Background Many methods are widely studied to improve the therapeutic effect of trabeculectomy for glaucoma,and the clinical effectiveness of the amniotic membrane application during trabeculectomy is one of the research hotspots.Objective This study was to evaluate the efficacy and safety between trabeculectomy with (TE-AMT) and without amniotic membrane transplantation (TE-noAMT) for treating glaucoma.Methods Articles published from 1965 to December 2010 were searched from The Cochrane Library,PubMed,EMBASE,CNKI,Chinese Biomedicine Database,internet by computer,and manual search then was performed according to the predetermined strategy.Randomized controlled trials (RCT) on TE-AMT and TE-noAMT were included.The quality of included articles were scored based on Jadad table,and the relative parameters and information were extracted,including author,design of the trials,country,number of eyes and patients,gender,follow-up duration,age,classification of glaucoma,baseline IOP and loss rate.The main analysis indicators were the percentage of IOP reduction,completely operative successful rate,qualified success rate and adverse events.The pooled estimates were carried out with RevMan version 5.0 software.Results Nineteen RCTs documents were reviewed by meta-analysis with the Jaded scores ≥3 in 2 papers and ＜3 in 17 papers.Total 977 eyes of 818 patients were included.The weighted mean differences (WMD) of the percentage of IOP from baseline were (WMD =8.47％,95％ CI:5.20-11.75) at 6 months and (WMD=9.37％,95％ CI:4.97-13.77) at 12 months postoperatively.Relative risk (RR) of complete success rate and qualified success rate at postoperative 6 months were (1.40,95％ CI:1.19-1.65) and (0.47,95％ CI:0.22-1.00),respectively.RR values of adverse event such as shallow anterior chamber,hyphema,hypotony and choroidal detachment,failed filtering blebs at 6,12 months were 0.51 (95 ％ CI:0.30-0.85),0.43 (95％ CI:0.20-0.92),0.51(95％CI:0.26-1.00) and 0.57(95％CI:0.14-2.31),0.31(95％CI:0.20-0.47),0.31 (95％ CI:0.17-0.55),respectively.Conclusions TE-AMT appears to have better efficacy in lowering IOP,increasing complete success rate and reducing adverse event I in comparison with TE-noAMT.%背景 青光眼患者行小梁切除术后的疗效一直是眼科医师关注的问题,手术中羊膜植入的有效性评价成为目前该领域研究的热点之一. 目的 评价小梁切除术中应用羊膜(TE-AMT)和未应用羊膜(TE-noAMT)在青光眼治疗中的疗效和安全性. 方法 按照预先制定的检索策略,通过计算机检索The Cochrane Library、PubMed、CNKI、中国生物医学文献数据库等,并通过因特网和手工检索进行补充,检索时间从1965年1月至2010年12月,纳入小梁切除术中应用羊膜和未应用羊膜的临床随机对照试验的文献.参照Jadad量表评分标准对纳入的文献质量进行评价,并对纳入文献的相关参数和数据进行信息提取,包括文献作者、试验设计类型、国籍、眼数、患者数量、性别、随访时间、平均年龄、青光眼种类、基础眼压值、失访率；分析指标包括术后≥6个月的眼压下降率、手术成功率以及并发症情况,采用RevMan 5.0软件进行Meta分析.结果 共纳入19篇随机对照试验文献,其中15篇为Jadad量表评分2分以上,共纳入818例977眼.眼压的下降率在术后6个月和12个月的总体合并加权均数差(WMD=8.47％,95％ CI:5.20 ～ 11.75,P=0.00)、(WMD=9.37％,95％CI:4.97～13.77,P=0.O0)；完全手术成功率和条件手术成功率在术后6个月的总体相对危险度(RR)分别为(1.40,95％ CI:1.19～ 1.65)、(0.47,95％ CI:0.22 ～ 1.00).并发症发生情况分析表明,术后浅前房、前房出血、低眼压、脉络膜脱离,术后6个月和12个月非功能性滤过泡的RR分别为0.51(95％ CI:0.30 ～0.85)、0.43(95％ CI:0.20 ～0.92)、0.51 (95％ CI:0.26～1.00)、0.57 (95％ CI:0.14 ～2.31)、0.31(95％ CI:0.20～0.47)、0.31(95％ CI:0.17 ～0.55). 结论 Meta分析结果表明,与TE-noAMT手术比较,TE-AMT能更好地降低青光眼患者的术后眼压,提高完全手术成功率并降低并发症的发生率.
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