小梁消融术治疗原发性开角型青光眼的Meta分析

Efficacy and safety of trabectome for primary open-angle glaucoma:a Meta-analysis

目的通过Meta分析小梁消融术治疗原发性开角型青光眼的有效性及安全性。方法计算机检索PubMed、The Cochrane Library、EMbase、中国生物医学、中国知网、维普和万方数据库,搜集有关小梁消融术(试验组)与传统手术组(对照组)治疗原发性开角型青光眼的文献资料,检索时限从建库至2020年6月22日。筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入2篇随机对照试验(Randomized Controlled Trials,RCT)研究、5篇队列研究,共740例患者。Meta分析结果显示,试验组术后3月、6月及12月的眼压控制效果相比对照组更为理想[MD=-8.71,95%CI(-16.07,-1.36),P=0.02]、[MD=-10.40,95%CI(-18.07,-2.72),P=0.008]、[MD=-8.64,95%CI(-13.55,-3.74),P=0.0006]。试验组术后3月、6月及12月使用抗青光眼药物数量少于对照组[MD=-41.26,95%CI(-75.05,-7.47),P=0.02]、[MD=-36.96,95%CI(-56.63,-17.30),P=0.0002]、[MD=-29.92,95%CI(-36.68,-23.16),P<0.00001]。早期眼压低(眼压<10 mmHg)发生率的对比差异有统计学意义[OR=0.08,95%CI(0.02,0.40),P=0.002];浅前房发生率的对比差异有统计学意义[OR=0.09,95%CI(0.01,0.67),P=0.02]。结论当前证据表明,与传统手术相比,小梁消融术在治疗原发性开角型青光眼上具有术后眼压控制效果好、显著降低对青光眼药物的依赖性及并发症发生率低等优点。但受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。

Objective To evaluate the efficacy and safety of trabectome for primary open-angle glaucoma through Meta-analysis.Methods We searched PubMed,The Cochrane Library,EMbase,CBM,CNKI,VIP,and Wanfang databases,and collected related trabectome(test group)and traditional surgery group(control group)for the treatment of primary open-angle.The time limit for searching the literature on glaucoma was from the establishment of the database to June 22,2020.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Then,Meta-analysis was performed by using RevMan 5.3 software.Results A total of 2 Randomized Controlled Trials and 5 cohort studies were included,with a total of 740 patients.The results of meta-analysis showed that the effect of intraocular pressure control in the experimental group at 3,6 and 12 months after surgery was better than that of the control group[MD=-8.71,95%CI(-16.07,-1.36),P=0.02],[MD=-10.40,95%CI(-18.07,-2.72),P=0.008],[MD=-8.64,95%CI(-13.55,-3.74),P=0.0006].The number of anti-glaucoma drugs used in the experimental group at 3,6 and 12 months after surgery was less than that of the control group[MD=-41.26,95%CI(-75.05,-7.47),P=0.02],[MD=-36.96,95%CI(-56.63,-17.30),P=0.0002],[MD=-29.92,95%CI(-36.68,-23.16),P<0.00001].The comparative difference in the incidence of early low intraocular pressure(<10 mmHg)is statistically significant[OR=0.08,95%CI(0.02,0.40),P=0.002].The difference in the incidence of shallow anterior chamber is statistically significant[OR=0.09,95%CI(0.01,0.67),P=0.02].Conclusion The current evidence shows that compared with traditional surgery,trabectome in the treatment of primary open-angle glaucoma has the advantages of good postoperative intraocular pressure control,significantly reduced dependence on glaucoma drugs,and low complication rate.However,limited by the number and quality of the included studies,the above conclusions need to be verified by more high-quality studies.