National University Singapore, National University Hospital, Singapore.
J Glaucoma. 2010 Oct-Nov;19(8):519-27. doi: 10.1097/IJG.0b013e3181ca7694.
Compare the efficacy and safety profile of viscocanalostomy versus trabeculectomy in uncontrolled glaucoma.
We looked through various search engines for randomized controlled trials directly comparing viscocanalostomy with trabeculectomy. Outcome measurements we examined were mean intraocular pressure difference at 6 months, 12 months, and 24 months, mean difference in postoperative number of antiglaucomatous medications and relative risk of adverse events. Subgroup analysis looked at studies that included 1 eye per patient, studies that included only white patients, studies with only primary open angle glaucoma, studies that did not allow the use of intraoperative mitomycin C in trabeculectomy treatment, studies that did not allow any postoperative use of antimetabolites, and studies with and without the use of postviscocanalostomy Nd:YAG goniopuncture.
Ten randomized controlled trials were selected and included in the meta-analysis with a total of 458 eyes of 397 patients with medically uncontrolled glaucoma. At 6 months, mean intraocular pressure difference was 2.25 mm Hg (95% confidence interval 1.38-3.12), at 12 months it was 3.64 mm Hg (2.74, 4.54), whereas at 24 months it was 3.42 mm Hg (1.80, 5.03). Trabeculectomy was found to have a significantly better pressure-lowering outcome (P<0.0001). Relative risk of adverse events such as perforation of Descemet membrane, hypotony, hyphema, shallow anterior chamber, and cataract formation, were found to be 7.72 (2.37, 25.12), 0.29 (0.15, 0.58), 0.50 (0.30, 0.84), 0.19 (0.08, 0.45), and 0.31 (0.15, 0.64), respectively. Viscocanalostomy had a significantly higher relative risk of intraoperative perforation of Descemet membrane, whereas trabeculectomy had significantly more postoperative adverse events (P≤0.008).
Trabeculectomy was found to have a greater pressure-lowering effect compared with viscocanalostomy. However, viscocanalostomy had a significantly better risk profile.
比较粘小管切开术与小梁切除术治疗未控制青光眼的疗效和安全性。
我们通过各种搜索引擎查找了直接比较粘小管切开术和小梁切除术的随机对照试验。我们检查的主要结果是 6 个月、12 个月和 24 个月时的平均眼内压差异、术后抗青光眼药物数量的平均差异以及不良事件的相对风险。亚组分析包括对每例患者 1 只眼的研究、仅白人患者的研究、单纯开角型青光眼的研究、不允许术中使用丝裂霉素 C 治疗小梁切除术的研究、不允许术后使用抗代谢物的研究、以及使用和不使用粘小管切开术后 Nd:YAG 前房角穿刺的研究。
共选择了 10 项随机对照试验，对 397 例患有药物控制不佳青光眼的 458 只眼进行了荟萃分析。6 个月时，平均眼压差异为 2.25mmHg（95%置信区间 1.38-3.12），12 个月时为 3.64mmHg（2.74-4.54），24 个月时为 3.42mmHg（1.80-5.03）。小梁切除术具有显著更好的降压效果（P<0.0001）。穿透性角膜内皮、低眼压、前房积血、浅前房和白内障形成等不良事件的相对风险分别为 7.72（2.37-25.12）、0.29（0.15-0.58）、0.50（0.30-0.84）、0.19（0.08-0.45）和 0.31（0.15-0.64）。粘小管切开术术中穿透性角膜内皮的相对风险显著更高，而小梁切除术术后不良事件显著更多（P≤0.008）。
与粘小管切开术相比，小梁切除术具有更强的降压效果。然而，粘小管切开术具有更好的风险特征。
