比较贝伐单抗和MMC辅助小梁切除术效果的Meta分析  

Efficacy and safety of Bevacizumab versus MMC in augmenting trabeculectomy: a Meta-analysis

作　　者：王越[1] 柯敏[1] 王文欢[1] 

机构地区：[1]武汉大学中南医院眼科,中国湖北省武汉市430071

出　　处：《国际眼科杂志》2016年第11期2030-2035,共6页International Eye Science

摘　　要：目的：比较贝伐单抗与丝裂霉素C（ mitomycin C,MMC）辅助小梁切除术治疗青光眼的有效性和安全性。 方法：计算机检索 PubMed、CBM、VIP、CNKI 和万方数据库,查找所有比较贝伐单抗与MMC辅助小梁切除术治疗青光眼效果的随机对照试验（ randomized controlled trials, RCTs）,检索时限均为建库至2016-06-30。同时按纳入和排除标准由两名评价员独立进行RCT的筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果：共纳入4项研究,总计286眼（贝伐单抗组143眼, MMC组143眼）。 Meta分析结果显示：（1）有效性：贝伐单抗组与MMC组术后随访末次眼压（ intraocular pressure, IOP）（WMD=2.21,95% CI：-0.17-4.58,P=0.07）和手术完全成功率（OR=0.69,95% CI：0.26-1.81,P=0.45）均无统计学差异；两组患者随访末次抗青光眼药物使用数量（OR=0.12,95% CI：-0.15-0.39,P=0.39）相似,结果无统计学意义。（2）安全性：两组患者术后并发症发生率相同,无统计学差异,低眼压（OR=0.7,95% CI：0.12-4.05, P=0.69）、滤泡漏（OR=1,95% CI：0.21-4.74,P=1）、包囊型滤泡（OR=1.15,95% CI：0.38-3.44,P=0.81）、脉络膜脱离（OR=1.22,95% CI：0.29-5.22,P=0.78）和白内障（OR=1.15,95% CI：0.38-3.44,P=0.81）。 结论：小梁切除术联合贝伐单抗与联合MMC治疗青光眼具有相似的疗效和安全性,贝伐单抗并不能更有效地降低眼压,临床医师应根据患者疾病特点选择适合药物辅助手术。AIM： To compare the efficacy and safety of bevacizumab with mitomycin （ MMC ） in augmenting trabeculectomy for glaucoma. METHODS： Databases including PubMed, CBM, CNKI, VIP and WanFang Data were electronically searched for all randomized controlled trials （ RCTs） about comparing the efficacy and safety between bevacizumab and MMC in augmenting trabeculectomy for glaucoma before the date of Jun. 2016. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, and evaluated the included studies. Then, Meta-analysis was performed. RESULTS： A total 4 RCT involving 286 eyes （ 143 for bevacizumab group, 143 for MMC group） were included. The results of Meta-analysis showed that there was no significant difference between bevacizumab and MMC in the last follow-up after surgery in IOP （WMD=2. 21, 95%CI： -0.17 to 4.58, P=0.07）, complete success rate （OR=0. 69, 95%CI：0. 26 to 1. 81, P=0. 45） and the numbers of anti-glaucoma medicine （ OR= 0. 12, 95%CI： -0. 15 to 0.39,P=0. 39）. And there was no significant difference between bevacizumab and MMC in postoperative complications：hypotony （OR=0.7, 95%CI：0.12 to 4.05, P=0.69）, bleb leak （OR=1, 95%CI： 0. 21 to 4. 74,P=1）, encapsulated bleb （OR=1. 15, 95%CI： 0. 38 to 3. 44, P=0.81）, choroidal detachment （OR=1. 22, 95%CI： 0. 29 to 5.22, P=0. 78） and cataract （OR=1. 15, 95%CI： 0. 38 to 3.44, P=0. 81）. CONCLUSION： Bevacizumab and MMC in augmenting trabeculectomy for glaucoma have similar efficacy andsafety. Bevacizumab can＇t result in better outcome in term of IOP reduction. Clinicians should choose suitable solution according to disease characteristics.

关 键 词：贝伐单抗 小梁切除术 青光眼 META分析 

分 类 号：R779.6[医药卫生—眼科]