中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2013年
3期
270-274
,共5页
青光眼/闭角型%超声乳化术%超声乳化联合小梁切除术%随机对照试验%Meta分析%循证医学
青光眼/閉角型%超聲乳化術%超聲乳化聯閤小樑切除術%隨機對照試驗%Meta分析%循證醫學
청광안/폐각형%초성유화술%초성유화연합소량절제술%수궤대조시험%Meta분석%순증의학
Glaucoma/angle closure%Phacoemulsification%Phacotrabeculectomy%Randomized controlled trial%Meta analysis%Evidence-based medicine
背景 初期白内障晶状体增厚是引起原发性闭角型青光眼(PACG)发病的主要因素之一.目前国内外有大量文献报道单纯白内障超声乳化术或白内障超声乳化联合小梁切除术治疗合并白内障的PACG,但哪种手术方式更安全、有效尚缺少循证医学的证据. 目的 系统评价和比较白内障超声乳化术与超声乳化联合小梁切除术治疗PACG的临床疗效.方法 按照预定的检索策略用计算机检索1966年1月至201 1年6月PubMed和EMB Reviews收录期刊发表的关于单纯白内障超声乳化术或白内障超声乳化联合小梁切除术治疗PACG合并白内障的文献、Cochrane Library数据库(2011年第1期)及中国生物医学文献数据库收录的1979年1月至2011年6月发表的相关文献,并采用手工检索等方法收集会议文献,纳入所有相关研究的临床随机对照试验(RCT).根据RCT设计的标准对纳入研究的方法学质量进行评级,评价指标包括眼压降低水平、术后抗青光眼药物用量、术后并发症的发生率、术后最佳矫正视力(BCVA)的情况和青光眼视野损害进展,采用RevMan 4.2软件进行Meta分析. 结果 共纳入3篇关于单纯白内障超声乳化与白内障超声乳化联合小梁切除术治疗PACG合并白内障的RCT,总样本量为164例164眼.Meta分析结果表明,与单纯白内障超声乳化术相比,白内障超声乳化联合小梁切除术手术后患者眼压降低的幅度较大(WMD=1.17,95％ CI:0.06 ～ 2.27,P=0.040)；术后抗青光眼药物用量减少(WMD=0.50,95％ CI:0.24～0.77,P=0.000)；手术后并发症的发生率增加(RR=0.08,95％ CI:0.02 ～ 0.33,P=0.000).两者手术后BCVA(WMD=0,95％ CI:-0.13～0.13,P=1.000)以及青光眼视野损害进展(WMD=1.01,95％ CI:0.56 ～ 1.82,P=0.980)的差异均无统计学意义.结论 与单纯白内障超声乳化术相比,白内障超声乳化联合小梁切除术降眼压效果好,但安全性下降,两种术式术后对BCVA及青光眼视野损害进展的影响接近.因病例数较少,上述结论有待更多大样本RCT加以验证.
揹景 初期白內障晶狀體增厚是引起原髮性閉角型青光眼(PACG)髮病的主要因素之一.目前國內外有大量文獻報道單純白內障超聲乳化術或白內障超聲乳化聯閤小樑切除術治療閤併白內障的PACG,但哪種手術方式更安全、有效尚缺少循證醫學的證據. 目的 繫統評價和比較白內障超聲乳化術與超聲乳化聯閤小樑切除術治療PACG的臨床療效.方法 按照預定的檢索策略用計算機檢索1966年1月至201 1年6月PubMed和EMB Reviews收錄期刊髮錶的關于單純白內障超聲乳化術或白內障超聲乳化聯閤小樑切除術治療PACG閤併白內障的文獻、Cochrane Library數據庫(2011年第1期)及中國生物醫學文獻數據庫收錄的1979年1月至2011年6月髮錶的相關文獻,併採用手工檢索等方法收集會議文獻,納入所有相關研究的臨床隨機對照試驗(RCT).根據RCT設計的標準對納入研究的方法學質量進行評級,評價指標包括眼壓降低水平、術後抗青光眼藥物用量、術後併髮癥的髮生率、術後最佳矯正視力(BCVA)的情況和青光眼視野損害進展,採用RevMan 4.2軟件進行Meta分析. 結果 共納入3篇關于單純白內障超聲乳化與白內障超聲乳化聯閤小樑切除術治療PACG閤併白內障的RCT,總樣本量為164例164眼.Meta分析結果錶明,與單純白內障超聲乳化術相比,白內障超聲乳化聯閤小樑切除術手術後患者眼壓降低的幅度較大(WMD=1.17,95％ CI:0.06 ～ 2.27,P=0.040)；術後抗青光眼藥物用量減少(WMD=0.50,95％ CI:0.24～0.77,P=0.000)；手術後併髮癥的髮生率增加(RR=0.08,95％ CI:0.02 ～ 0.33,P=0.000).兩者手術後BCVA(WMD=0,95％ CI:-0.13～0.13,P=1.000)以及青光眼視野損害進展(WMD=1.01,95％ CI:0.56 ～ 1.82,P=0.980)的差異均無統計學意義.結論 與單純白內障超聲乳化術相比,白內障超聲乳化聯閤小樑切除術降眼壓效果好,但安全性下降,兩種術式術後對BCVA及青光眼視野損害進展的影響接近.因病例數較少,上述結論有待更多大樣本RCT加以驗證.
배경 초기백내장정상체증후시인기원발성폐각형청광안(PACG)발병적주요인소지일.목전국내외유대량문헌보도단순백내장초성유화술혹백내장초성유화연합소량절제술치료합병백내장적PACG,단나충수술방식경안전、유효상결소순증의학적증거. 목적 계통평개화비교백내장초성유화술여초성유화연합소량절제술치료PACG적림상료효.방법 안조예정적검색책략용계산궤검색1966년1월지201 1년6월PubMed화EMB Reviews수록기간발표적관우단순백내장초성유화술혹백내장초성유화연합소량절제술치료PACG합병백내장적문헌、Cochrane Library수거고(2011년제1기)급중국생물의학문헌수거고수록적1979년1월지2011년6월발표적상관문헌,병채용수공검색등방법수집회의문헌,납입소유상관연구적림상수궤대조시험(RCT).근거RCT설계적표준대납입연구적방법학질량진행평급,평개지표포괄안압강저수평、술후항청광안약물용량、술후병발증적발생솔、술후최가교정시력(BCVA)적정황화청광안시야손해진전,채용RevMan 4.2연건진행Meta분석. 결과 공납입3편관우단순백내장초성유화여백내장초성유화연합소량절제술치료PACG합병백내장적RCT,총양본량위164례164안.Meta분석결과표명,여단순백내장초성유화술상비,백내장초성유화연합소량절제술수술후환자안압강저적폭도교대(WMD=1.17,95％ CI:0.06 ～ 2.27,P=0.040)；술후항청광안약물용량감소(WMD=0.50,95％ CI:0.24～0.77,P=0.000)；수술후병발증적발생솔증가(RR=0.08,95％ CI:0.02 ～ 0.33,P=0.000).량자수술후BCVA(WMD=0,95％ CI:-0.13～0.13,P=1.000)이급청광안시야손해진전(WMD=1.01,95％ CI:0.56 ～ 1.82,P=0.980)적차이균무통계학의의.결론 여단순백내장초성유화술상비,백내장초성유화연합소량절제술강안압효과호,단안전성하강,량충술식술후대BCVA급청광안시야손해진전적영향접근.인병례수교소,상술결론유대경다대양본RCT가이험증.
Background Increase of lens thickness at incipient cataract is a key factor of onset of primary angle-closure glaucoma (PACG).Phacoemulsification (Phaco) or phacotrabeculectomy (Phacotrabe) have been documented to be effective for the patients of PACG associated with cataract.However,which surgery is more effective and safe is lack of evidence.Objective This study was to assess and compare the clinical effectiveness of Phaco versus Phacotrabe for PACG with cataract.Methods The relevant literature was searched electronically from the PubMed (1966 to June 2011),EMB Reviews (1966 to June 2011) and Cochrane Library (Issue 1,2011).The manually searching of relevant conference proceedings was used as the supplement.The articles of randomized controlled trial (RCT) about the clinical effectiveness of Phaco versus Phacotrabe for PACG with cataract were included.The methodology quality of included literature was graded.The analysis indexes included intraocular pressure (IOP)-lowing range,postoperative administration of glaucoma drugs,incidence of positive complication,postoperative best corrective visual acuity (BCVA) and perimetry damage.The RevMan4.2 software from Cochrane Collaboration was used for the Meta analyses.Results Three RCTs about phaco versus Phacotrabe for PACG with cataract were selected in this study with the 164 eyes of 164 cases.Meta analysis showed that the IOP-lowing range was larger in the Phacotrabe group compared to only Phaco group with the WMD of 1.17 and 95％ CI of 0.06-2.27 (P =0.040),and the drug dosage of anti-glaucoma was less in the Phacotrabe group in comparison with the Phaco group with the WMD of 0.5 and 95％ CI of 0.24-0.77 (P =0.000).However,the incidence of postoperative complication was higher in the Phacotrabe group than that of the Phaco group with the RR of 0.08 and 95％ CI of 0.02-0.33 (P =0.000).No significant difference was found in the BCVA (WMD =0,95％ CI:-0.13-0.13,P=1.00) andperimetry (WMD =1.01,95％CI:0.56-1.82,P=0.98).Conclusions Compared with Phaco,Phacotrab has a better IOP-lowing effectiveness and slightly worse safety.Phaco and Phacotrab have a fairly influencc in the postoperative BCVA and perimetry.As the sample sizes of the included trials are relatively small,more welldesigned large-scale RCTs are needed.
