Feyi-Waboso Andrew, Ejere Henry O D
Eye Department, Royal Gwent NHS Trust, Newport, UK.
Cochrane Database Syst Rev. 2012 Aug 15;2012(8):CD003658. doi: 10.1002/14651858.CD003658.pub3.
Encapsulation of a filtering bleb following trabeculectomy may lead to elevation of intraocular pressure, prompting further medical or surgical intervention. It has been suggested that needling of an encapsulated bleb may be effective in re-establishing drainage and lowering intraocular pressure.
The objective of this review was to assess the effects of needling encapsulated blebs on intraocular pressure.
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to February 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 14 February 2012.
We included randomised and quasi-randomised in which bleb needling was compared with any form of antiglaucoma medication in people with encapsulated trabeculectomy blebs. The primary outcome was mean intraocular pressure measured in millimetres of mercury at day one, one week, one month and at last available follow-up.
Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.
One trial, which randomised 25 eyes to either needling or medical treatment, met the inclusion criteria. At one day post-treatment, mean intraocular pressure was lower in the needling group (16.28 mmHg, standard deviation 5.9) than the medical group (19.45 mmHg, standard deviation 3.75). The difference was not statistically significant. At all other follow-up points, mean intraocular pressure was consistently higher in the needling group than the medical group, although the differences were not statistically significant. However, only one needled bleb remained successful at the end of follow-up compared to 10 out of the 11 blebs managed conservatively. This difference was statistically highly significant.
AUTHORS' CONCLUSIONS: Evidence from one small trial suggests that needling of encapsulated trabeculectomy blebs is not better than medical treatment in reducing intraocular pressure.
小梁切除术后滤过泡的包封可能导致眼压升高，从而促使进一步的药物或手术干预。有人提出，对包封的滤过泡进行针刺可能有效地重新建立引流并降低眼压。
本综述的目的是评估针刺包封滤过泡对眼压的影响。
我们检索了CENTRAL（其中包含Cochrane眼科和视觉组试验注册库）（《Cochrane图书馆》2012年第1期）、MEDLINE（1950年1月至2012年2月）、EMBASE（1980年1月至2012年2月）、拉丁美洲和加勒比地区健康科学文献数据库（LILACS）（1982年1月至2012年2月）、对照试验元注册库（mRCT）（www.controlled-trials.com）、ClinicalTrials.gov（www.clinicaltrials.gov）以及世界卫生组织国际临床试验注册平台（ICTRP）（www.who.int/ictrp/search/en）。在电子检索试验时，我们未使用任何日期或语言限制。电子数据库的最后检索日期为2012年2月14日。
我们纳入了将针刺滤过泡与任何形式的抗青光眼药物用于包封小梁切除术后滤过泡患者的随机和半随机试验。主要结局是在第1天、1周、1个月以及最后一次随访时以毫米汞柱为单位测量的平均眼压。
两位综述作者独立评估试验质量并提取数据。我们联系了研究作者以获取更多信息。
一项将25只眼随机分为针刺组或药物治疗组的试验符合纳入标准。治疗后第1天，针刺组的平均眼压（16.28 mmHg，标准差5.9）低于药物治疗组（19.45 mmHg，标准差3.75）。差异无统计学意义。在所有其他随访点，针刺组的平均眼压始终高于药物治疗组，尽管差异无统计学意义。然而，随访结束时，针刺组仅1个滤过泡仍保持成功，而保守治疗的11个滤过泡中有10个成功。这一差异具有高度统计学意义。
一项小型试验的证据表明，针刺小梁切除术后包封的滤过泡在降低眼压方面并不优于药物治疗。
