青光眼引流装置植入术与小梁切除术治疗青光眼临床疗效的Meta分析

Meta-Analysis of comparing glaucoma drainage device with trabeculectomy for glaucoma

目的评价青光眼引流装置(GDD)植入术与小梁切除术(Trab)治疗青光眼的疗效。方法运用Cochrane系统评价方法,利用计算机检索关于GDD植入术与Trab治疗青光眼效果比较的随机对照试验(RCT)文献。在控制眼压(IOP)方面,分别收集手术前的基线IOP和手术后的IOP,计算IOP下降百分率(IOPR%),以加权均数(MD)作为效应量指标,分析IOP控制效果。分别比较手术后1年时未使用抗青光眼药物及使用抗青光眼药物达到目标IOP的成功率,以相对危险度(RR)作为效应量指标。结果总共有来自351名患者的351只眼被纳入此次Meta分析。其中172只眼接受GDD植入术(113只眼接受EX-PRESS植入术,59只眼接受Ahmed青光眼阀植入术)设为GDD组;179只眼接受Trab设为Trab组。在控制IOP方面,2组患者的IOPR%差异无统计学意义(MD=-0.59,95%CI=-7.48~6.29,P=0.87)。GDD组患者手术后1年未使用抗青光眼药物达到目标IOP(5mmHg<IOP<18mmHg,1mmHg=0.133kPa)的成功率高于Trab组,差异有统计学意义(RR=1.55,95%CI=1.21~1.99,P=0.000 6)。GDD组患者手术后1年使用抗青光眼药物达到目标IOP(5mmHg<IOP<18mmHg)的成功率高于Trab组,差异有统计学意义(RR=1.11,95%CI=1.03~1.20,P=0.008)。结论在青光眼治疗中,GDD植入术与Trab控制IOP的效果相近,而GDD植入术达到目标IOP的成功率明显高于Trab。

Objective To evaluate the efficacy of glaucoma drainage device(GDD)compared to trabeculectomy(Trab)in the treatment of patients with glaucoma.Methods Cochrane evaluation Methodology was used to evaluate the literature of randomized controlled trail(RCT)of comparing glaucoma drainage device with trabeculectomy for glaucoma.As controlling intraocular pressure(IOP),the baseline IOP before the operation and end-point IOP after the operation were collected to calculate the intraocular pressure ratio(IOPR%).And the mean difference(MD)was used as effect factors to analyze the efficacy to control IOP.1year after the operation comparing the success rate of reaching the target IOP with or without anti-glaucoma medicine and the relative risk(RR)were used as effect factors.Results A total of 351 eyes from 351 patients were studied in this meta-analysis.172 eyes of GDD group received GDD among which 113 eyes received EX-PRESS and 59 eyes received Ahmed glaucoma valve implant;179eyes received Trab as the Trab group.There was no significant difference between IOP% of 2groups in controlling the IOP(MD=-0.59,95%CI=-7.48~6.29,P=0.87).1year after the operation the success rate of GDD group reaching the target IOP(5 mmHg<IOP<18mmHg,1mmHg=0.133kPa)without anti-glaucoma was higher than the Trab group and the difference was significant(RR=1.55,95%CI=1.21~1.99,P=0.000 6).1year after the operation the success rate of GDD group reaching the target IOP(5 mmHg<IOP<18 mmHg)with anti-glaucoma was higher than the Trab group and the difference was significant(RR=1.11,95%CI=1.03~1.20,P=0.008).Conclusion In the treatment of glaucoma the efficacy of GDD and Trab are similar while in controlling the IOP the success rate of GDD is higher than the Trab.