Accepted for/Published in: JMIR Research Protocols
Date Submitted: Dec 2, 2024
Date Accepted: Sep 12, 2025
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The efficacy and safety of canaloplasty for the management of primary open angle glaucoma: A systematic review protocol
ABSTRACT
Background:
Glaucoma forms the leading cause of irreversible blindness worldwide, with a disproportionately rising prevalence in Asian and African countries. Primary open angle glaucoma (POAG) accounts for the majority of cases. Medical therapies of POAG are not without side effects, meanwhile surgical treatments carry high complication rates. Ab-interno canaloplasty promises a safer, minimally invasive yet effective treatment option for mild-to-moderate POAG, as well as a cost-effective technique for low-resource countries. Despite this, no systematic review currently exists to verify this procedure's efficacy.
Objective:
To develop a protocol for a systematic review aimed at evaluating the efficacy canaloplasty against all other forms of POAG treatment.
Methods:
This systematic review and meta-analysis will include randomised controlled trials (RCTs) evaluating the short-term, medium-term and long-term efficacy and safety of ab-interno canaloplasty in treating POAG in comparison to all other treatments with the primary outcome measure of mean change in intraocular pressure (IOP). Secondary outcome measures include proportion of participants medication free after treatment and mean change in health-related quality of life. MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov databases will be searched for relevant RCTs. All studies will be subject to pre-specified inclusion and exclusion criteria. Quality of eligible RCTs will be assessed using the Cochrane risk of bias tool. Data will be extracted with a focus on raw data where possible and analysis will be performed using Revman 5.4 software to compare the mean changes in IOP (mmHg) between ab-interno canaloplasty and other comparator therapies. A funnel plot will be used to assess risk of publication bias if 10 or more trials are included in the review. I2 statistics will be used to assess heterogeneity. Sensitivity analysis will be conducted to exclude studies with high-risk of bias and, where possible, on the primary outcome. The GRADE approach will be used to summarise the main findings.
Results:
The results of this systematic review are not yet available as it is still at the protocol stage. This protocol was registered on the PROSPERO database for systematic reviews (CRD42024558671) on the 27th of June 2024. Data collection for this review began on the 14th of July 2024 with the anticipated completion date being within the following year.
Conclusions:
The findings of this systematic review will be important to patients, clinicians and policymakers worldwide in addressing the growing burden and health inequality of glaucoma. Clinical Trial: Trial registration: PROSPERO CRD42024558671
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