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
275-281
,共7页
高颖%吴艺君%曾蕊%李文生
高穎%吳藝君%曾蕊%李文生
고영%오예군%증예%리문생
青光眼%小梁切除术%羊膜%随机对照试验%Meta分析
青光眼%小樑切除術%羊膜%隨機對照試驗%Meta分析
청광안%소량절제술%양막%수궤대조시험%Meta분석
Glaucoma%Trabeculectomy%Amniotic membrane%Randomized controlled trial%Meta-analysis
背景 青光眼患者行小梁切除术后的疗效一直是眼科医师关注的问题,手术中羊膜植入的有效性评价成为目前该领域研究的热点之一. 目的 评价小梁切除术中应用羊膜(TE-AMT)和未应用羊膜(TE-noAMT)在青光眼治疗中的疗效和安全性. 方法 按照预先制定的检索策略,通过计算机检索The Cochrane Library、PubMed、CNKI、中国生物医学文献数据库等,并通过因特网和手工检索进行补充,检索时间从1965年1月至2010年12月,纳入小梁切除术中应用羊膜和未应用羊膜的临床随机对照试验的文献.参照Jadad量表评分标准对纳入的文献质量进行评价,并对纳入文献的相关参数和数据进行信息提取,包括文献作者、试验设计类型、国籍、眼数、患者数量、性别、随访时间、平均年龄、青光眼种类、基础眼压值、失访率；分析指标包括术后≥6个月的眼压下降率、手术成功率以及并发症情况,采用RevMan 5.0软件进行Meta分析.结果 共纳入19篇随机对照试验文献,其中15篇为Jadad量表评分2分以上,共纳入818例977眼.眼压的下降率在术后6个月和12个月的总体合并加权均数差(WMD=8.47％,95％ CI:5.20 ～ 11.75,P=0.00)、(WMD=9.37％,95％CI:4.97～13.77,P=0.O0)；完全手术成功率和条件手术成功率在术后6个月的总体相对危险度(RR)分别为(1.40,95％ CI:1.19～ 1.65)、(0.47,95％ CI:0.22 ～ 1.00).并发症发生情况分析表明,术后浅前房、前房出血、低眼压、脉络膜脱离,术后6个月和12个月非功能性滤过泡的RR分别为0.51(95％ CI:0.30 ～0.85)、0.43(95％ CI:0.20 ～0.92)、0.51 (95％ CI:0.26～1.00)、0.57 (95％ CI:0.14 ～2.31)、0.31(95％ CI:0.20～0.47)、0.31(95％ CI:0.17 ～0.55). 结论 Meta分析结果表明,与TE-noAMT手术比较,TE-AMT能更好地降低青光眼患者的术后眼压,提高完全手术成功率并降低并发症的发生率.
揹景 青光眼患者行小樑切除術後的療效一直是眼科醫師關註的問題,手術中羊膜植入的有效性評價成為目前該領域研究的熱點之一. 目的 評價小樑切除術中應用羊膜(TE-AMT)和未應用羊膜(TE-noAMT)在青光眼治療中的療效和安全性. 方法 按照預先製定的檢索策略,通過計算機檢索The Cochrane Library、PubMed、CNKI、中國生物醫學文獻數據庫等,併通過因特網和手工檢索進行補充,檢索時間從1965年1月至2010年12月,納入小樑切除術中應用羊膜和未應用羊膜的臨床隨機對照試驗的文獻.參照Jadad量錶評分標準對納入的文獻質量進行評價,併對納入文獻的相關參數和數據進行信息提取,包括文獻作者、試驗設計類型、國籍、眼數、患者數量、性彆、隨訪時間、平均年齡、青光眼種類、基礎眼壓值、失訪率；分析指標包括術後≥6箇月的眼壓下降率、手術成功率以及併髮癥情況,採用RevMan 5.0軟件進行Meta分析.結果 共納入19篇隨機對照試驗文獻,其中15篇為Jadad量錶評分2分以上,共納入818例977眼.眼壓的下降率在術後6箇月和12箇月的總體閤併加權均數差(WMD=8.47％,95％ CI:5.20 ～ 11.75,P=0.00)、(WMD=9.37％,95％CI:4.97～13.77,P=0.O0)；完全手術成功率和條件手術成功率在術後6箇月的總體相對危險度(RR)分彆為(1.40,95％ CI:1.19～ 1.65)、(0.47,95％ CI:0.22 ～ 1.00).併髮癥髮生情況分析錶明,術後淺前房、前房齣血、低眼壓、脈絡膜脫離,術後6箇月和12箇月非功能性濾過泡的RR分彆為0.51(95％ CI:0.30 ～0.85)、0.43(95％ CI:0.20 ～0.92)、0.51 (95％ CI:0.26～1.00)、0.57 (95％ CI:0.14 ～2.31)、0.31(95％ CI:0.20～0.47)、0.31(95％ CI:0.17 ～0.55). 結論 Meta分析結果錶明,與TE-noAMT手術比較,TE-AMT能更好地降低青光眼患者的術後眼壓,提高完全手術成功率併降低併髮癥的髮生率.
배경 청광안환자행소량절제술후적료효일직시안과의사관주적문제,수술중양막식입적유효성평개성위목전해영역연구적열점지일. 목적 평개소량절제술중응용양막(TE-AMT)화미응용양막(TE-noAMT)재청광안치료중적료효화안전성. 방법 안조예선제정적검색책략,통과계산궤검색The Cochrane Library、PubMed、CNKI、중국생물의학문헌수거고등,병통과인특망화수공검색진행보충,검색시간종1965년1월지2010년12월,납입소량절제술중응용양막화미응용양막적림상수궤대조시험적문헌.삼조Jadad량표평분표준대납입적문헌질량진행평개,병대납입문헌적상관삼수화수거진행신식제취,포괄문헌작자、시험설계류형、국적、안수、환자수량、성별、수방시간、평균년령、청광안충류、기출안압치、실방솔；분석지표포괄술후≥6개월적안압하강솔、수술성공솔이급병발증정황,채용RevMan 5.0연건진행Meta분석.결과 공납입19편수궤대조시험문헌,기중15편위Jadad량표평분2분이상,공납입818례977안.안압적하강솔재술후6개월화12개월적총체합병가권균수차(WMD=8.47％,95％ CI:5.20 ～ 11.75,P=0.00)、(WMD=9.37％,95％CI:4.97～13.77,P=0.O0)；완전수술성공솔화조건수술성공솔재술후6개월적총체상대위험도(RR)분별위(1.40,95％ CI:1.19～ 1.65)、(0.47,95％ CI:0.22 ～ 1.00).병발증발생정황분석표명,술후천전방、전방출혈、저안압、맥락막탈리,술후6개월화12개월비공능성려과포적RR분별위0.51(95％ CI:0.30 ～0.85)、0.43(95％ CI:0.20 ～0.92)、0.51 (95％ CI:0.26～1.00)、0.57 (95％ CI:0.14 ～2.31)、0.31(95％ CI:0.20～0.47)、0.31(95％ CI:0.17 ～0.55). 결론 Meta분석결과표명,여TE-noAMT수술비교,TE-AMT능경호지강저청광안환자적술후안압,제고완전수술성공솔병강저병발증적발생솔.
Background Many methods are widely studied to improve the therapeutic effect of trabeculectomy for glaucoma,and the clinical effectiveness of the amniotic membrane application during trabeculectomy is one of the research hotspots.Objective This study was to evaluate the efficacy and safety between trabeculectomy with (TE-AMT) and without amniotic membrane transplantation (TE-noAMT) for treating glaucoma.Methods Articles published from 1965 to December 2010 were searched from The Cochrane Library,PubMed,EMBASE,CNKI,Chinese Biomedicine Database,internet by computer,and manual search then was performed according to the predetermined strategy.Randomized controlled trials (RCT) on TE-AMT and TE-noAMT were included.The quality of included articles were scored based on Jadad table,and the relative parameters and information were extracted,including author,design of the trials,country,number of eyes and patients,gender,follow-up duration,age,classification of glaucoma,baseline IOP and loss rate.The main analysis indicators were the percentage of IOP reduction,completely operative successful rate,qualified success rate and adverse events.The pooled estimates were carried out with RevMan version 5.0 software.Results Nineteen RCTs documents were reviewed by meta-analysis with the Jaded scores ≥3 in 2 papers and ＜3 in 17 papers.Total 977 eyes of 818 patients were included.The weighted mean differences (WMD) of the percentage of IOP from baseline were (WMD =8.47％,95％ CI:5.20-11.75) at 6 months and (WMD=9.37％,95％ CI:4.97-13.77) at 12 months postoperatively.Relative risk (RR) of complete success rate and qualified success rate at postoperative 6 months were (1.40,95％ CI:1.19-1.65) and (0.47,95％ CI:0.22-1.00),respectively.RR values of adverse event such as shallow anterior chamber,hyphema,hypotony and choroidal detachment,failed filtering blebs at 6,12 months were 0.51 (95 ％ CI:0.30-0.85),0.43 (95％ CI:0.20-0.92),0.51(95％CI:0.26-1.00) and 0.57(95％CI:0.14-2.31),0.31(95％CI:0.20-0.47),0.31 (95％ CI:0.17-0.55),respectively.Conclusions TE-AMT appears to have better efficacy in lowering IOP,increasing complete success rate and reducing adverse event I in comparison with TE-noAMT.
