Popovic Marko, Campos-Moller Xavier, Saheb Hady, Ahmed Iqbal Ike K
Research Assistant, Faculty of Medicine, University of Toronto, Toronto, Canada.
Ophthalmologist, Western Health Eye Care Centre, Corner Brook, Newfoundland, Canada.
J Curr Glaucoma Pract. 2018 May-Aug;12(2):67-84. doi: 10.5005/jp-journals-10008-1248. Epub 2018 Aug 1.
This meta-analysis explores the efficacy and adverse event profile of the iStent, an ab interno implant for the treatment of open-angle glaucoma.
A systematic literature search of Ovid MEDLINE and EMBASE was used to identify peer-reviewed original studies that provided efficacy data on the first or second generation iStent for at least five eyes. Intraocular pressure (IOP) was the primary efficacy endpoint, while the number of medication classes was the secondary outcome. Weighted mean differences were reported for continuous endpoints, while a relative risk was computed for dichotomous variables.
The search revealed 545 results, of which 1767 eyes from 28 studies were included. The cohort age was 71.4 ± 5.4 years, and 44.9% of patients were male. There was a significantly greater IOP reduction after the use of two first-generation stents compared to one, irrespective of phacoemulsification status (p < 0.001). Additionally, there was a significantly greater IOP reduction following iStent alone relative to phaco-iStent for the first-generation iStent (p < 0.001) and the iStent inject (p < 0.001). For the first generation stent, combined phaco-iStent provided a greater level of IOP reduction (p < 0.001) and reduction in the number of medication classes relative to phacoemulsification alone (p < 0.001). In total, 22.5% of eyes that received iStent implantation sustained some type of adverse event. The most common adverse events were intraocular pressure elevation, stent blockage or obstruction, stent malposition and hyphema.
Statistically significant differences in efficacy outcomes exist between different numbers of stents and the presence or absence of concurrent phacoemulsification. Popovic M, Campos-Moller X, Saheb H, Ahmed IIK. Efficacy and Adverse Event Profile of the iStent and iStent Inject Trabecular Micro-bypass for Open-angle Glaucoma: A Meta-analysis. J Curr Glaucoma Pract 2018;12(2):67-84.
本荟萃分析探讨iStent（一种用于治疗开角型青光眼的眼内植入物）的疗效和不良事件情况。
通过对Ovid MEDLINE和EMBASE进行系统文献检索，以确定至少为五只眼提供第一代或第二代iStent疗效数据的同行评审原始研究。眼压（IOP）是主要疗效终点，而药物种类数量是次要结局。对于连续性终点报告加权平均差，对于二分变量计算相对风险。
检索共得到545条结果，其中纳入了来自28项研究的1767只眼。队列年龄为71.4±5.4岁，44.9%的患者为男性。无论是否进行超声乳化手术，使用两个第一代支架后眼压降低幅度显著大于使用一个支架（p<0.001）。此外，对于第一代iStent，单独使用iStent后的眼压降低幅度显著大于超声乳化联合iStent（p<0.001）以及iStent注射装置（p<0.001）。对于第一代支架，超声乳化联合iStent相对于单纯超声乳化手术，眼压降低幅度更大（p<0.001），且药物种类数量减少（p<0.001）。总共22.5%接受iStent植入的眼发生了某种类型的不良事件。最常见的不良事件是眼压升高、支架堵塞或梗阻、支架位置异常和前房积血。
不同数量的支架以及是否同时进行超声乳化手术在疗效结果上存在统计学显著差异。波波维奇M、坎波斯 - 莫勒X、萨赫布H、艾哈迈德IIK。iStent及iStent注射小梁微旁路治疗开角型青光眼的疗效和不良事件情况：一项荟萃分析。《当代青光眼实践杂志》2018年；12(2):67 - 84。
