丝裂霉素C与氟尿嘧啶用于小梁切除术有效性与安全性比较的系统评价再评价

Overview of systematic reviews of mitomycin C versus 5-fluorouracil for trabeculectomy’s efficacy and safety

目的:基于系统评价的方法学和证据质量,对丝裂霉素C与氟尿嘧啶用于小梁切除术的有效性和安全性进行进一步评价。方法:检索PubMed、Embase、Cochrane library、中国学术期刊网络出版总库、万方数据库、中国生物医学文献数据库,搜集公开发表的丝裂霉素C与氟尿嘧啶用于小梁切除术的系统评价,时限均为建库至2018年12月。2名作者独立筛选并提取数据,采用A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2)工具评价各系统评价的方法学质量,采用GRADE工具评价纳入研究结局指标的证据质量。结果:本研究最终共纳入4篇系统评价与Meta分析。AMSTAR 2评价结果表明,1篇系统评价为高质量,其余3篇系统评价为中等质量;GRADE证据评级结果表明,1个结局指标的证据质量为中等,7个结局指标的证据质量为低或极低。与氟尿嘧啶相比,使用丝裂霉素C的患者术后眼压显著降低(术后眼压降低率WMD=7.09,95%CI:1.47~12.70;术后平均眼压MD=-2.17,95%CI:-3.26^-1.08;MD=-3.05,95%CI:-4.60^-1.50),术后抗青光眼药用量显著减少(MD=-0.71,95%CI:-1.34^-0.09),脉络膜病变发生风险显著降低(OR=0.25,95%CI:0.08~0.79;RR=0.23,95%CI:0.11~0.47),以及前房出血发生风险(RR=0.62,95%CI:0.42~0.91)显著降低;但在手术成功率、术后视力变化,以及伤口渗漏、滤过泡渗漏、眼内炎、低眼压等其他并发症发生风险方面,二者差异无统计学意义(P>0.05)。结论:系统评价再评价的结果表明,丝裂霉素C比氟尿嘧啶能够更有效地控制眼压,氟尿嘧啶可能会增加部分术后并发症发生风险。丝裂霉素C用于抑制青光眼术后瘢痕形成较氟尿嘧啶有更好的有效性与安全性。

Objective:This study was designed to compare the efficacy and safety of mitomycin C versus fluorouracil for trabeculectomy,on the basis of evaluating methodological quality and reliability of the evidences of systematic reviews(SRs).Methods:Databases including PubMed,Embase,Cochrane library,China National Knowledge Infrastructure(CNKI),Wanfang data,and Chinese Science and Technology Journal Database(CBM)were searched from inceptions to December 2018.Two reviewers independently screened literature,extracted data and assessed the methodological quality of included SRs by the A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2),and assessed the quality of evidence by the GRADE approach.Results:Totally,4 SRs and meta analyses were included.The assessment results of AMSTAR 2 tool showed that one SR was considered high quality,and another three SRs were considered moderate quality.GRADE results showed the quality of the evidence of 1 outcome was moderate,and 7 outcomes were low or very low.Compared with 5-fluorouracil,mitomycin C appeared to be with lower intraocular pressure(the rate of intraocular pressure reduction WMD=7.09,95%CI:1.47 ~12.70);mean intraocular pressure MD=-2.17,95%CI:-3.26^-1.08;MD=-3.05,95%CI:-4.60^-1.50),less use of postoperative anti-glaucoma medications(MD=-0.71,95%CI:-1.34^-0.09),lower risk of choroidal detachment(OR=0.25,95%CI:0.08 ~0.79;RR=0.23,95%CI:0.11 ~0.47)and hyphema(RR=0.62,95%CI:0.42~0.91).No significant differences were found in success rate,visual acuity changes and other complications(wound leak,bleb leak,endophthalmitis and hypotony).Conclusion:This overview revealed that mitomycin C may be more effective in controlling intraocular pressure,5-fluorouracil may increase the risk of some complications.Therefore,mitomycin C is more effective and safer than 5-fluorouracil for trabeculectomy.