急性闭角型青光眼治疗方法的循证评价

An evidence-based appraisal of interventions for acute angle closure glaucoma

目的从循证医学的角度对有关急性闭角型青光眼发作眼和对侧眼的治疗方法进行文献回顾和证据评价，并对今后的研究工作提出建议。方法系统综述，检索MEDLINE、EMBASE、Cochrane组织（1966年至2006年12月）所有相关英文文献以及中国期刊全文数据库收录的中文核心刊物发表的相关文献（1979年至2006年12月），纳入文献包括随机对照临床研究（RCT）、非随机对照研究、前瞻性病例分析和病例数大于50例的回顾性病例分析，并对相关综述和入选文献的参考文献进行手工检索。人选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和评价。结果共23篇英文文献和5篇中文文献入选。英文、中文文献中分别有5项和3项RCT，其余证据来自非随机临床对照研究和病例分析，涉及的治疗方法包括药物、激光和手术三大类。结论目前已有较为有力证据的治疗方法：急性发作时即刻行激光周边虹膜成形术较传统的药物治疗方案降眼压作用起效快；急性发作缓解后行激光周边虹膜切开术（LPI）以及对侧眼的预防性LPI，具有解除瞳孑L阻滞、控制眼压和预防急性发作再发或新发的效果；LPI和周边虹膜切除手术（SPI）治疗效果相当。白内障摘除术等治疗方法缺乏足够的高级别研究证据和远期随访结果证明其效果和安全性。

Objective To give an evidence-based appraisal to the interventions to treat acute angle closure glaucoma （AACG） in the affected or contralateral eye, and provide some suggestions to further clinical research. Methods Systematic review. Studies published in the English language were identified （ 1966 to December 2006） from MEDLINE,PubMed,EMBASE,and the Cochrane Collaborations,as well as studies published in the Chinese language from core journals of Chinese Periodical Fulltext Database （1979 to December 2006）. Randomized clinical trials （RCTs）,prospective controlled clinical trials,prospective noncontrolled clinical trials, and retrospective case series with 〉 50 cases that evaluated treatments for AACG were included. The reference of existing reviews and included articles were hand-searched. The evidence qualities were classified based on the levels of interventional evidence. Results Twenty-three articles in English and 5 articles in Chinese were eligible, including 8 randomized clinical trials （five in English, three in Chinese） ,and nonrandomized clinical trials and case series. The interventions include laser,surgical and medical therapies. Conclusions Laser peripheral iridoplasty as primary treatment to the acute attack of AACG showed a decrease of intraocular pressure （lOP） more rapidly than conventional medical treatment. Laser peripheral iridotomy （LPI） was an efficacious intervention to relieve pupillary block, control IOP, and prevent new attacks. LPI was found to be as effective as surgical peripheral iridectomy （SPI） in the lOP control of affected or contralateral eyes of AACG. There is still insufficient evidence and long-term follow-up reports about other interventions for the treatment of AACG.