非穿透性小梁手术联合植入物治疗开角型青光眼的Meta分析

Meta-analysis of nonpenetrating trabecular surgery combined with implant in treatment of open angle glaucoma

目的:系统评价非穿透性小梁手术联合植入物(NPTSI)治疗开角型青光眼的有效性。方法:通过计算机和手工检索,获得以往发表的相关文献,16项对照临床试验符合选择标准而纳入Meta分析。临床评价指标包括眼压降低百分率(IOPR%)、治疗完全成功率和治疗总成功率。应用RevMan4.2分析软件进行统计,选择随机效应模型计算总的治疗效应。结果:与非穿透性小梁手术(NPFS)相比较,NPTSI的IO-PR%加权平均差为3.3(-5.3~12.0),治疗完全成功率的合并危险差为0.13(-0.02~0.28),治疗总成功率的合并危险差为0.09(-0.04~0.21)。与小梁切除术(TE)相比较,NPTSI的IOPR%加权平均差为-4.4(-7.7^-1.1),治疗完全成功率的合并危险差为-0.04(-0.17~0.09),治疗总成功率的合并危险差为0.00(-0.06~0.06)。NPTSI的并发症发生率与NPTS相似,而远较TE为低。结论:NPTSI作为一种安全的滤过性手术,具有略优于标准NPTS的降眼压效果,是治疗开角型青光眼的可行性选择。

AIM：To evaluate the efficacy of nonpenetrating trabecular surgery combined with implant（NPTSI）in the treatment of open angle glaucoma.METHODS：Published articles were selected for study based on a computerized search of the literature and a manual search of the bibliographies of relevant articles.Sixteen controlled clinical trials meeting the pre-defined criteria were systematically reviewed by meta-analysis.The main outcome measures were percentage of intraocular pressure reduction（IOPR%）and risk difference in complete and total success rates for efficacy.The pooled estimates were carried out by RevMan version 4.2 software according to a random effect model.RESULTS：Comparing NPTSI with nonpenetrating trabecular surgery（NPTS）,the weighted mean difference of IOPR% was 3.3（-5.3 to 12.0）,the pooled risk difference of complete success rate was 0.13（-0.02 to 0.28）,and the pooled risk difference of total success rate was 0.09（-0.04 to 0.21）.Compared with trabeculectomy（TE）,the weighted mean difference of IOPR% of NPTSI was-4.4（-7.7 to-1.1）,the pooled risk difference of complete success rate was-0.04（-0.17 to 0.09）,and the pooled risk difference of total success rate was 0.00（-0.06 to 0.06）.NPTSI caused significantly less postoperative complications than TE,and resulted in the same incidence as NPTS.CONCLUSION：NPTS combined with implant,as a safe IOP-lowering procedure,is a little more effective in intraocular pressure control than standard NPTS,and it may be an alternative filtering procedure in treating open angle glaucoma.