| 摘要: |
| 目的系统评价粘小管成形术对比小梁切除术治疗青光眼的有效性和安全性。方法检索美国国立医学图书馆、荷兰医学文摘、循证医学数据库、中国期刊全文数据库、万方数据库，共纳入7篇临床对照试验，共390眼,其中粘小管成形组218眼，小梁切换组172眼。采用Newcastle-OttawaScale（NOS）文献质量评价量表评价纳入研究的质量，然后采用Revman5.0软件进行统计学处理。结果meta分析结果显示：（1）术后眼压值：治疗后6、12个月，粘小管成形组眼压值均高于小梁切除组，差异有统计学意义[WMD=1.61，95％CI（2.69～0.52），P＜0.05；WMD=2.60，95％CI（3.92～1.27），P＜0.05]。（2）手术成功率：治疗1年后，粘小管成形组眼压控制成功率低于小梁切除组，差异有统计学意义[RR=0.84，95％CI（0.74～0.94），P＜0.01]。（3）住院时间：粘小管成形组术后住院时间低于小梁切除组，差异有统计学意义[WMD=-5.30，95％CI（-6.05～-4.55），P＜0.05]。（4）并发症：粘小管成形组术后早期前房积血发生率高于小梁切除组，差异有统计学意义[RR=7.79，95％CI（2.82～21.50），P＜0.05]。粘小管成形组术后早期低眼压发生率低于小梁切除组，差异有统计学意义[RR=0.24，95％CI（0.06～0.89），P＜0.05]。粘小管成形组术后脉络膜异常的发生率低于小梁切除组，差异有统计学意义[RR=0.16，95％CI（0.04～0.58），P＜0.05]。结论小梁切除术和粘小管成形术在术后6个月及1年均能显著降低青光眼患者的眼压值，粘小管成形术的降眼压效果及控制眼压成功率不及小梁切除术。但粘小管成形术术后低眼压、脉络膜异常等并发症发生率更低，相对更安全。 |
| 关键词: 粘小管成形术 小梁切除术 青光眼 |
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| Efficacy and safety of canaloplasty versus trabeculectomy in treatment of glaucoma: a meta-analysis |
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ZHANG Yun, CHEN Junhong, LV Zhe, WANG Qihua, SHEN Lijun, TAO Jiwei
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the Eye Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To compare the efficacy and safety of canaloplasty with trabeculectomy for treatment of glaucoma. Methods The databases of Pubmed, EMbase, Cochrane Library, CNKI and Wanfang were searched for clinical studies of canaloplasty and trabeculectomy in treatment of glaucoma. Seven clinical controlled trials were selected for meta-analysis, in which 390 eyes were involved, including canaloplasty for 172 eyes and trabeculectomy for 218 eyes. The methodological quality was assessed according to evidence-based medicine; the quality of clinical controlled trials (CCT) was evaluated according to Newcastle-Ottawa Scale (NOS). The software RevMan 5.3 was used for meta-analysis. Results Intraocular pressure (IOP) in canaloplasty group at 6 and 12 months after operation was higher than that in trabeculectomy group [WMD=1.61, 95％CI(2.69～
0.52), P＜0.05, WMD=2.60, 95％CI(3.92～1.27), P＜0.05, respectively]. The canaloplasty group showed higher success rate than trabeculectomy group [RR=0.84, 95％ CI (0.74 ～0.94), P＜0.01]. The canaloplasty group required a lower postoperative hospitalization than trabeculectomy group[WMD=-5.30, 95％CI(-6.05～-4.55), P＜0.05]. The canaloplasty group was more likely to have hyphema [RR=7.79, 95％CI (2.82～21.50), P＜0.05] and hypotony than trabeculectomy group [RR=0.24, 95％ CI (0.06～ 0.89), P＜0.05]. The incidence of postoperative choroid abnormalities in canaloplasty group was significantly lower than that in trabeculectomy group [RR=0.16, 95％CI (0.04～0.58), P＜0.05]. Conclusion Both trabeculectomy and canaloplasty can signifi- cantly reduce the intraocular pressure in glaucoma patients after operation, trabeculectomy leads a more marked IOP decrease than canaloplasty at the cost of a higher complication rate and more demanding for postoperative care. |
| Key words: Canaloplasty Trabeculectomy Glaucoma |
