Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Clin Exp Ophthalmol. 2024 Sep-Oct;52(7):740-760. doi: 10.1111/ceo.14408. Epub 2024 Jun 9.
This systematic review and meta-analysis quantitatively examines the efficacy of angle-based minimally invasive glaucoma surgery (MIGS) in normal tension glaucoma (NTG).
A literature search was performed on Medline, Embase, PubMed, CINAHL and Cochrane Library from inception until 20 December 2022. Pilot, cohort, observational studies and randomised controlled trials including at least 5 subjects undergoing angle-based MIGS (trabecular-bypass devices, excisional trabeculotomy, goniotomy and ab-interno canaloplasty) for NTG, with or without cataract surgery, were included. Meta-analysis of continuous outcome using the meta routine in R version 2022.12.0+353 was performed to determine mean intraocular pressure (IOP) and anti-glaucoma medication (AGM) reduction post-operatively.
Of the 846 studies initially identified, 15 studies with a pooled total of 367 eyes which underwent combined phacoemulsification and angle-based MIGS were included for final meta-analysis. Outcomes of the iStent were reported in 5 studies, iStent inject in 7 studies, Hydrus Microstent in 1 study, Kahook Dual Blade in 3 studies, and Trabectome in 2 studies. There was significant reduction in both IOP and AGM post-operatively at 6 months (2.44 mmHg, 95%CI: 1.83-3.06; 1.21 AGM, 95%CI: 0.99-1.44), 12 months (2.28 mmHg, 95%CI: 1.71-2.84; 1.18 AGM, 95%CI: 0.90-1.47), 24 months (2.10 mmHg, 95%CI: 1.51-2.68; 1.26 AGM, 95%CI: 0.85-1.68) and 36 months (2.43 mmHg, 95%CI: 1.71-3.15, 0.87 AGM, 95%CI: 0.21-1.53) (all p < 0.05). Subgroup analysis on combined phacoemulsification-iStent inject surgery demonstrated a reduction in both IOP (2.31 mmHg, 95%CI: 1.07-3.56, p < 0.001) and AGM (1.07 AGM, 95%CI: 0.86-1.29, p < 0.001) at 12 months post-operatively.
Angle-based MIGS combined with phacoemulsification effectively reduces IOP and AGM in NTG eyes for up to 36 months after surgery.
本系统评价和荟萃分析定量研究了基于角度的微创青光眼手术（MIGS）在正常眼压性青光眼（NTG）中的疗效。
从建库到 2022 年 12 月 20 日，我们在 Medline、Embase、PubMed、CINAHL 和 Cochrane 图书馆中进行了文献检索。纳入了至少 5 例接受基于角度的 MIGS（小梁旁路装置、小梁切开术、房角切开术和内路巩膜切开术）治疗 NTG 的试点、队列、观察性研究和随机对照试验，包括接受白内障手术或不接受白内障手术的患者。使用 R 版本 2022.12.0+353 中的 meta 例程对连续结果进行荟萃分析，以确定术后平均眼内压（IOP）和抗青光眼药物（AGM）的降低。
最初确定的 846 项研究中，有 15 项研究共纳入 367 只眼，这些研究均接受了联合超声乳化白内障吸除术和基于角度的 MIGS 治疗，最终进行了荟萃分析。5 项研究报告了 iStent 的结果，7 项研究报告了 iStent inject 的结果，1 项研究报告了 Hydrus Microstent 的结果，3 项研究报告了 Kahook Dual Blade 的结果，2 项研究报告了 Trabectome 的结果。术后 6 个月（2.44mmHg，95%CI：1.83-3.06；1.21 AGM，95%CI：0.99-1.44）、12 个月（2.28mmHg，95%CI：1.71-2.84；1.18 AGM，95%CI：0.90-1.47）、24 个月（2.10mmHg，95%CI：1.51-2.68；1.26 AGM，95%CI：0.85-1.68）和 36 个月（2.43mmHg，95%CI：1.71-3.15，0.87 AGM，95%CI：0.21-1.53）时，IOP 和 AGM 均显著降低（均 P<0.05）。联合超声乳化白内障吸除术-iStent inject 手术的亚组分析显示，术后 12 个月时，IOP（2.31mmHg，95%CI：1.07-3.56，P<0.001）和 AGM（1.07 AGM，95%CI：0.86-1.29，P<0.001）均显著降低。
对于 NTG 眼，基于角度的 MIGS 联合超声乳化白内障吸除术可有效降低术后长达 36 个月的 IOP 和 AGM。
