The efficacy and safety of reducing intraocular pressure to single-digit levels in Normal-tension glaucoma: A systematic review and meta-analysis

IF 3 3区医学 Q1 OPHTHALMOLOGY

Acta Ophthalmologica Pub Date : 2026-10-09 Epub Date: 2026-03-20 DOI:10.1111/aos.70110

Beatriz Araújo-Azevedo, Renato Ferreira-da-Silva, João Barbosa-Breda

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引用次数: 0

Abstract

Purpose

This systematic review and meta-analysis aim to evaluate the efficacy and safety of further lowering intraocular pressure (IOP) to single-digit levels in treated patients with progressive normal-tension glaucoma (NTG).

Methods

A literature search was conducted in MEDLINE (via PubMed), Scopus and Web of Science. We selected studies that reported quantitative visual field (VF) data on the efficacy of the interventions. Study outcomes include VF progression rates, changes in IOP and IOP-lowering medication use. Meta-analysis was conducted for VF mean deviation (MD) slope (db/year) using R, with paired mean differences and 95% confidence intervals (CI) calculated.

Results

Nine observational studies, including 270 eyes, were analysed. Trabeculectomy was performed across all studies. One study compared trabeculectomy with prostaglandin analogues. On average, IOP decreased from 14.77 ± 0.95 mmHg preoperatively to 9.82 ± 1.55 mmHg postoperatively, reflecting a mean reduction of 33.65 ± 10.37%. This reduction slowed glaucoma progression, as indicated by a change in the mean VF MD slope from −0.91 ± 0.27 dB/year preoperatively to −0.25 ± 0.16 dB/year postoperatively. Meta-analysis showed a significant change in VF MD slope following trabeculectomy, with a pooled mean difference of 0.59 dB/year (95% CI: 0.38 to 0.80; p < 0.0001). Single-digit IOP levels were shown to be both achievable and sustainable. The most common postoperative complications included hypotony-related complications and hyphema.

Conclusions

Achieving single-digit IOP levels is associated with a significant reduction in visual field progression rates. However, the balance between efficacy and safety must be considered, as aggressive IOP reduction is also associated with a higher risk of hypotony-related complications. Postoperative hypotony was relatively frequent but generally transient and did not appear to have a significant impact on long-term visual acuity. Copyright © 2026 Acta Ophthalmologica Scandinavica Foundation.

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将眼压降至个位数水平治疗正常眼压型青光眼的有效性和安全性：一项系统综述和荟萃分析。

目的：本系统综述和荟萃分析旨在评价进一步降低眼压（IOP）至个位数水平治疗进行性正常眼压青光眼（NTG）患者的有效性和安全性。方法：在MEDLINE（通过PubMed）、Scopus和Web of Science进行文献检索。我们选择的研究报告了干预措施有效性的定量视野（VF）数据。研究结果包括VF进展率、IOP变化和降低IOP的药物使用。使用R对VF平均偏差（MD）斜率（db/year）进行meta分析，计算成对平均差和95%置信区间（CI）。结果：分析了9项观察性研究，包括270只眼睛。所有研究均行小梁切除术。一项研究比较了小梁切除术和前列腺素类似物。平均眼压由术前14.77±0.95 mmHg下降至术后9.82±1.55 mmHg，平均下降33.65±10.37%。这种减少减缓了青光眼的进展，正如平均VF MD斜率从术前的-0.91±0.27 dB/年变化到术后的-0.25±0.16 dB/年所示。荟萃分析显示，小梁切除术后VF MD斜率有显著变化，合并平均差异为0.59 dB/年（95% CI: 0.38 - 0.80; p）。结论：达到个位数IOP水平与视野进展率显著降低相关。然而，必须考虑到有效性和安全性之间的平衡，因为积极的IOP降低也与低斜视相关并发症的高风险相关。术后低斜视相对频繁，但通常是短暂的，似乎对长期视力没有显著影响。版权所有©2026斯堪的纳维亚眼科学报基金会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Ophthalmologica 医学-眼科学

CiteScore

7.60

自引率

5.90%

发文量

433

审稿时长

6 months

期刊介绍： Acta Ophthalmologica is published on behalf of the Acta Ophthalmologica Scandinavica Foundation and is the official scientific publication of the following societies: The Danish Ophthalmological Society, The Finnish Ophthalmological Society, The Icelandic Ophthalmological Society, The Norwegian Ophthalmological Society and The Swedish Ophthalmological Society, and also the European Association for Vision and Eye Research (EVER). Acta Ophthalmologica publishes clinical and experimental original articles, reviews, editorials, educational photo essays (Diagnosis and Therapy in Ophthalmology), case reports and case series, letters to the editor and doctoral theses.