摘要
背景初期白内障晶状体增厚是引起原发性闭角型青光眼（PACG）发病的主要因素之一。目前国内外有大量文献报道单纯白内障超声乳化术或白内障超声乳化联合小梁切除术治疗合并白内障的PACG，但哪种手术方式更安全、有效尚缺少循证医学的证据。目的系统评价和比较白内障超声乳化术与超声乳化联合小梁切除术治疗PACG的临床疗效。方法按照预定的检索策略用计算机检索1966年1月至2011年6月PubMed和EMBReviews收录期刊发表的关于单纯白内障超声乳化术或白内障超声乳化联合小梁切除术治疗PACG合并白内障的文献、CochraneLibrary数据库（2011年第1期）及中国生物医学文献数据库收录的1979年1月至2011年6月发表的相关文献，并采用手工检索等方法收集会议文献，纳入所有相关研究的临床随机对照试验（RCT）。根据RCT设计的标准对纳入研究的方法学质量进行评级，评价指标包括眼压降低水平、术后抗青光眼药物用量、术后并发症的发生率、术后最佳矫正视力（BCVA）的情况和青光眼视野损害进展，采用RevMan4．2软件进行Meta分析。结果共纳入3篇关于单纯白内障超声乳化与白内障超声乳化联合小梁切除术治疗PACG合并白内障的RCT，总样本量为164例164眼。Meta分析结果表明，与单纯白内障超声乳化术相比，白内障超声乳化联合小梁切除术手术后患者眼压降低的幅度较大（WMD=1．17，95％CI：0．06～2．27，P=0．040）；术后抗青光眼药物用量减少（WMD=0．50，95％CI：0．24～0．77，P=0．000）；手术后并发症的发生率增加（RR=0．08，95％CI：0．02～0．33，P=0．000）。两者手术后BCVA（WMD=0，95％CI：一0．13～0．13，P=1．000）以及青光眼视野损害进展（WMD=1．01，95％CI：0．56～1．82，P=0．980）的差异均无统计学意义。结论与单纯白内障超声乳化术相比，白内障超声乳化联合小梁切除术降眼压效果好，但安全性下降，两种术式术后对BCVA及青光眼视野损害进展的影响接近。因病例数较少，上述结论有待更多大样本RCT加以验证。
Background Increase of lens thickness at incipient cataract is a key factor of onset of primary angle-closure glaucoma （PACG）. Phacoemulsifieation （Phaeo） or phacotrabeculeetomy （Phacotrabe） have been documented to be effective for the patients of PACG associated with cataract. However,which surgery is more effective and safe is lack of evidence. Objective This study was to assess and compare the clinical effectiveness of Phaco versus Phacotrabe for PACG with cataract. Methods The relevant literature was searched electronically from the PubMed （1966 to June 2011）,EMB Reviews （1966 to June 2011） and Cochrane Library （Issue 1,2011）. The manually searching of relevant conference proceedings was used as the supplement. The articles of randomized controlled trial （RCT） about the clinical effectiveness of Phaco versus Phacotrabe for PACG with cataract wereincluded. The methodology quality of included literature was graded. The analysis indexes included intraocular pressure （IOP）-lowing range, postoperative administration of glaucoma drugs, incidence of positive complication, postoperative best corrective visual acuity （BCVA） and perimetry damage. The RevMan4.2 software from Cochrane Collaboration was used for the Meta analyses. Results Three RCTs about phaco versus Phacotrabe for PACG with cataract were selected in this study with the 164 eyes of 164 cases. Meta analysis showed that the lOP-lowing range was larger in the Phacotrabe group compared to only Phaco group with the WMD of 1. 17 and 95% C1 of 0.06-2.27 （ P = 0. 040） ,and the drug dosage of anti-glaucoma was less in the Phacotrabe group in comparison with the Phaco group with the WMD of 0.5 and 95% C1 of 0. 24- 0.77 （P = 0. 000）. However, the incidence of postoperative complication was higher in the Phacotrabe group than that of the Phaco group with the RR of 0. 08 and 95% C1 of 0. 02-0.33 （P= 0. 000）. No significant difference was found in the BCVA （WMD = 0,95% CI：-0. 13-0. 13, P=I.00） and perimetry （WMD =1.01,95%CI： 0.56-1.82,P=0.98）. Conclusions Compared with Phaco, Phacotrab has a better lOP-lowing effectiveness and slightly worse safety. Phaco and Phacotrab have a fairly influence in the postoperative BCVA and perimetry. As the sample sizes of the included trials are relatively small, more well- designed large-scale RCTs are needed.
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2013年第3期270-274,共5页
Chinese Journal Of Experimental Ophthalmology
基金
卫生部临床学科重点项目
