背景:这项系统综述和荟萃分析定量检查了基于角度的微创青光眼手术(MIGS)在正常眼压性青光眼(NTG)中的疗效。
方法:在Medline上进行了文献检索,Embase,PubMed,CINAHL和Cochrane图书馆从成立到2022年12月20日。飞行员,队列,观察性研究和随机对照试验,包括至少5名接受基于角度的MIGS(小梁旁路装置,切除小梁切开术,NTG的性腺切开术和行囊腔内成形术),有或没有白内障手术,包括在内。使用R版本2022.12.0+353的meta常规对连续结局进行meta分析,以确定术后平均眼压(IOP)和抗青光眼药物(AGM)降低。
结果:在最初确定的846项研究中,最终的荟萃分析包括15项研究,共有367只眼进行了联合超声乳化和基于角度的MIGS。在5项研究中报告了iStent的结果,7项研究中的iStent注射,1项研究中的Hydrus微支架,KahookDualBlade在3项研究中,和小梁在2项研究中。术后6个月眼压和AGM均显著降低(2.44mmHg,95CI:1.83-3.06;1.21AGM,95CI:0.99-1.44),12个月(2.28mmHg,95CI:1.71-2.84;1.18AGM,95CI:0.90-1.47),24个月(2.10mmHg,95CI:1.51-2.68;1.26AGM,95CI:0.85-1.68)和36个月(2.43mmHg,95CI:1.71-3.15,0.87AGM,95CI:0.21-1.53)(所有p<0.05)。联合超声乳化-支架注射手术的亚组分析显示两种眼压均降低(2.31mmHg,95CI:1.07-3.56,p<0.001)和AGM(1.07AGM,95CI:0.86-1.29,p<0.001),术后12个月。
结论:基于角度的MIGS联合超声乳化术可有效降低NTG眼术后36个月的IOP和AGM。
BACKGROUND: This systematic review and meta-analysis quantitatively examines the efficacy of angle-based minimally invasive glaucoma surgery (MIGS) in normal tension glaucoma (NTG).
METHODS: A literature search was performed on Medline, Embase, PubMed, CINAHL and Cochrane Library from inception until 20 December 2022. Pilot, cohort, observational studies and randomised controlled trials including at least 5 subjects undergoing angle-based MIGS (trabecular-bypass devices, excisional trabeculotomy, goniotomy and ab-interno canaloplasty) for NTG, with or without cataract surgery, were included. Meta-analysis of continuous outcome using the meta routine in R version 2022.12.0+353 was performed to determine mean intraocular pressure (IOP) and anti-glaucoma medication (AGM) reduction post-operatively.
RESULTS: Of the 846 studies initially identified, 15 studies with a pooled total of 367 eyes which underwent combined phacoemulsification and angle-based MIGS were included for final meta-analysis. Outcomes of the iStent were reported in 5 studies, iStent inject in 7 studies, Hydrus Microstent in 1 study, Kahook Dual Blade in 3 studies, and Trabectome in 2 studies. There was significant reduction in both IOP and AGM post-operatively at 6 months (2.44 mmHg, 95%CI: 1.83-3.06; 1.21 AGM, 95%CI: 0.99-1.44), 12 months (2.28 mmHg, 95%CI: 1.71-2.84; 1.18 AGM, 95%CI: 0.90-1.47), 24 months (2.10 mmHg, 95%CI: 1.51-2.68; 1.26 AGM, 95%CI: 0.85-1.68) and 36 months (2.43 mmHg, 95%CI: 1.71-3.15, 0.87 AGM, 95%CI: 0.21-1.53) (all p < 0.05). Subgroup analysis on combined phacoemulsification-iStent inject surgery demonstrated a reduction in both IOP (2.31 mmHg, 95%CI: 1.07-3.56, p < 0.001) and AGM (1.07 AGM, 95%CI: 0.86-1.29, p < 0.001) at 12 months post-operatively.
CONCLUSIONS: Angle-based MIGS combined with phacoemulsification effectively reduces IOP and AGM in NTG eyes for up to 36 months after surgery.