Summary of findings 2. Brimonidine compared with apraclonidine for preventing temporarily increased IOP after laser trabeculoplasty.
| Brimonidine compared with apraclonidine for preventing temporarily increased IOP after LTP | ||||||
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Participant or population: people with glaucoma receiving LTP Intervention: brimonidine Comparison: apraclonidine | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Apraclonidine | Brimonidine | |||||
|
IOP increase of ≥ 5 mmHg within 2 hours |
29 per 1000 | 67 per 1000 (9 to 471) | RR 2.28 (0.32 to 16.03) | 71 (2 RCTs) | ⊕⊝⊝⊝1,2,3 Very low | 1 other study reported this outcome but found that no participants in either study group had an IOP increase of ≥ 5 mmHg. This study was not included in the meta‐analysis. |
|
IOP increase of ≥ 10 mmHg within 2 hours |
See comment | ‐ | ‐ | ‐ | 1 study reported that no participants given either medication had an IOP increase of ≥ 10 mmHg. Another study reported that only 1 eye that had received apraclonidine had an IOP spike > 10 mmHg, but this was not statistically significant given the size of the study (RR 0.33, 95% CI 0.02 to 7.32). | |
|
Mean change in IOP from pre‐LTP within 2 hours |
The mean change in IOP ranged across control groups from‐4.29 to ‐5.00 mmHg | The mean change in IOP in the intervention groups was 0.69 mmHg lower (2.56 lower to 1.17 higher) | ‐ | 71 (2 RCTs) | ⊕⊕⊕⊝3 Moderate | ‐ |
|
IOP increase of ≥ 5 mmHg between 2 and 24 hours |
This outcome was not reported for this comparison. | |||||
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IOP increase of ≥ 10 mmHg between 2 and 24 hours |
This outcome was not reported for this comparison. | |||||
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Mean change in IOP from pre‐LTP between 2 and 24 hours |
See comment | ‐ | ‐ | ‐ | 1 study reported that participants randomized to receive brimonidine had a mean (± SD) IOP reduction of 2.6 ± 3.6 mmHg, while participants randomized to receive apraclonidine had a mean IOP reduction of 2.3 ± 3.7 mmHg (MD ‐0.30 mmHg, 95% CI ‐2.41 to 1.81). | |
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Adverse events ‐ during study period |
This outcome was not reported for this comparison. | |||||
| *The basis for the assumed risk is the control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; IOP: intraocular pressure; LTP: laser trabeculoplasty; MD: mean difference; RCT: randomized controlled trial; RR: risk ratio; SD: standard deviation. | ||||||
| GRADE Working Group grades of evidence High‐certainty: Further research is very unlikely to change our confidence in the estimate of effect. Moderate‐certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low‐certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low‐certainty: We are very uncertain about the estimate. | ||||||
1 The certainty of the evidence was downgraded two levels due to imprecision: our effect measurement had a very wide confidence interval.
2 The certainty of the evidence was downgraded due to inconsistency: the RRs of the individual trials were very different.
3 The certainty of the evidence was downgraded due to concerns of risk of bias: masking of participants and personnel was unclear, and in one study, both eyes of the participants were included in the study and received different medications but the authors did not report if and how they took into account the interdependability of eyes.