Abstract：
OBJECTIVE: The effectiveness of mitomycin C (MMC) in trabeculectomy has long been established. The aim of this review is to evaluate the efficacy and safety of adjunctive agents in tube shunt drainage device surgery for glaucoma or ocular hypertension, since controversy still exists regarding their benefit.
METHODS: We searched CENTRAL, PubMed, Embase, Web of Science, Scopus, and BASE for RCTs, which have used adjuvant antimetabolites-either MMC or 5-Fluorouracil (5-FU)-and/or anti-vascular endothelial growth factors (anti-VEGF) agents. The main outcome was IOP reduction at 12 months.
RESULTS: Ten studies met our inclusion criteria. Nine used the Ahmed Glaucoma Valve (AGV) implant, while the double-plate Molteno implant was used in one study. Four studies used MMC. The remaining six studies used an anti-VEGF drug - either bevacizumab, ranibizumab or conbercept. Only one MMC-study reported a significant difference in the IOP reduction between groups at 12 months, favouring the MMC group (55% and 51%; p < 0.01). A significant difference was also reported by two out of five bevacizumab-studies, both favouring the bevacizumab group (55% and 51%, p < 0.05; 58% and 27%, p < 0.05), with the highest benefit seen in neovascular glaucoma cases, especially when panretinal photocoagulation (PRP) was also used. Neither ranibizumab nor conbercept were found to produce significant differences between groups regarding IOP reduction.
CONCLUSIONS: There is no high-quality evidence to support the use of MMC in tube shunt surgery. As for anti-VEGF agents, specifically bevacizumab, significant benefit seems to exist in neovascular glaucoma patients, especially if combined with PRP.
METHODS: We searched CENTRAL, PubMed, Embase, Web of Science, Scopus, and BASE for RCTs, which have used adjuvant antimetabolites-either MMC or 5-Fluorouracil (5-FU)-and/or anti-vascular endothelial growth factors (anti-VEGF) agents. The main outcome was IOP reduction at 12 months.
RESULTS: Ten studies met our inclusion criteria. Nine used the Ahmed Glaucoma Valve (AGV) implant, while the double-plate Molteno implant was used in one study. Four studies used MMC. The remaining six studies used an anti-VEGF drug - either bevacizumab, ranibizumab or conbercept. Only one MMC-study reported a significant difference in the IOP reduction between groups at 12 months, favouring the MMC group (55% and 51%; p < 0.01). A significant difference was also reported by two out of five bevacizumab-studies, both favouring the bevacizumab group (55% and 51%, p < 0.05; 58% and 27%, p < 0.05), with the highest benefit seen in neovascular glaucoma cases, especially when panretinal photocoagulation (PRP) was also used. Neither ranibizumab nor conbercept were found to produce significant differences between groups regarding IOP reduction.
CONCLUSIONS: There is no high-quality evidence to support the use of MMC in tube shunt surgery. As for anti-VEGF agents, specifically bevacizumab, significant benefit seems to exist in neovascular glaucoma patients, especially if combined with PRP.
摘要：
目的：丝裂霉素C（MMC）在小梁切除术中的有效性早已确立。这篇综述的目的是评估辅助药物在青光眼或高眼压管分流引流装置手术中的疗效和安全性。因为关于他们的利益仍然存在争议。
方法：我们搜索了CENTRAL，PubMed,Embase,WebofScience,Scopus,和RCT的基础，已使用佐剂抗代谢物-MMC或5-氟尿嘧啶（5-FU）-和/或抗血管内皮生长因子（抗VEGF）剂。主要结果是12个月时IOP降低。
结果：10项研究符合纳入标准。9人使用了Ahmed青光眼瓣膜（AGV）植入物，而在一项研究中使用了双板Molteno植入物。4项研究使用MMC。其余六项研究使用了抗VEGF药物-贝伐单抗，雷珠单抗或康柏西普。只有一项MMC研究报告了12个月时组间IOP降低的显着差异，有利于MMC组(55%和51%；p<0.01)。五个贝伐单抗研究中的两个也报告了显着差异，两者都有利于贝伐单抗组(55%和51%，p<0.05；58%和27%，p<0.05)，在新生血管性青光眼病例中获益最高，特别是当也使用全视网膜光凝（PRP）时。没有发现雷珠单抗和康柏西普在降低IOP方面在组间产生显著差异。
结论：没有高质量的证据支持在管分流手术中使用MMC。至于抗VEGF药物，特别是贝伐单抗，新生血管性青光眼患者似乎存在显著的益处，特别是与PRP结合使用时。
方法：我们搜索了CENTRAL，PubMed,Embase,WebofScience,Scopus,和RCT的基础，已使用佐剂抗代谢物-MMC或5-氟尿嘧啶（5-FU）-和/或抗血管内皮生长因子（抗VEGF）剂。主要结果是12个月时IOP降低。
结果：10项研究符合纳入标准。9人使用了Ahmed青光眼瓣膜（AGV）植入物，而在一项研究中使用了双板Molteno植入物。4项研究使用MMC。其余六项研究使用了抗VEGF药物-贝伐单抗，雷珠单抗或康柏西普。只有一项MMC研究报告了12个月时组间IOP降低的显着差异，有利于MMC组(55%和51%；p<0.01)。五个贝伐单抗研究中的两个也报告了显着差异，两者都有利于贝伐单抗组(55%和51%，p<0.05；58%和27%，p<0.05)，在新生血管性青光眼病例中获益最高，特别是当也使用全视网膜光凝（PRP）时。没有发现雷珠单抗和康柏西普在降低IOP方面在组间产生显著差异。
结论：没有高质量的证据支持在管分流手术中使用MMC。至于抗VEGF药物，特别是贝伐单抗，新生血管性青光眼患者似乎存在显著的益处，特别是与PRP结合使用时。
