非穿透性青光眼手术治疗开角型青光眼有效性的系统评价

目的 评估非穿透性青光眼手术（NPGS）治疗开角型青光眼患者的降眼压（IOP）效果。方法 全面收集评价NPGS治疗原发性/继发性开角型青光眼的随机对照试验，进行系统评价。主要疗效指标包括IOP下降百分比和IOP达标率。应用多功能meta分析软件2.0版的随机效应模型进行汇总分析，计算合并评价量。结果 术后2年，与小梁切除术（TE）相比，深层巩膜切开术（DS）、黏小管切开术（VCO）的降眼压作用均相对较低，IOP下降百分比分别为35.2%（DS）、30.2%（VCO）、45.6%（TE）。术中加用植入物及丝裂霉素C（MMC）均可提高DS的降眼压作用，术后2年的IOP下降百分比分别为41.1%和41.7%。术后4年，DS、VCO、TE的IOP达标率分别为35.4%、22.7%、47.6%；DS加用植入物和MMC的IOP达标率分别为64.6%、52.1%，高于单纯DS。NPGS并发症的发生率较TE低。结论 常用的NPGS（DS和VCO）能有效降低眼压，并发症也比TE少，但是NPGS的降眼压作用要比TE为低。术中加用植入物、MMC可提高DS的降眼压作用。

Systematic Overview of the Efficacy of Nonpenetrating Glaucoma Surgery in the Treatment of Open Angle Glaucoma

Objective To evaluate the intraocular pressure (IOP)-lowering effects achieved by nonpenetrating glaucoma surgery (NPGS) in patients with open angle glaucoma. Methods Randomized controlled trials evaluating patients with primary and secondary open angle glaucoma treated with NPGS were identified and were subjected to systematic review analysis. The main outcome measurements included the percentage of IOP reduction and the complete success rate. The pooled estimates were calculated using the random effect model by comprehensive meta-analysis software version 2.0. Results Both deep sclerectomy (DS) and viscocanalostomy (VCO) were less effective than trabeculectomy (TE) in lowering IOP, with the of IOP reduction percent at 2 years being 35.2% for DS, 30.2% for VCO, and 45.6% for TE. Intraoperative use of implants and mitomycin C (MMC) improved IOP-lowering effects of DS, with IOP reduction at percent 2 years being 41.1% and 41.7%, respectively. The complete success rates at 4 years were 35.4% for DS and 22.7% for VCO, lower than that of TE (47.6%). The complete success rates of DS with implants and MMC were 64.6% and 52.1% at 4 years, respectively, both being higher than that of primary DS. NPGS caused less complications than TE. Conclusion Primary deep sclerectomy and primary viscocanalostomy can significantly lower IOP and have less complication than TE. However, the IOP-lowering effect of NPGS is slighter than primary TE. The efficacy of DS can be improved by intraoperative use of implants and MMC.