Han Luyi, Mao Yingyan, Sang Qing, Wan Yue, Wang Ningli
Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, China.
Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, China.
Surv Ophthalmol. 2025 Nov-Dec;70(6):1035-1042. doi: 10.1016/j.survophthal.2025.06.001. Epub 2025 Jun 6.
Microcatheter-assisted minimally invasive glaucoma surgery (MIGS) procedures are increasingly being used as an alternative to trabeculectomy combined with mitomycin C (MMC Trab) for controlling intraocular pressure (IOP) in open-angle glaucoma (OAG), but there are no head-to-head trials comparing different microcatheter-assisted MIGS procedures and MMC Trab. We evaluate the relative efficacy and safety of microcatheter-assisted MIGS procedures, including microcatheter-assisted trabeculotomy (MAT), gonioscopy-assisted transluminal trabeculotomy (GATT), Ab-interno Canaloplasty(ABiC), ab externo canaloplasty(ABeC), and trabeculotome tunnelling trabeculoplasty surgery (3 T), through a network meta-analysis with a focus on their priority ranking in IOP reduction and medication use. MMC Trab was included as the reference standard to contextualize the performance of emerging microcatheter-assisted techniques. We conducted searches for studies published between 01/01/2009 and 16/10/2024, with no restrictions regarding participant age or language of publication. We followed a protocol registered on PROSPERO (CRD42024557637). PRISMA guidelines were followed for reporting. For observational studies and randomized clinical trials, use the Newcastle-Ottawa Quality Assessment Scale and Cochrane Risk of Bias tool for Randomized Trials (RoB 2) respectively for evaluation. Data extraction was conducted by 2 independent reviewers, and then checked and adjudicated by a third reviewer. The mean differences for continuous variables, risk ratios for binary variables, 95 % credible intervals, and ranks of interventions were estimated. The outcomes examined included the reduction (%) in IOP and the reduction in medication used from baseline at 3 months and 1 year. We also extracted adverse events reported, such as hyphema, IOP spike and hypotony. Sixteen studies (a total of 1081 eyes) were included in the NMA. For efficacy at 1 year, MAT showed no significant difference compared to MMC Trab in both percent reduction in IOP (MD -4.78 % (95 %CI -3.01-3.45 %), SUCRA 65.7) and reduction in medication used (MD 0.18 (95 %CI -0.19-0.54 %), SUCRA 97.4), GATT (MD -7.20 % (95 %CI -13.73 % to -0.67 %), SUCRA 53.1 %) showed no significant difference from MMC Trab in terms of reduction in medication use. For complications within 3 months postoperatively, all microcatheter-assisted MIGS procedures showed no significant difference versus MMC Trab in terms of postoperative IOP spike. GATT (RR 0.06 (95 %CI, 0.01-0.35), SUCRA 87 %) and ABeC (RR 0.3 (95 %CI, 0.1-2.92), SUCRA 44.3 %) were associated with a lower risk of hypotony compared to MMC Trab. All microcatheter-assisted MIGS procedures were associated with a higher risk of hyphema. Compared to MMC Trab, MAT showed no significant difference in efficacy at 1 year postoperatively, and certain microcatheter-assisted MIGS procedures have specific advantages over MMC Trab in terms of postoperative complications.
微导管辅助微创青光眼手术（MIGS）越来越多地被用作小梁切除术联合丝裂霉素C（MMC小梁切除术）的替代方法，用于控制开角型青光眼（OAG）的眼压（IOP），但尚无直接比较不同微导管辅助MIGS手术和MMC小梁切除术的头对头试验。我们通过网络荟萃分析评估微导管辅助MIGS手术的相对疗效和安全性，包括微导管辅助小梁切开术（MAT）、前房角镜辅助经腔小梁切开术（GATT）、内路房角成形术（ABiC）、外路房角成形术（ABeC）和小梁刀隧道小梁成形术（3T），重点关注它们在降低眼压和药物使用方面的优先排名。将MMC小梁切除术作为参考标准，以了解新兴微导管辅助技术的性能。我们检索了2009年1月1日至2024年10月16日发表的研究，对参与者年龄或发表语言没有限制。我们遵循在PROSPERO（CRD42024557637）上注册的方案。报告遵循PRISMA指南。对于观察性研究和随机临床试验，分别使用纽卡斯尔-渥太华质量评估量表和Cochrane随机试验偏倚风险工具（RoB 2）进行评估。数据提取由2名独立评审员进行，然后由第三名评审员进行检查和裁决。估计连续变量的平均差异、二元变量的风险比、95%可信区间和干预措施的排名。检查的结果包括眼压降低的百分比（%）以及3个月和1年时与基线相比药物使用的减少情况。我们还提取了报告的不良事件，如前房积血、眼压峰值和低眼压。网络荟萃分析纳入了16项研究（共1081只眼）。在1年的疗效方面，MAT在眼压降低百分比（MD -4.78%（95%CI -3.01-3.45%），SUCRA 65.7）和药物使用减少方面（MD 0.18（95%CI -0.19-0.54%），SUCRA 97.4）与MMC小梁切除术相比均无显著差异，GATT（MD -7.20%（95%CI -13.73%至-0.67%），SUCRA 53.1%）在药物使用减少方面与MMC小梁切除术相比无显著差异。在术后3个月内的并发症方面，所有微导管辅助MIGS手术在术后眼压峰值方面与MMC小梁切除术相比均无显著差异。与MMC小梁切除术相比，GATT（RR 0.06（95%CI，0.01-0.35），SUCRA 87%）和ABeC（RR 0.3（95%CI，0.1-2.92），SUCRA 44.3%）发生低眼压的风险较低。所有微导管辅助MIGS手术发生前房积血的风险较高。与MMC小梁切除术相比，MAT术后1年的疗效无显著差异，某些微导管辅助MIGS手术在术后并发症方面比MMC小梁切除术具有特定优势。
