*Glaucoma Service, Department of Ophthalmology, Tulane University, New Orleans, LA †Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, MA.
J Glaucoma. 2014 Sep;23(7):424-9. doi: 10.1097/IJG.0b013e31827a0712.
To perform a meta-analysis on postkeratoplasty glaucoma and directly compare the affect of trabeculectomy, cyclophotocoagulation (CPC), and glaucoma drainage device (GDD) on intraocular pressure (IOP) control and corneal graft survival.
We searched Medline (Ovid, PubMed), EMBASE, and The Cochrane Library databases for clinical articles that maintained our inclusion criteria. The primary outcome measures were IOP control and overall corneal graft survival. The secondary outcomes were failure rate of the primary glaucoma procedure and change in visual acuity. We used 1-way analysis of variance weighed by the number of participants in each study to compare the outcomes.
Information from a total of 266 eyes was collected from 13 articles. Trabeculectomy reduced IOP by 13.6 mm Hg compared with 20.4 mm Hg with CPC and 20.2 mm Hg with GDD (P<0.001). The failure rate of glaucoma surgery was highest after trabeculectomy 37% (95% CI, 31.4%-41.9%) compared with 20.7% (95% CI, 17.6%-23.7%) after CPC and 16% (95% CI, 13.8%-18.9%) after GDD and this was statistically significant (P<0.001). GDD was associated with higher rate of corneal graft failure (35%) than either CPC or trabeculectomy (21% and 24%, P=0.001 and P<0.001, respectively). The percentage of patients who experienced worsening of vision was the highest after CPC (26%) and the least with GDD (20%).
Our meta-analysis shows that in patients with postkeratoplasty glaucoma, GDD is associated with greater IOP control, the lowest glaucoma surgery failure rate, and less vision loss compared with other forms of glaucoma surgery. However, GDD surgery is also associated with higher rate of graft failure.
对角膜移植术后青光眼进行荟萃分析，并直接比较小梁切除术、睫状体光凝术（CPC）和青光眼引流装置（GDD）对眼压（IOP）控制和角膜移植物存活率的影响。
我们在 Medline（Ovid、PubMed）、EMBASE 和 The Cochrane Library 数据库中搜索符合我们纳入标准的临床文章。主要结局指标为 IOP 控制和总体角膜移植物存活率。次要结局指标为原发性青光眼手术失败率和视力变化。我们使用每个研究中参与者人数加权的单向方差分析来比较结果。
从 13 篇文章中收集了 266 只眼的信息。与 CPC（20.4mmHg）和 GDD（20.2mmHg）相比，小梁切除术使眼压降低了 13.6mmHg（P<0.001）。青光眼手术的失败率最高，小梁切除术为 37%（95%CI，31.4%-41.9%），CPC 为 20.7%（95%CI，17.6%-23.7%），GDD 为 16%（95%CI，13.8%-18.9%），差异具有统计学意义（P<0.001）。与 CPC 或小梁切除术相比，GDD 与更高的角膜移植物失败率（35%）相关（分别为 21%和 24%，P=0.001 和 P<0.001）。CPC 组（26%）视力下降的患者比例最高，GDD 组（20%）最低。
我们的荟萃分析表明，在角膜移植术后青光眼患者中，与其他形式的青光眼手术相比，GDD 与更高的眼压控制、最低的青光眼手术失败率和较少的视力丧失相关，但 GDD 手术也与更高的移植物失败率相关。
