选择性激光小梁成形术与抗青光眼药物治疗青光眼和高眼压症疗效的Meta分析  

A meta-analysis of selective laser trabeculoplasty versus antiglaucomatous medication for glaucomatous and ocular hypertensive eyes

作　　者：魏雅慧 李雪迎[2] 才瑜[1] 

机构地区：[1]北京大学第一医院眼科,100034 [2]北京大学第一医院统计室,100034

出　　处：《中华实验眼科杂志》2016年第11期1019-1024,共6页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景 选择性激光小梁成形术（SLT）和抗青光眼药物均可用于青光眼或高眼压症（OHT）的治疗,但目前还缺乏比较两种治疗方法的疗效和安全性的循证医学证据. 目的 评价和比较SLT与抗青光眼药物治疗青光眼及OHT的疗效和安全性. 方法 利用计算机检索Pubmed、Embase、Cochrane Controlled Trials Register database、万方数据库2016年5月前发表的关于比较SLT与抗青光眼药物治疗青光眼及OHT疗效的随机对照研究的文献,采用Revman 5.3软件进行Meta分析,疗效评价指标包括眼压下降幅度值（IOPR）和治疗成功率,安全性评价指标包括治疗的不良反应.采用加权均数差值（WMD）分析IOPR,采用比值比（OR）分析随访期间的治疗成功率.结果 纳入6项随机临床对照试验,样本量共361例598眼（高加索人243眼,亚裔291眼,其他人种64眼）,研究对象均为青光眼或OHT患者,其中5项研究（431眼）比较了SLT与抗青光眼药物治疗后的IOPR,药物组患者IOPR比SLT组多0.21 mmHg（1 mmHg=0.133 kPa）,差异有统计学意义[WMD=-0.21 mmHg;95％置信区间（CI）：-0.30,-0.11;P＜0.000 1],各研究间无异质性（I^2=0％）.纳入的6项研究均比较了2种治疗方法的成功率,药物组成功率高于SLT组,差异有统计学意义（OR=0.57;95％ CI：0.37 -0.87;P=0.01）,各研究间无异质性（I^2=13％）. 结论 抗青光眼药物和SLT疗法对青光眼和OHT患者均有降眼压作用,但抗青光眼药物的降眼压效果优于SLT.Background Selective laser trabeculoplasty （SLT） and antiglaucomatous medications can be used to treat both glaucoma and ocular hypertension.However,which is more effective and safe remains proofless.Objective This meta-analysis was to identify the possible differences in clinical outcomes between SLT and topical medication administration in the treatment of glaucoma and ocular hypertension.Methods Pertinent prospective randomized controlled trials that compare the efficacy and safety between SLT and medication were selected by extensive searches of PubMed,Embase,Cochrane Controlled Trials Register database and Wanfang database from their inception to May 2016.The efficacy included the range of intraocular pressure reduce （IOPR） and successful rate in follow-up period were estimated by weighted mean difference （WMD） and the odds ratio （OR） respectively.The safety was to observe the adverse reactions of both SLT and medications.Results Six prospective randomized controlled trials were included in the meta-analysis with 598 eyes of 361 patients who suffered from glaucoma and ocular hypertension,including 243 eyes of Caucasian patients,291 eyes of Asian patients and 67 eyes of other races.Five studies involving 431 eyes compared SLT with medication in terms of IOPR and showed that the IOPR in antiglaucomatous medication group was 0.21 mmHg higher than that in the SLT group [WMD =-0.21 mmHg;95% （confidence interval） CI：-0.30,-0.11;P〈0.000 1].No statistical heterogeneity was observed among the studies （I^2 =0%）.All the six studies reported success rate and exhibited that the successful rate was higher in antiglaucomatous medication group than that in the SLT group,with statistical significance between the 2 groups （OR=0.57;95% CI：0.37,0.87;P =0.01）.No statistical heterogeneity was observed （I^2 =13%）.Conclusions Both antiglaucomatous medication and SLT therapies can lower IOP in the patients with glaucoma and ocular hypertension,and the medication therapy seems to be more effectiv

关 键 词：青光眼/治疗 高眼压症/治疗 选择性小梁成形术 激光/治疗用途 药物 随机对照临床试验 META分析 

分 类 号：R779.6[医药卫生—眼科]