目的:小梁切除术,青光眼的初级手术治疗,通常使用丝裂霉素C(MMC)来减少瘢痕形成并改善手术效果。然而,MMC的最优应用方法,无论是注射还是海绵,仍然是一个辩论的主题。这项荟萃分析旨在比较可注射和海绵基MMC在疗效和安全性方面的应用。关注青光眼患者的各种临床结果。
方法:Scopus的全面文献检索,MEDLINE,EMBASE,奥维德,中国生物医学文献数据库,中国国家知识基础设施,和Cochrane图书馆是针对符合条件的研究进行的,这些研究报告了青光眼患者在小梁切除术期间通过注射或海绵应用MMC的数据.感兴趣的结果包括眼内压(IOP)降低,气泡外观分级(高度,范围,血管分布),使用抗青光眼药物,和完全成功率,合格的成功,和失败。数据报告为加权平均差(WMD)或比值比(OR)和置信区间(CI)。采用Tau2的DerSimonian-Laird估计的随机效应逆方差模型,在必要时应用连续性校正。
结果:共纳入15项研究,1276名参与者。荟萃分析显示,通过MMC注射和海绵应用治疗的患者在降低IOP方面没有显着差异(WMD=-0.434)。在高度(WMD=-0.170)和程度(WMD=0.174)的气泡外观评分方面观察到显着差异,具有很大的异质性。注射组抗青光眼药物的使用明显较低(WMD=-0.274)。然而,完全成功率没有显着差异,合格的成功,和失败。该研究显示了各种结果的中度到高度异质性。
结论:这项荟萃分析表明,虽然在小梁切除术期间注射和海绵方法应用MMC对降低眼压同样有效,它们对气泡形态和术后药物需求的影响不同。研究结果强调了青光眼手术中个性化治疗方法的必要性,考虑到每个患者的具体需求和特征。
OBJECTIVE: Trabeculectomy, a primary surgical treatment for glaucoma, often employs mitomycin C (MMC) to reduce scar formation and improve surgical outcomes. However, the optimal application method of MMC, whether by injection or sponge, remains a subject of debate. This meta-analysis aims to compare injectable and sponge-based MMC application in terms of efficacy and safety, focusing on various clinical outcomes in glaucoma patients.
METHODS: A comprehensive literature search of Scopus, MEDLINE, EMBASE, Ovid, Chinese biomedical literature database,
China National Knowledge Infrastructure, and Cochrane Library was done for eligible studies that report data of glaucoma patients who were administered MMC by injection or sponge application during
trabeculectomy. Outcomes of interest included intraocular pressure (IOP) reduction, bleb appearance grading (height, extent, vascularity), use of anti-glaucoma medications, and rates of complete success, qualified success, and failure. Data were reported as weighted mean differences (WMD) or odds ratios (OR) with confidence intervals (CI). The random-effects inverse-variance model with DerSimonian-Laird estimate of tau2 was employed, with continuity correction applied where necessary.
RESULTS: A total of 15 studies with 1276 participants were included. The meta-analysis revealed no significant difference in IOP reduction between patients treated by MMC injection and sponge application (WMD = - 0.434). Significant differences were observed in bleb appearance grading scores for height (WMD = - 0.170) and extent (WMD = 0.174), with substantial heterogeneity. The use of anti-glaucoma medications was significantly lower in the injection group (WMD = - 0.274). However, there were no significant differences in the rates of complete success, qualified success, and failure. The study demonstrated moderate to high heterogeneity across various outcomes.
CONCLUSIONS: This meta-analysis indicated that while both injection and sponge methods of MMC application during
trabeculectomy were equally effective for IOP reduction, they differ in their impact on bleb morphology and postoperative medication requirement. The findings highlight the need for individualized treatment approaches in glaucoma surgery, taking into account the specific needs and characteristics of each patient.