背景:Ahmed青光眼瓣膜(AGV)是治疗难治性青光眼的常用手术方法。Aurolab房水引流植入物(AADI)是近年来在临床上应用的一种新型手术方法。
目的:本研究的目的是比较AADI和AGV治疗难治性青光眼的疗效和安全性。
方法:我们全面搜索了四个数据库,包括PubMed,EMBASE,WebofScience,和Cochrane图书馆的数据库,选择相关研究。连续变量,即,降低眼压(IOPR)和减少抗青光眼药物(AGMR),由加权平均差(WMD)汇集,和二分法的结果,包括成功率和并发症的结果通过比值比(ORs)进行汇总.
结果:共纳入来自6项研究的820名患者的825只眼。在3个月时,AADI和AGV植入物之间的IOPR的WMD为0.58(95%CI:0.07至1.09),6个月时为0.44(95%CI:0.11至0.77),12个月时为2.20(95%CI:0.63至3.77),随访终点为3.24(95%CI:1.73至4.75)。在任何时间点两组之间检测到显著差异。在6个月时,AADI和AGV植入物之间的AGMR的WMD为0.87(95%CI:0.61至1.13),12个月时1.04(95%CI:0.66至1.42),在随访终点为0.93(95%CI:0.52至1.34),在任何时间点差异均达到统计学意义。AADI与AGV的合并OR比较,完全成功率为3.64(95%CI:2.44至5.45),合格成功率为1.72(95%CI:1.24至2.39),两组间有显著差异。AADI和AGV植入物之间的不良事件发生率没有显着差异。
结论:AADI在手术成功率和降低IOP和AGM方面更有效。两种植入物可能具有相当的不良事件发生率。
BACKGROUND: Ahmed glaucoma valve (AGV) is a common surgical method for the treatment of refractory glaucoma.Aurolab aqueous drainage implant (AADI) is a novel surgical method which has been applied in clinical practice in recent years.
OBJECTIVE: The purpose of this study was to compare the efficacy and safety of the AADI and the AGV for the treatment of refractory glaucoma.
METHODS: We comprehensively searched four databases, including PubMed, Embase, Web of Science, and the Cochrane Library databases, selecting the relevant studies. The continuous variables, namely, intraocular pressure reduction (IOPR) and a reduction in antiglaucoma medication (AGMR), were pooled by the weighted mean differences (WMDs), and the dichotomous outcomes, including success rates and complications, were pooled by the odds ratio (OR).
RESULTS: A total of 825 eyes from 820 patients from six studies were included. The WMDs of the IOPR between the AADI and the AGV implant were 0.58 (95% CI: 0.07-1.09) at 3 months, 0.44 (95% CI: 0.11-0.77) at 6 months, 2.20 (95% CI: 0.63-3.77) at 12 months, and 3.24 (95% CI: 1.73-4.75) at follow-up endpoint. Significant difference was detected between the two groups at any point in time. The WMDs of the AGMR between the AADI and the AGV implant were 0.87 (95% CI: 0.61-1.13) at 6 months, 1.04 (95% CI: 0.66-1.42) at 12 months, and 0.93 (95% CI: 0.52-1.34) at the follow-up endpoint; the differences reached statistical significance at any point in time. The pooled ORs comparing the AADI with the AGV were 3.64 (95% CI: 2.44-5.45) for the complete success rate and 1.72 (95% CI: 1.24-2.39) for qualified success rate; significant difference was detected between the two groups. There were no significant differences between the AADI and the AGV implant on the rates of adverse events.
CONCLUSIONS: The AADI is more effective in both its surgical success rate and reducing IOP and AGM. And the two implants may have comparable incidences of adverse events.