, 4 to 6 weeks follow‐up |
298 per 1000 | 784 per 1000 (492 to 1246) | RR 2.63 (95% CI 1.65 to 4.18) | 93 (1) | ⊕⊕⊝⊝ Lowa,b | None |
| Proportion of participants with relief of pain and resolution of redness, 1 year follow‐up |
Included studies did not report data for this outcome |
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| Proportion of participants with adverse events at various follow‐up times |
Hypotony (IOP ≤ 6 mmHg) | |||||
| 15 per 100 |
10 per 100 (2 to 54) | RR 0.67 (95% CI 0.12 to 3.57) | 40 (1) | ⊕⊕⊝⊝ Lowa,b | The follow‐up period was 18 months. | |
| Tractional retinal detachment | ||||||
| 5 per 100 | 2 per 100 (0 to 39) | RR 0.33 (95% CI 0.01 to 7.72) | 40 (1) | ⊕⊕⊝⊝ Lowa,b | The follow‐up period was 24 months. | |
| Serious adverse events (e.g. systemic thrombosis, stroke, and coronary thrombosis) | ||||||
| Included studies did not report data for this outcome | Inatani 2021 reported an occurrence of serious ocular treatment‐emergent adverse events in both groups during the non‐randomized period, where participants could receive both sham injection and aflibercept injection if the re‐treatment criteria were met. | |||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). Anti‐VEGF: anti‐vascular endothelial growth factor; CI: confidence interval; IOP: intraocular pressure; MD: mean difference; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
aDowngraded (‐1) due to limitations in the design bDowngraded (‐1) due to imprecision of results
cDowngraded (‐1) due to inconsistency dDowngraded (‐1) due to indirectness of evidence