Ahmadzadeh Afrouz, Kessel Line, Subhi Yousif, Bach-Holm Daniella
Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
J Ophthalmol. 2021 Feb 13;2021:6682534. doi: 10.1155/2021/6682534. eCollection 2021.
There is no consensus on the surgical management of coexisting cataract in patients who undergo glaucoma surgery. In this study, we systematically reviewed the literature to compare the efficacy and safety of phacotrabeculectomy and trabeculectomy either alone or followed by later phacoemulsification. We systematically searched the literature databases PubMed/MEDLINE, EMBASE, and the Cochrane Central. Eligible studies were comparative trials of eyes with glaucoma that underwent either phacotrabeculectomy or trabeculectomy with or without later phacoemulsification. Our primary outcome measure was intraocular pressure (IOP) control closest to 12 months. Secondary outcome measures were efficacy closest to 12 months in terms of visual acuity, visual field, prevalence of complications, needling or revision, number of antiglaucomatous medications, and surgical success. We identified 25 studies with a total of 4,749 eyes. The IOP did not differ significantly between those who underwent phacotrabeculectomy versus trabeculectomy with (MD: 0.63, CI95%: -0.32, 1.59, =0.19) or without later phacoemulsification (MD: -0.52, CI95%: -1.45, 0.40, =0.27). However, phacotrabeculectomy was associated with lower risk of complications (RR: 0.80, CI95%: 0.67, 0.95, =0.01) and better visual acuity corresponding to a 1.4-line difference (MD: -0.14, CI95%: -0.27, -0.95, =0.03) compared to trabeculectomy. Other secondary outcome measures did not differ significantly (visual field, needling or revision, number of antiglaucomatous medications, and surgical success). In conclusion, postoperative IOP is comparable, and the number of complications is lower when phacotrabeculectomy is compared to trabeculectomy with or without later phacoemulsification in patients with coexisting glaucoma and cataract. However, our study also reveals that the level of evidence is low, and randomized clinical trials are warranted.
对于接受青光眼手术的患者并存白内障的手术治疗，目前尚无共识。在本研究中，我们系统回顾了文献，以比较超声乳化小梁切除术和单纯小梁切除术（无论是否随后进行超声乳化）的疗效和安全性。我们系统检索了文献数据库PubMed/MEDLINE、EMBASE和Cochrane Central。符合条件的研究是对接受超声乳化小梁切除术或小梁切除术（无论是否随后进行超声乳化）的青光眼患者进行的对照试验。我们的主要结局指标是最接近12个月时的眼压（IOP）控制情况。次要结局指标包括最接近12个月时的视力、视野、并发症发生率、针刺或翻修、抗青光眼药物数量以及手术成功率方面的疗效。我们确定了25项研究，共涉及4749只眼睛。接受超声乳化小梁切除术的患者与接受小梁切除术（无论是否随后进行超声乳化）的患者相比，眼压无显著差异（平均差：0.63，95%置信区间：-0.32，1.59，P = 0.19）。然而，与小梁切除术相比，超声乳化小梁切除术的并发症风险较低（风险比：0.80，95%置信区间：0.67，0.95，P = 0.01），且视力更好，相差1.4行（平均差：-0.14，95%置信区间：-0.27，-0.05，P = 0.03）。其他次要结局指标无显著差异（视野、针刺或翻修、抗青光眼药物数量以及手术成功率）。总之，在并存青光眼和白内障的患者中，与单纯小梁切除术或小梁切除术后再行超声乳化相比，超声乳化小梁切除术后的眼压相当，并发症数量更少。然而，我们的研究也表明证据水平较低，有必要进行随机临床试验。
