| Apraclonidine compared with pilocarpine for temporarily increased IOP after LTP | ||||||
|---|---|---|---|---|---|---|
| Participant or population: people with glaucom a receiving LTP Intervention: apraclonidine Comparison: pilocarpine | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Pilocarpine | Apraclonidine | |||||
| IOP increase of ≥ 5 mmHg within 2 hours | See comment | - | - | - | 1 study reported that 8. 8% of the apraclonidine group had an increase of ≥5 mmHg vs 4.4%of the pilocarpine group. These were not statistically different (RR 2.00, 95% CI 0.71 to 5.67) | |
| IOP increase of ≥ 10 mmHg within 2 hours | This outcome was not reported for this comparison. | |||||
| Mean change in IOP from pre-LTP within 2 hours | The mean change in IOP was only reported in 1 study: −3.6 mmHg. The second study reported only the mean IOP at a time point rather than the mean change | The mean change in IOP in the intervention groups was 0.61 mmHg higher (0.44 lower to 1. 66 higher) | - | 277 (2 RCTs) | ⊕⊕⊕○1 Moderate |
- |
| IOP increase of ≥ 5 mmHg between 2 and 24 hours | See comment. | ⊕⊕○○1,2 Low |
2 studies reported on this outcome and 1 favored apraclonidine while the other favored pilocarpine. Due to significant statistical heterogeneity (I2 = 91%), we did not perform a meta-analysis. | |||
| IOP increase of ≥ 10 mmHg between 2 and 24 hours | 13 per 1000 | 12 per 1000 (2 to 75) | RR 0.87 (0.14 to 5.63) | 390 (2 RCTs) | ⊕⊕○○2,3 Low |
1 additional study reported on this outcome but found that no participants in either study group had an IOP increase of ≥ 10 mmHg. This study was not included in the meta-analysis |
| Mean change in IOP from pre-LTP between 2 and 24 hours | See comment. | - | 277 (2 RCTs) | ⊕⊕○○1,2 Low |
2 studies reported on this outcome and 1 favored apraclonidine while the other favored pilocarpine. Due to significant statistical heterogeneity (I2 = 92%), we did not perform a meta-analysis. | |
| 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; RCT: randomized controlled trial; RR: risk ratio.
| 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. |
The certainty of the evidence was downgraded due to concerns of plausible bias: one study included in the analyses had issues with masking of their participants due to the nature of the study design, and additionally the authors were employees of the company that manufactured the study drug.
The certainty of the evidence was downgraded due to inconsistency: in each outcome analysis, one study favored pilocarpine while the other favored apraclonidine.
The certainty of the evidence was downgraded due to imprecision: our effect measurement had a very wide confidence interval.