Cai Wenting, Lou Qiyang, Fan Jiaqi, Yu Donghui, Shen Tianyi, Yu Jing
Department of Ophthalmology, Ninghai First Hospital, Ninghai, Zhejiang, China.
Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China.
J Ophthalmol. 2019 May 2;2019:7697416. doi: 10.1155/2019/7697416. eCollection 2019.
The purpose of this meta-analysis was to assess the percent reduction in the intraocular pressure (IOP) after argon laser peripheral iridoplasty (ALPI) and systemic medical therapy in patients with acute primary angle closure (APAC).
We searched a number of electronic databases, including MEDLINE, EMBASE, PubMed, and Cochrane Library. We searched the electronic databases from the inception of the databases to August 2018. The primary outcomes included the IOP reduction (IOPR), percent reduction in IOP (IOPR%) from baseline to the endpoint and peripheral anterior synechiae (PAS). The secondary outcomes included the cup-to-disc ratio (CDR), mean endothelial count, and percent of patients requiring topical glaucoma medication. Summary weighted mean difference (WMD), odds ratio (OR), and 95% confidence intervals (CIs) were calculated.
Four eligible studies including 183 eyes (92 in the ALPI group and 91 in the medical therapy group) were identified. When comparing ALPI to medical therapy, the WMDs of the IOPR% were 30.03 (95% CI: 21.33 to 38.72, < 0.00001) at 15 minutes, 27.39 (95% CI: 18.89 to 35.89, < 0.00001) at 30 minutes, 18.15 (95% CI: 10.63 to 25.68, < 0.00001) at 1 hour, and 12.91 (95% CI: 4.50 to 21.32, =0.003) at 2 hours. There was no statistically significant difference between the two groups at 24 hours and at more than 6 months after therapy. Meanwhile, no significant difference was observed in the degree of PAS, CDR, mean endothelial count, and percent of patients requiring topical glaucoma medication after treatment between the two groups.
Both ALPI and systemic medications were effective with regard to decreasing the IOP. ALPI was more effective in lowering the IOP within the first two hours. Therefore, ALPI may be a better choice for rapidly lowering the IOP in patients with APAC within a short period.
本荟萃分析旨在评估氩激光周边虹膜成形术（ALPI）联合全身药物治疗对急性原发性闭角型青光眼（APAC）患者眼压（IOP）降低的百分比。
我们检索了多个电子数据库，包括MEDLINE、EMBASE、PubMed和Cochrane图书馆。我们检索了从数据库建立至2018年8月的电子数据库。主要结局包括眼压降低（IOPR）、从基线到终点的眼压降低百分比（IOPR%）以及周边前粘连（PAS）。次要结局包括杯盘比（CDR）、平均内皮细胞计数以及需要局部使用青光眼药物治疗的患者百分比。计算汇总加权平均差（WMD）、比值比（OR）和95%置信区间（CI）。
共纳入4项符合条件的研究，包括183只眼（ALPI组92只眼，药物治疗组91只眼）。将ALPI与药物治疗进行比较时，15分钟时IOPR%的WMD为30.03（95%CI：21.33至38.72，P<0.00001），30分钟时为27.39（95%CI：18.89至35.89，P< 0.00001），1小时时为18.15（95%CI：10.63至25.68，P<0.00001），2小时时为12.91（95%CI：4.50至21.32，P=0.003）。治疗后24小时及6个月以上，两组之间无统计学显著差异。同时，两组治疗后PAS程度、CDR、平均内皮细胞计数以及需要局部使用青光眼药物治疗的患者百分比均无显著差异。
ALPI和全身药物在降低IOP方面均有效。ALPI在前两小时内降低IOP更有效。因此，ALPI可能是短期内快速降低APAC患者IOP的更好选择。
