Chen Xuhao, Suo Lingge, Hong Ying, Zhang Chun
Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
J Ophthalmol. 2020 Nov 30;2020:4310258. doi: 10.1155/2020/4310258. eCollection 2020.
Bleb needling with subconjunctival injection of antimetabolites had become a widely accepted approach for trabeculectomy failure. However, IOP reduction effects, success rates, and complications occurrence for this procedure showed great inconsistency among the different studies.
We conducted a literature search on PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. A random-effects model was performed on the extracted data based on the included studies. The intraocular pressure (IOP) and number of antiglaucomatous medications before and after the surgery were pooled for meta-analysis. The success and complication rates were estimated based on the results. Subgroup analysis, sensitivity analysis, and metaregression were applied to explore the origination of heterogeneity.
Thirty-seven studies with a total of 2182 patients were finally included in our review. For the present meta-analysis, the overall effects of bleb needling at the last visit revealed a reduction in IOP of 9.74 mmHg (95% confidence interval (CI) [8.85, 10.63]), 45.9% (95% CI [39.0%, 53.0%]) for complete success rate, and 70.4% (95% CI [63.5%, 77.0%]) for qualified success rate. Application of mitomycin C (MMC) and 5-fluorouracil (5-Fu) during the procedure were efficacious for IOP control during the follow-up. Metaregression revealed that possible origination of heterogeneity was baseline IOP before bleb needling, revealing a trend that higher baseline IOP correlated with a greater IOP reduction results ( < 0.001). For safety profile, conjunctival haemorrhage (5.7%, 95% CI [2.5%, 10.1%]), hyphema (5.5%, 95% CI [3.0%, 8.7%]), and bleb leakage (5.0%, 95% CI [3.2%, 7.3%]) had the highest estimate of incidence. An increasing number of needling was the main risk factor for needling failure.
Bleb needling with antimetabolites could be considered an effective and safe procedure after trabeculectomy failure. After the process, patients will gain IOP control and reduce antiglaucomatous medications for at least six months with 5-Fu or MMC. Meanwhile, the overall estimates for complications were relatively low in the whole process.
小梁切除术失败后，结膜下注射抗代谢药物的滤过泡针刺术已成为一种广泛接受的方法。然而，该手术的眼压降低效果、成功率和并发症发生率在不同研究中差异很大。
我们在PubMed、Embase、Cochrane图书馆和ClinicalTrials.gov上进行了文献检索。基于纳入的研究，对提取的数据进行随机效应模型分析。汇总手术前后的眼压（IOP）和抗青光眼药物数量进行荟萃分析。根据结果估计成功率和并发症发生率。应用亚组分析、敏感性分析和Meta回归来探讨异质性的来源。
我们的综述最终纳入了37项研究，共2182例患者。对于本次荟萃分析，末次随访时滤过泡针刺术的总体效果显示眼压降低9.74 mmHg（95%置信区间[CI][8.85, 10.63]），完全成功率为45.9%（95% CI[39.0%, 53.0%]），合格成功率为70.4%（95% CI[63.5%, 77.0%]）。术中应用丝裂霉素C（MMC）和5-氟尿嘧啶（5-Fu）在随访期间对眼压控制有效。Meta回归显示，异质性的可能来源是滤过泡针刺术前的基线眼压，显示出基线眼压越高与眼压降低结果越大相关的趋势（<0.001）。在安全性方面，结膜出血（5.7%，95% CI[2.5%, 10.1%]）、前房积血（5.5%，95% CI[3.0%, 8.7%]）和滤过泡渗漏（5.0%，95% CI[3.2%, 7.3%]）的发生率估计最高。针刺次数增加是针刺失败的主要危险因素。
小梁切除术失败后，抗代谢药物滤过泡针刺术可被认为是一种有效且安全的手术。术后，患者使用5-Fu或MMC可实现至少六个月的眼压控制并减少抗青光眼药物使用。同时，整个过程中并发症的总体估计相对较低。
