非穿透性小梁手术联合应用丝裂霉素C治疗开角型青光眼的meta分析

目的 评价非穿透性小梁手术联合使用丝裂霉素C对治疗开角型青光眼患者的疗效及耐受性的差异.方法 检索MEDLINE、EMBASE、中国生物医学文献数据库、Cochrane图书馆,获得以往发表的相关论文,经筛选后共有8项临床对照试验纳入meta分析.比较非穿透性小梁手术联合使用与未使用丝裂霉素C的眼压下降百分比、治疗完全成功率、治疗总成功率和并发症等指标.使用RevMan 5.0软件进行统计分析.结果 术后6、12、24、36个月非穿透性小梁手术联合使用丝裂霉素C组与单纯非穿透性小梁手术组眼压下降百分比的加权均数差分别为5.24％(95％CI,-3.24～13.72)、8.31％(95％CI,4.33～12.30)、9.56％(95％CI,4.88～14.24)、14.45％(95％CI,9.02～19.88),除术后6个月外的其余各个时间点两组之间差异均存在统计学意义(P＜0.05).非穿透性小梁手术联合使用丝裂霉素C组的治疗完全成功率较单纯非穿透性小梁手术组增加,治疗完全成功率的合并风险差在术后6、12、24、36个月分别为1.16(95％CI,1.05～1.27)、1.20(95％CI,1.05～1.38)、1.30(95％CI,1.05～1.61)、1.36(95％CI,1.06～1.73),各个时间点两组之间差异均存在统计学意义(P＜0.05).术中应用丝裂霉素C未出现与药物相关的并发症.结论 联合应用丝裂霉素C可以改善非穿透性小梁手术的疗效,而且耐受性良好.

Intra-operative mitomycin C for nonpenetrating filtering surgery in treatment of open angle glaucoma: a systematic review and meta-analysis

ObjectiveTo compare the efficacy and tolerability between nonpenetrating filtering surgery with (NPFS-MMC) and without (NPFS-noMMC) intraoperative mitomycin C application for treatment open angle glaucoma. MethodsPertinent studies were selected through extensive searches of the Cochrane Library, PubMed, Embase, and Chinese Biomedicine Database. Eight controlled clinical trials meeting the pre-defined criteria were systematically reviewed by meta-analysis. The main outcome measures were percentage intraocular pressure reduction (IOPR%), complete remission rate, total remission rate, and complications. The pooled estimates were carried out using RevMan version 5.0 software. ResultsThe weighted mean differences of the IOPR% between the NPFS-MMC group and NPFS-noMMC group were 5.24% (95% confidence intervals\95%CI\], -3.24 to 13.72) after 6 months, 8.31% (95%CI,4.33 to 12.30) after 12 months(P<0.05), 9.56% (95%CI, 4.88 to 14.24) after 24 months(P<0.05), and 14.45% (95%CI, 9.02 to 19.88) after 36 months(P<0.05). NPFS-MMC was associated with significant greater complete remission rates compared with NPFS-noMMC, with the pooled risk difference being 1.16 (95%CI, 1.05 to 1.27) after 6 months(P<0.05), 1.20 (95%CI, 1.05 to 1.38) after 12 months (P<0.05), 1.30 (95%CI, 1.05 to 1.61) after 24 months (P<0.05), and 1.36 (95%CI, 1.06 to 1.73) after 36 months (P<0.05). Intraoperative mitomycin C was not associated with any drug-induced complications. ConclusionThe use of intraoperative mitomycin C is safe and can improve the effect of nonpenetrating filtering surgery in patients with open ganle glaucoma.