EX-PRESS引流器植入术与小梁切除术治疗开角型青光眼有效性和安全性的Meta分析

doi:10.6040/j.issn.1673-3770.0.2016.230

摘要/Abstract

摘要： 目的比较EX-PRESS引流器植入术与小梁切除术治疗开角型青光眼(OAG)的有效性和安全性。方法计算机检索PubMed, EMbase, CNKI, VIP和万方数据库,搜集全部比较EX-PRESS引流器植入术与小梁切除术治疗OAG有效性和安全性的随机对照试验(RCTs)。检索时限为数据库建库至2016年3月31日。按照纳入与排除标准筛选文献、提取资料、质量评价后,使用RevMan5.3软件进行Meta分析。结果共纳入7篇文献,共447例,462眼,其中EX-PRESS组234眼,小梁组228眼。Meta分析的结果显示:(1)有效性:两种手术后6个月和12个月IOPR%分别为［WMD=-7.67, 95%CI(-14.85,-0.50), P=0.04］和［WMD=11.38, 95%CI(1.55,21.22), P=0.02］,差异有统计学意义,而术后24个月和随访结束时IOPR%差异无统计学意义。两种手术后1年完全成功率［OR=2.29, 95%CI(1.27, 4.13), P=0.006］差异有统计学意义,术后1年不全成功率［OR=1.59, 95%CI(0.73, 3.44), P=0.24］差异无统计学意义,两种手术在术后随访结束时抗青光眼药物应用数量比较［WMD=-0.10, 95%CI(-0.36,0.17), P=0.48］差异无统计学意义,两种手术后2年视力比较［WMD=-0.12, 95%CI(-0.23,-0.00), P=0.04］差异有统计学意义;(2)安全性:两种手术后浅前房、低眼压、包囊型滤泡、伤口漏、脉络膜渗漏的发生,差异无统计学意义,但与小梁切除术相比,EX-PRESS植入术后前房出血［OR=0.13, 95%CI(0.04, 0.42), P=0.000 6］差异有统计学意义。结论 EX-PRESS引流器植入术治疗开角型青光眼在术后6个月不如小梁切除术能更有效地降低眼压,但在术后12个月却比小梁切除术能更好地降低眼压,但长期疗效并没有显著差异,且EX-PRESS引流器植入术手术后前房出血的发生更少,1年完全成功率更高,然而小梁切除术后2年视力恢复更好,而对于术后仍需使用抗青光眼药物的患者,其使用抗青光眼药物的数量并没有差别。

关键词: 小梁切除术, EX-PRESS, Meta分析, 开角型青光眼

Abstract: Objective To evaluate the efficacy and safety of EX-PRESS implantation(EX-PRESS)compared with trabeculectomy(Trab)in open-angle glaucoma(OAG). Methods Databases including PubMed, EMbase, CNKI, VIP and WanFang Data were electronically searched for all randomized controlled trials(RCTs)about comparing the efficacy and safety between EX-PRESS implantation and trabeculectomy in open-angle glaucoma before the date of March 31, 2016. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and evaluated the included studies. Then, meta-analysis was performed using RevMan5.3 software. Results A total 7 RCTs involving 447 patients with 462 eyes were included, 234 eyes in the EX-PRESS group and 228 eyes in the Trab group. The results of meta-analysis showed that there was significant difference between EX-PRESS and Trab in the postoperative 6 months and 1 year IOPR% ［WMD=-7.67, 95%CI(-14.85, -0.50), P=0.04］ and ［WMD=11.38, 95%CI(1.55, 21.22, P=0.02］, there was no significant difference between EX-PRESS and Trab in 24 months and end of follow-up after surgery IOPR%. The pooled OR was ［OR=2.29, 95%CI(1.27, 4.13), P=0.006］ comparing EX-PRESS with Trab for the complete success rate at one year after surgery and there was no significant difference between Ex-PRESS and Trab in the qualified success rate at one year after surgery ［OR=1.59, 95%CI(0.73, 3.44), P= 山东大学耳鼻喉眼学报31卷2期 -王越,等.EX-PRESS引流器植入术与小梁切除术治疗开角型青光眼有效性和安全性的Meta分析 \=-0.24］ and the number of anti-glaucoma medication ［WMD=-0.10, 95%CI(-0.36, 0.17), P=0.48］. But postoperative 2 year visual acuity ［WMD=-0.12, 95%CI(-0.23,-0.00), P=0.04］ had difference compared EX-PRESS with Trab. The pooled ORs of shallow or flat anterior chamber, hypotony, encapsulated bleb, wound leak, and choroidal effusion respectively was ［OR=1.43, 95%CI(0.71, 2.87), P=0.32］, ［OR=1.03, 95%CI(0.54, 1.96), P=0.94］, ［OR=0.25, 95%CI(0.05, 1.25), P=0.09］, ［OR=0.96, 95%CI(0.35, 2.64), P=0.94］, and ［OR=0.69, 95%CI(0.28, 1.72, P=0.43］ compared EX-PRESS with Trab. But EX-PRESS compared to Trab, with pooled ORs of hyphema ［OR=0.13, 95% CI(0.04, 0.42), P=0.0006］. Conclusion Trab had a better effect in IOPR% at 6 months after surgery, but EX-PRESS had a better effect in 1 year after surgery. But EX-PRESS surgery complete success rate was higher and EX-PRESS was associated with a significantly lower frequency of the hyphema compared to trabeculectomy. Moreover, Trab got better recovery of visual acuity. And there was no difference in the number of anti-glaucoma medication for the people need medications control the IOP between the two surgeries.

Key words: Meta-analysis, EX-PRESS implanation, Trabeculectomy, Open-angle glaucoma

中图分类号:

R775.2

王越,柯敏,韩芳芳,王文欢,翁鸿. EX-PRESS引流器植入术与小梁切除术治疗开角型青光眼有效性和安全性的Meta分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 104-111.

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