非穿透性小梁切除术与传统小梁切除术治疗开角型青光眼的系统评价

Non-penetrating Trabecular Surgery versus Trabeculectomy for Open Aangle Glaucoma:A Systematic Review

目的系统评价非穿透性小梁切除术与传统小梁切除术治疗开角型青光眼的疗效。方法按Cochrane系统评价方法,计算机检索MEDLINE(1966～2008.5)、EMbase(1980～2008.5)、Cochrane图书馆(2007年2期)和中国生物医学文献数据库(1979～2008.5),并手工检索相关会议文献。文献语种限制为中英文。收集所有相关随机对照试验,采用RevMan5.0软件进行Meta分析。结果共纳入3篇随机对照试验,包括127例患者(144只患眼)。Meta分析结果显示:与非穿透性小梁切除术相比,传统小梁切除术能提高开角型青光眼术后眼压降低水平[WMD=2.78,95%CI(1.41,4.15)]和手术成功率[RR=0.53,95%CI(0.37,0.77)],能减少术后抗青光眼药用量[WMD=0.96,95%CI(0.84,1.08)]。非穿透性小梁切除术能降低术后并发症发生率[RR=17.00,95%CI(8.00,26.00)]。结论与非穿透性小梁切除术相比,传统小梁切除术能提高眼压降低水平和手术成功率,并减少术后抗青光眼药用量;而非穿透性小梁切除术能降低术后并发症发生率。但两种术式与视野缺损进展、视神经纤维层丢失、视盘损坏等指标的关系尚待进一步研究。因本系统评价纳入研究病例数较少,上述结论尚需更多设计严谨的大样本随机对照试验加以验证。

Objectives To assess the clinical effectiveness of non-penetrating trabecular surgery versus trabeculectomy for open angle glaucoma. Methods We searched the Cochrane Central Register of Controlled Trials （issue 2, 2007）, MEDLINE （1966 to May 2008）, EMbase （1980 to May 2008）, and CMB-disk （1979 to May 2008）. We also hand searched relevant journals and conference proceedings. Data were extracted by two reviewers independently using an extraction form. The Cochrane Collaboration＇s RevMan 5.0 software was used for statistical analysis. Results Three RCTs involving 127 participants （144 eyes） with previously untreated open angle glaucoma were included. Meta-analysis showed that compared with non-penetrating trabecular surgery, trabeculectomy increased the proportion of patients with reduced postoperative intraocular pressure （WMD2.78, 95%CI 1.41 to 4.15）, improved the operation success rate （RR 0.53, 95%CI 0.37 to 0.77）, and reduced the use of postoperative antiglaucoma medication （WMD 0.96, 95%CI 0.84 to 1.08）. Non-penetrating trabecular surgery reduced the incidence of postoperative complications （RR 17.00, 95%CI 8.36 to 26.00）. Conclusion Since the sample sizes of the included trials are relatively small, and the two procedures are also related to progressive visual field loss and optic disk damage, more well-designed large-scale RCTs are required.