眼内注射抗血管内皮生长因子(抗VEGF)在抑制新生血管性青光眼(NVG)中的眼新血管形成方面表现出显著功效。Ahmed青光眼阀植入术(AGVI)广泛用于治疗各种青光眼类型。
■进一步评价抗VEGF联合AGVI治疗新生血管性青光眼的疗效和安全性。
■在八个数据库中对随机对照试验(RCT)进行了彻底搜索:PubMed,EMBASE,Cochrane图书馆,WebofScience,中国国家知识基础设施,万方,SinoMed,和VIP。搜索期从每个数据库开始到2024年3月2日,以确定研究AGVI与抗VEGF治疗对NVG的有效性和安全性的RCT。我们使用Cochrane偏差风险评估工具评估文献质量,并使用Stata15.0软件进行统计分析。
■14项随机对照试验纳入本研究。与单独的AGVI相比,抗VEGF药物和AGVI联合应用可降低术后1周时的眼压(IOP)[WMD=-4.03,95%CI(-5.73,-2.34),p<0.001],1个月[WMD=-5.39,95%CI(-7.05,-3.74),p<0.001],3个月[WMD=-6.59,95%CI(-7.85,-5.32),p<0.001],6个月[WMD=-4.99,95%CI(-9.56,-0.43),p=0.032],超过12个月[WMD=-3.86,95%CI(-6.82,-0.90),p=0.011],有效率较高[RR=1.27,95%CI(1.18,1.37),p<0.001],术后前房积血发生率降低[RR=0.24,95%CI(0.15,0.39),p<0.001],减少术后抗青光眼药物的使用[WMD=-0.48,95%CI(-0.61,-0.35),p<0.001],房水VEGF水平降低[SMD=-2.84,95%CI(-4.37,-1.31),p<0.001]。
■与单独的AGVI相比,AGVI联合抗VEGF治疗在不同时间间隔降低IOP方面效果较好,减少术后抗青光眼药物需求和降低房水VEGF水平。此外,它有效地减少了术后前房积血的发生率。然而,由于所包括的试验质量的可变性,未来将需要进一步的高质量实验来证实这一结论。
■PROSPERO,标识符CRD42024519862,https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42024519862。
UNASSIGNED: The intraocular injections of anti-vascular endothelial growth factor (anti-VEGF) demonstrates significant efficacy in inhibiting the formation of ocular neovascularization in neovascular glaucoma (NVG). Ahmed glaucoma valve implantation (AGVI) is extensively employed for the management of diverse glaucoma types.
UNASSIGNED: To further evaluate the efficacy and safety of anti-VEGF combined with AGVI in the treatment of neovascular glaucoma.
UNASSIGNED: A thorough search for randomized controlled trials (RCTs) was conducted across eight databases: PubMed, EMBASE, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, SinoMed, and VIP. The search period was set from the inception of each database until March 2, 2024, to identify RCTs investigating the effectiveness and safety of combining AGVI with anti-VEGF therapy for NVG. We used the Cochrane Risk of Bias Assessment Tool to evaluate the quality of the literature and performed statistical analysis using Stata 15.0 software.
UNASSIGNED: Fourteen RCTs were included in this study. Compared with AGVI alone, the combination of anti-VEGF drugs and AGVI can reduce postoperative intraocular pressure (IOP) at 1 week [WMD = -4.03, 95% CI (-5.73, -2.34), p < 0.001], 1 month [WMD = -5.39, 95% CI (-7.05, -3.74), p < 0.001], 3 months [WMD = -6.59, 95% CI (-7.85, -5.32), p < 0.001], 6 months [WMD = -4.99, 95% CI (-9.56, -0.43), p = 0.032], and more than 12 months [WMD = -3.86, 95% CI (-6.82, -0.90), p = 0.011], with a higher Effective rate [RR = 1.27, 95% CI (1.18, 1.37), p < 0.001], decreased incidence of postoperative hyphema [RR = 0.24, 95% CI (0.15, 0.39), p < 0.001], reduced use of postoperative antiglaucoma medications [WMD = -0.48, 95% CI (-0.61, -0.35), p < 0.001], and decreased aqueous humor VEGF levels [SMD = -2.84, 95% CI (-4.37, -1.31), p < 0.001].
UNASSIGNED: In comparison to AGVI alone, the combination of AGVI with anti-VEGF therapy has better effects in reducing IOP at various time intervals, diminishing postoperative antiglaucoma medication requirements and reducing aqueous humor VEGF levels. Furthermore, it effectively minimizes the incidence of postoperative hyphema. Nevertheless, due to the variability in the quality of the trials included, further high-quality experiments will be required in the future to substantiate this conclusion.
UNASSIGNED: PROSPERO, identifier CRD42024519862, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024519862.