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

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。

Efficacy and safety of EX-PRESS implanation versus trabeculectomy for open-angle glaucoma: a meta-analysis

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 =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.