晶状体摘除术治疗原发性闭角型青光眼合并白内障的循证评价

The systematic review of the cataract extraction for primary angle-closure glaucoma coexisting cataract

目的 将目前有关白内障摘除术治疗原发性闭角型青光眼的文献按照循证医学的要求进行系统评价,以期能为该种治疗方式的临床应用提供较为可靠的证据。设计 系统综述。方法 检索MEDLINE ,中国生物医学文献期刊数据库,至2 0 0 4年9月的英文及中文文献。依据纳入标准和排除标准筛选后剩余文献按照治疗性医学文献证据级别的判定标准进行证据分级,并按照终点指标进行证据评价。主要指标 眼压,前房角,降眼压药物种数,并发症。结果 2 4篇文献入选,Ⅰ～Ⅱ级证据的0篇,Ⅲ级证据的4篇,Ⅳ级证据的2 0篇。原发性闭角型青光眼白内障摘除/超声乳化白内障吸除联合人工晶状体植入术后眼压降低1 3～2 2 7mmHg ,降低幅度超过2 0mmHg的均为原发性急性闭角型青光眼(Ⅲ～Ⅳ级证据)。有对手术成功率报道的文章2篇(Ⅲ级证据)。3篇文献描述了术后房角增宽(Ⅳ级证据) ,5篇文献描述了术后PAS范围减少(Ⅲ～Ⅳ级证据)。9篇文献描述了术前和术后使用降眼压药物种数的变化情况,表明白内障摘除术后,抗青光眼药物的使用种数较术前减少(Ⅳ级证据)。9篇文献报告了术后早期眼压并发症,其中31 2 %出现了术后早期眼压升高(Ⅲ～Ⅳ级证据)。结论 病例系列研究表明晶状体摘除术对于急性闭角型青光眼合并白内障的降眼压幅度高于慢性闭角型青?

Objective To make a systematic review of cataract extraction for primary angle-closure glaucoma (PACG) coexisting cataract by the rule of evidence-based medicine,and to assess the safety and effect of this therapy for further clinic use.Design Systematic review.Methods A systematic review of all the relevant references was performed.The references were identified from Medline,Chinese Bio-medicine Database.According to the inclusion and exclusion criterion,the evidence qualities were classified by the grades of the evidence quality for the therapy articles,then we assessed the evidence by the final targets.Main Outcome Measures IOP,anterior chamber angle,anti-glaucoma medicines,complications.Results We assessed twenty-four articles,in which none was in grade Ⅰ～Ⅱ,4 were in grade Ⅲ,and 20 were in grade Ⅳ.The IOPs decrease by 1.3 ～22.7mmHg after the cataract extractionphacoemulsification for the patients with PACG.The patients with the IOPs decrease value more than 20mmHg were all those with APACG(grade Ⅲ～Ⅳ).There were two reporting surgical-success rate(grade Ⅲ～Ⅳ).In three papers the anterior chamber angle was described being wider than preoperation(grade Ⅳ),and in 5 papers the PAS was lessened postoperately(grade Ⅲ～Ⅳ).There were 5 papers in which anti-glaucoma medicines were described being reduced after that surgery(grade Ⅳ).Nine papers reported complication from IOP and 31.2% occurred the IOP peaks(grade Ⅲ～Ⅳ).Conclusion The case reports showed that IOPs dropped more in patients with APACG than with CPACG coexisting cataract after the cataract extraction and there were no serious IOP peaks in the early time after that surgery.There were no ample evidences to show that cataract extraction was safer and more effective than tradition therapeutic choices for PACG.