Clinical Research Laboratory, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy.
Department of Ophthalmology, University of Brescia, Brescia, Italy.
JAMA Ophthalmol. 2013 Dec;131(12):1573-82. doi: 10.1001/jamaophthalmol.2013.5059.
To date, only a few studies have directly compared nonpenetrating surgery (NPS) and trabeculectomy (TE). Therefore, there is no strong evidence as to which surgical technique leads to the best results in terms of ocular hypotensive effect and safety.
To compare the hypotensive effect and safety of NPS and TE in terms of intraocular pressure (IOP) reduction and incidence of complications.
The MEDLINE and EMBASE databases were searched for studies potentially eligible in any language published up to March 31, 2013.
Systematic review and meta-analysis of comparative studies of 2 or more surgical techniques (1 of which had to be TE), including patients with open-angle glaucoma.
The considered interventions were TE, deep sclerectomy (DS), viscocanalostomy, and canaloplasty.
The primary outcome was the mean between-group difference in the reduction in diurnal IOP from baseline to the 6- or 12-month follow-up evaluation. We also considered the incidence of complications, expressed as relative risk.
Eighteen articles, accounting for 20 comparisons, were selected for data extraction and analysis. Analysis of the 6-month follow-up data showed that the pooled estimate of the mean between-group difference was -2.15 mm Hg (95% CI, -2.85 to -1.44) in favor of TE. There was no difference between the NPS subgroups. In the subgroup antimetabolite analysis, the addition of mitomycin C to TE and DS decreased the difference in the reduction in IOP (TE and DS without mitomycin C: -2.65 mm Hg [95% CI, -3.90 to -1.39]; TE and DS with mitomycin C: -0.83 mm Hg [95% CI, -2.40 to 0.74]). In the subgroup analysis by implant addition, no significant difference induced by DS with or without drainage devices was detected (test for subgroup differences: χ(2)(1) = 0.24; P = .62). The absolute risk of hypotony, choroidal effusion, cataract, and flat or shallow anterior chamber was higher in the TE group than in the NPS group.
Trabeculectomy seems to be the most effective surgical procedure for reducing IOP in patients with open-angle glaucoma. However, as expected, it was associated with a higher incidence of complications when compared with NPS.
迄今为止，仅有少数研究直接比较了非穿透性手术（NPS）和小梁切除术（TE）。因此，尚无强有力的证据表明哪种手术技术在降压效果和安全性方面效果最佳。
比较 NPS 和 TE 在眼压（IOP）降低和并发症发生率方面的降压效果和安全性。
以任何语言发表的截止到 2013 年 3 月 31 日的潜在合格研究的 MEDLINE 和 EMBASE 数据库进行检索。
2 种或多种手术技术（其中 1 种必须为 TE）的系统评价和荟萃分析，包括开角型青光眼患者。
考虑的干预措施为 TE、深层巩膜切除术（DS）、黏弹剂分离术和房水引流管植入术。
主要结局是从基线到 6 个月或 12 个月随访评估时两组间日间 IOP 降低的平均组间差异。我们还考虑了以相对危险度表示的并发症发生率。
纳入了 18 篇文章，共 20 个比较，用于提取和分析数据。分析 6 个月随访数据显示，TE 组的平均组间差异估计值为-2.15mmHg（95%CI，-2.85 至-1.44），有利于 TE。NPS 亚组之间没有差异。在抗代谢物分析亚组中，将丝裂霉素 C 加入 TE 和 DS 可降低 IOP 降低的差异（TE 和 DS 无丝裂霉素 C：-2.65mmHg[95%CI，-3.90 至-1.39]；TE 和 DS 加丝裂霉素 C：-0.83mmHg[95%CI，-2.40 至 0.74]）。在植入物添加亚组分析中，未检测到 DS 加或不加引流装置引起的显著差异（检验亚组差异：χ²（1）=0.24；P=0.62）。与 NPS 组相比，TE 组发生低眼压、脉络膜脱离、白内障和扁平或浅前房的绝对风险更高。
小梁切除术似乎是降低开角型青光眼患者眼压的最有效手术方法。然而，与 NPS 相比，其预期的并发症发生率更高。
