Incidence and Association of Angle-Closure Glaucoma in Retinitis Pigmentosa: A Meta-Analysis.

Abstract

Precis: Low certainty evidence suggests elevated angle-closure glaucoma incidence (1.30% (95%CI [0.71-2.36]) with retinitis pigmentosa than without (risk ratio: 2.01, 95%CI [1.59-2.53]). RP patients may benefit from enhanced monitoring for glaucomatous complications.

Purpose: To determine the literature-pooled rate and association of angle-closure glaucoma (ACG) with retinitis pigmentosa (RP). ACG is a potentially sight-threatening cause of optic neuropathy. To-date, several reports have documented the potential association between ACG and RP.

Materials and methods: Cochrane library, Embase, and Medline were searched to August 2024. We included all studies that reported the incidence of ACG among patients with RP, or the comparative risk of ACG among patients with or without RP. Two independent reviewers completed study screening, data extraction and risk of bias assessment using the Cochrane risk of bias (ROB) in nonrandomized studies (exposure) tool. Non-pairwise and pairwise meta-analyses, using random effects and the Mantel-Haenszel method, were conducted to calculate the pooled rate of ACG in RP patients and to determine whether this risk differed significantly from patients without RP. Subgroup analysis excluded "high" ROB studies.

Results: Eight observational studies (n=31,501 patients; 456 events) were identified, three of which were of comparative design. Of this pooled population, there were 29,363 patients with RP (238 events). Across all studies, the pooled incidence of ACG with RP was 1.30% (95%CI [0.71-2.36], I2: 97%), though this heterogeneity resolved when sub-grouped by studies with low ROB (1.59%, 95%CI [1.31-0.192], I2: 0%). In the comparative analysis, patients with RP had a significantly higher risk of developing ACG (RR: 2.02 (95%CI [1.61-2.55], I2: 0%) compared to patients without RP. For either outcome, there was no significant evidence of publication bias, and the results remained consistent across subgroup and sensitivity analyses. Six of eight studies were rated as having "high" ROB due to a lack of adjusted analyses.

Conclusion: Low certainty evidence suggests that RP may confer an increased risk of ACG compared to patients without RP. The results of this study seem to support the view that more extensive clinical monitoring for ACG may be of benefit for patients with RP. Further studies controlling for individual patient-level confounding are needed.