Discipline of Surgery, School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Ireland.
Acta Ophthalmol. 2024 Jun;102(4):e443-e451. doi: 10.1111/aos.16658. Epub 2024 Feb 20.
To compare the safety and efficacy of the Preserflo Microshunt with trabeculectomy in the treatment of patients with glaucoma. A systematic review and meta-analysis was conducted. The primary outcome measures recorded as a measure of efficacy of the interventions were intra-ocular pressure (IOP) at final follow-up and IOP reduction (IOPR). Secondary outcomes recorded to measure efficacy were reduction in the number of glaucoma medications and reinterventions. To assess safety profile, the proportions of patients with post-operative complications were recorded. Seven articles were included in this study. A total of 1353 eyes were included in this review (Preserflo: 812, trabeculectomy: 541). Post-operative IOP (mean difference [MD] = 0.78 [0.66, 0.90], p < 0.001) results are significantly lower for trabeculectomy than Preserflo. The IOPR (MD = -1.20 [-2.30, -0.09], p = 0.034) results significantly favour trabeculectomy over Preserflo Microshunt. The reduction in topical glaucoma medications (MD = -0.32 [-0.58, -0.07], p = 0.014) is significantly higher for trabeculectomy. There is no statistically significant difference in levels of hypotony (risk ratio [RR] = -0.05 [-0.47, 0.37], p = 0.806), choroidal effusion/detachment (RR = -0.12 [-0.42, 0.19], p = 0.444), hyphaema (RR = 0.20 [-0.11, 0.51], p = 0.216) and flat anterior chamber (RR = 0.49 [-1.02, 0.03], p = 0.066). There are significantly more bleb-related complications in the trabeculectomy groups than Preserflo groups (RR = -0.63 [-1.01, -0.24], p = 0.001). There were statistically more reinterventions required in the trabeculectomy groups than Preserflo groups (RR = -0.48 [-0.65, -0.30], p < 0.001). Compared to trabeculectomy, the Preserflo Microshunt is not as effective in lowering intra-ocular pressure, has a similar safety profile and has a lower reintervention rate. Further research is required given the lack of randomised controlled trials within this study and resulting low strength of evidence.
比较 Preserflo Microshunt 微导管与小梁切除术治疗青光眼的安全性和疗效。进行了系统评价和荟萃分析。记录的主要结局指标是干预措施的疗效测量，包括最终随访时的眼内压（IOP）和眼压降低（IOPR）。记录次要结局以衡量疗效的指标是青光眼药物使用数量和再干预的减少。为了评估安全性，记录了术后并发症患者的比例。本研究纳入了 7 篇文章。本综述共纳入 1353 只眼（Preserflo：812 只，小梁切除术：541 只）。术后 IOP（平均差异[MD]=0.78[0.66, 0.90]，p<0.001）结果表明小梁切除术组明显低于 Preserflo 组。IOPR（MD=-1.20[-2.30, -0.09]，p=0.034）结果表明小梁切除术组明显优于 Preserflo Microshunt 组。局部降眼压药物的减少（MD=-0.32[-0.58, -0.07]，p=0.014）小梁切除术组明显更高。低眼压的发生率在统计学上没有差异（风险比[RR]=-0.05[-0.47, 0.37]，p=0.806）、脉络膜脱离/积液（RR=-0.12[-0.42, 0.19]，p=0.444）、前房积血（RR=0.20[-0.11, 0.51]，p=0.216）和浅前房（RR=0.49[-1.02, 0.03]，p=0.066）。小梁切除术组的与滤过泡相关的并发症明显多于 Preserflo 组（RR=-0.63[-1.01, -0.24]，p=0.001）。小梁切除术组需要再次干预的次数明显多于 Preserflo 组（RR=-0.48[-0.65, -0.30]，p<0.001）。与小梁切除术相比，Preserflo Microshunt 降低眼内压的效果并不理想，安全性相似，且再干预率较低。由于本研究中缺乏随机对照试验，证据强度较低，因此需要进一步研究。
