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目的评价首选青光眼引流装置(GDD)植入术与小梁切除术治疗青光眼的疗效及术后并发症的差异。设计系统综述。研究对象国内外于1966年至2009年发表与未发表的以青光眼患者作为研究对象,治疗方案采用GDD植入术与小梁切除术相比较的所有临床对照研究。方法采用Cochrane系统评价方法,检索Medline(1966~2009)、EMbase(1966~2009)、Cochrane图书馆(2009)及中国生物医学文献数据库CBM(1979~2009),按照纳入和排除标准收集所有相关临床对照研究,通过Jadad评分量表进行文献质量评估后,使用Cochrane协作网提供的RevMan4.2统计软件进行Meta分析,以获得GDD植入术与小梁切除术治疗青光眼患者的疗效及术后并发症是否存在差异的相关证据。主要指标不同研究中眼压降低、最佳矫正视力和术后并发症发生的组间差异。结果共纳入GDD植入术与小梁切除术治疗青光眼的临床对照研究8项,共计877眼。Meta分析结果显示,GDD植入术治疗青光眼在降低眼压、维持最佳矫正视力方面,与联合抗代谢药物的小梁切除术治疗组间的差异没有统计学意义(P>0.05)。各研究中随访期间两组间并发症和不良事件的发生分别为20.2%(GDD植入术组)和22.1%(小梁切除术组),两组间差异无统计学意义(P>0.05)。结论首选GDD植入术治疗青光眼与小梁切除术相比疗效相仿、术后并发症发生率近似,两术式间在疗效和安全性方面未见明显差异。
Objective To evaluate the efficacy and postoperative complications of glaucoma treated with the preferred glaucoma drainage system (GDD) and trabeculectomy. Design System Review. The subjects studied were published and unpublished studies from 1966 to 2009 in glaucoma patients at home and abroad. All the controlled clinical trials of GDD implantation and trabeculectomy were compared. Methods The Cochrane systematic review method was used to search all the related clinics according to inclusion and exclusion criteria, including Medline (1966-2009), EMbase (1966-2009), Cochrane Library (2009) and China Biomedical Literature Database CBM (1979-2009) The control study, after evaluating the quality of the literature by the Jadad Rating Scale, was performed using Meta-analysis using the RevMan 4.2 statistical software provided by the Cochrane Collaboration to obtain the efficacy and postoperative complications of GDD and trabeculectomy in patients with glaucoma Whether there is any difference between the relevant evidence. The main indicators of different studies in reducing intraocular pressure, best corrected visual acuity and postoperative complications occurred between the groups. Results A total of 8 controlled clinical trials of GDD implantation and trabeculectomy for glaucoma were included. Meta analysis showed that there was no significant difference between the GDD group and the trabeculectomy group (P> 0.05) in the treatment of glaucoma with reducing intraocular pressure and maintaining the best corrected visual acuity. Complications and adverse events were 20.2% (GDD) and 22.1% (trabeculectomy) during follow-up in each study, with no significant difference between the two groups (P> 0.05) . Conclusion The treatment of glaucoma with primary GDD is similar to trabeculectomy and the incidence of postoperative complications is similar. There is no significant difference between the two methods in efficacy and safety.