中国循证医学杂志

中国循证医学杂志

超声乳化联合小梁切除术治疗原发性闭角型青光眼合并白内障的系统评价

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目的系统评价超声乳化联合小梁切除术与单纯超声乳化术比较治疗原发性闭角型青光眼合并白内障的有效性和安全性。方法计算机检索 PubMed、EMbase、The Cochrane Library、CBM、CNKI、VIP 和 WanFang Data,搜集超声乳化联合小梁切除术与单纯超声乳化术比较治疗原发性闭角型青光眼合并白内障的随机对照试验(RCT),检索时间从建库至 2017 年 5 月。由 2 位研究者独立进行文献筛选、资料提取和评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。结果共纳入 8 个研究,包括 679 例患者。Meta 分析结果显示:超声乳化联合小梁切除术组与单纯超声乳化术在术后视力[MD=0.00,95%CI(–0.10,0.09),P=0.98]、术后前房深度[MD=0.14,95%CI(–0.17,0.45),P=0.37]和不良反应发生率[视神经损伤:RR=1.56,95%CI(0.70,3.47),P=0.28;视野缺损:RR=1.43,95%CI(0.70,2.92),P=0.33;角膜水肿:RR=0.57,95%CI(0.25,1.32),P=0.19]方面差异均无统计学意义。结论当前证据表明,超声乳化联合小梁切除术与单纯超声乳化术在治疗原发性闭角型青光眼合并白内障方面疗效和安全性相当。受纳入研究数量和质量的限制,上述结论尚需大样本高质量临床研究予以证实。

ObjectiveTo systematically review the efficacy and safety of phacoemulsification combined with trabeculectomy versus simple phacoemulsification for primary angle closure glaucoma with cataract.MethodsDatabases including PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about phacoemulsification combined with trabeculectomy vs. simple phacoemulsification for primary angle closure glaucoma with cataract from inception to May 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software.ResultsA total of eight studies involving 679 patients were included. The results of meta-analysis showed that: there were no significant differences between two groups in postoperative visual acuity (MD=0.00, 95%CI –0.10 to 0.09, P=0.98), postoperative anterior chamber depth (MD=0.14, 95%CI –0.17 to 0.45, P=0.37) and adverse reactions rates (optic nerve injury: RR=1.56, 95%CI 0.70 to 3.47, P=0.28; visual field defect: RR=1.43, 95%CI 0.70 to 2.92, P=0.33; corneal edema: RR=0.57, 95%CI 0.25 to 1.32, P=0.19).ConclusionCurrent evidence shows that phacoemulsification combined with trabeculectomy and simple phacoemulsification has the similar efficacy and safety for primary angle closure glaucoma with cataract. Due to limited quantity and quality of the included studies, the above conclusions still need to be verified by more high quality studies.

关键词: 超声乳化术; 小梁切除术; 原发性闭角型青光眼; 随机对照试验; 系统评价

Key words: Phacoemulsification; Trabeculectomy; Primary angle closure glaucoma; Randomized controlled trial; Systematic review

引用本文: 余晓娇, 陈春林, 周家兴, 叶剑. 超声乳化联合小梁切除术治疗原发性闭角型青光眼合并白内障的系统评价. 中国循证医学杂志, 2018, 18(2): 201-207. doi: 10.7507/1672-2531.201707089 复制

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