Progression of primary angle closure suspects: a systematic review and meta-analysis.

Abstract

This systematic review and meta-analysis examined the proportion of primary angle closure suspects (PACS) progressing to primary angle closure (PAC), acute angle closure (AAC), and primary angle closure glaucoma (PACG) and evaluated the impact of prophylactic laser peripheral iridotomy (LPI) on disease progression. A systematic search was performed on MEDLINE and EMBASE for studies published until November 2023 that reported on the proportion of PACS progressing to PAC. Using random-effects modelling, risk ratios and 95% confidence intervals estimated the proportion of progressing PACS between patients who received LPI versus those who did not. Two randomized-controlled-trials and three observational studies included a total of 1997 PACS patients. The weighted average age was 57.2 years with 74.7% females, and an average follow-up period of 6.2 years. Overall, 284 (14.2%) PACS patients progressed to either PAC (n = 258, 12.9%), AAC (n = 9, 0.5%), or PACG (n = 17, 0.9%). Patients receiving LPI displayed a 2.49-fold decrease in the risk of progression to PAC (RR: 2.49; 95% CI = 1.50-4.07; p < 0.001; NNT = 15), suggesting that there is a higher risk of disease progression without LPI. However, for the progressions to AAC and PACG, statistical significance was not reached. The present study provides valuable insights to the proportion of PACS who showed disease progression and underscores the potential benefit of prophylactic LPI in reducing the risk of angle closure disease progression. However, this study also addresses the issues surrounding the lack of demonstrated clinical efficacy for this intervention, thus advocating for a balanced approach in clinical decision-making.