Sun Yi, Zhang Bowen, Zhou Rouxi, Wang Tao, Deng Juan
Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Surgical Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
J Ophthalmol. 2019 Sep 24;2019:2071506. doi: 10.1155/2019/2071506. eCollection 2019.
Accumulating studies comparing the efficacy and safety of trabeculectomy and EX-PRESS implantation in open-angle glaucoma (OAG) report inconsistent findings. Thus, we conducted the updated meta-analysis to clarify the issue.
Randomized controlled trials (RCTs) were selected through search of databases PubMed, Web of Science, Embase, and the Cochrane Library from their inception up until November 2018. The pooled mean difference (MD) for intraocular pressure reduction (IOPR) and antiglaucoma medication reduction, odds ratio (OR) for operative success, complication, and postoperative intervention was calculated using the random effects model.
8 RCTs were enrolled, including 223 eyes in the EX-PRESS group and 217 eyes in the trabeculectomy group. EX-PRESS device implantation had a better IOPR% at 12 months postoperatively (MD = 8.9, 95% confidence interval (CI) = 2.5-15.3, =0.006). There was no statistically significant difference in the antiglaucoma medication reduction (MD = 6.01, 95% CI = -4.13-16.15, =0.25) and qualified success ( > 0.05). Statistically higher complete success at 1 year postoperatively was found in the EX-PRESS group (OR = 3.26, 95% CI = 1.24-8.55, =0.02). EX-PRESS was associated with a lower frequency of increased IOP (OR = 0.15, 95% CI = 0.03-0.93, =0.04) and hyphema (OR = 0.20, 95% CI = 0.05-0.74, =0.02). Less postoperative intervention was needed in the EX-PRESS group (OR = 0.43, 95% CI = 0.20-0.94, =0.04).
For OAG patients, EX-PRESS implantation provided better efficacy in IOP control and complete success at 1 year postoperatively, with fewer increased IOP and hyphema as well as postoperative interventions. EX-PRESS device and trabeculectomy were similar in the qualified success and antiglaucoma medication reduction.
越来越多比较小梁切除术和EX-PRESS植入术在开角型青光眼（OAG）治疗中的疗效和安全性的研究报告结果不一致。因此，我们进行了更新的荟萃分析以阐明该问题。
通过检索数据库PubMed、Web of Science、Embase和Cochrane图书馆，从其创建至2018年11月筛选随机对照试验（RCT）。使用随机效应模型计算眼压降低（IOPR）和抗青光眼药物减少的合并平均差（MD），手术成功率、并发症和术后干预的比值比（OR）。
纳入8项RCT，其中EX-PRESS组223眼，小梁切除术组217眼。EX-PRESS装置植入术后12个月时眼压降低百分比更好（MD = 8.9，95%置信区间（CI）= 2.5 - 15.3，P = 0.006）。抗青光眼药物减少方面无统计学显著差异（MD = 6.01，95% CI = -4.13 - 16.15，P = 0.25），合格成功率方面也无差异（P > 0.05）。EX-PRESS组术后1年完全成功率在统计学上更高（OR = 3.26，95% CI = 1.24 - 8.55，P = 0.02）。EX-PRESS与眼压升高频率较低（OR = 0.15，95% CI = 0.03 - 0.93，P = 0.04）和前房积血（OR = 0.20，95% CI = 0.05 - 0.74，P = 0.02）相关。EX-PRESS组术后需要的干预较少（OR = 0.43，95% CI = 0.20 - 0.94，P = 0.04）。
对于OAG患者，EX-PRESS植入术在眼压控制和术后1年完全成功率方面疗效更好，眼压升高和前房积血以及术后干预更少。EX-PRESS装置和小梁切除术在合格成功率和抗青光眼药物减少方面相似。
