选择性激光小梁成形术或前列腺素类药物初始治疗开角型青光眼和高眼压症的M eta 分析

摘要

目的：评价选择性激光小梁成形术（ SLT）或前列腺素衍生物（ PGA）治疗开角型青光眼（ OAG）及高眼压症（ OHT ）的疗效。方法文献分析。通过计算机检索 Medline （1966年1月至2012年12月），EMBASE Reviews （1974年1月至2012年12月），OVID循证医学数据库、中国生物医学文献数据库 SinoMed （1978年1月至2012年12月）及 CNKI 数据库（1999年1月至2012年12月），并采用手工检索等方法收集会议文献，纳入所有相关随机对照试验。评价所纳入研究的方法学质量后，采用RevMan 5.0软件进行Meta分析。结果共纳入3个随机对照试验，161例（231只眼）开角型青光眼或高眼压症患者。 Meta 分析结果表明，SLT组降低眼压值较PGA组少0.85 mmHg [1 mmHg＝0.133 kPa；WMD＝-0.85，95％CI（-1.43～-0.27）；P＝0.82，I2＝0％]；治愈成功率两组相当[OR＝0.70，95％CI＝（0.49～1.19）；P＝0.58，I2＝0％]；PGA组需要补充治疗的患眼所占比例较SLT组大[OR＝1.11，95％CI（0.60～2.06）；P＝0.08，I2＝61％]。结论对于开角型青光眼或高眼压症的初始治疗，SLT与PGA治疗成功率相当；SLT降低眼压值幅度较单一PGA小，与PGA相比，SLT可以减少患者抗青光眼药物的使用种类。（中华眼科杂志，2014，50：343-348）%Objective To compare the efficacy of selective laser trabeculoplasty ( SLT ) versus prostaglandinanalogue ( PGA) in the treatment of open angle glaucoma ( OAG) and ocular hypertension ( OHT) . Methods Literature analysis.Systematic review of randomized controlled trials comparing SLT versus PGA , identified by searching literatures including Medline (January,1966-December, 2012), EMBASE Reviews ( January , 1974-December , 2012 ) OVID Evidence-Based Medicine Reviews ( January , 1966-December , 2012), Chinese BioMedical Literature Database SinoMed (January,1966-December, 2012), and CNKI (January,1999-December, 2012).RevMan 5.0 was used to do meta-analysis.Results Three publications reporting 3 trials, 161 participants ( 231 eyes ) with OHT or OAG were included for meta-analysis.IOP reduction favored PGA group,weighted mean difference (WMD) =-0.85 [1 mmHg=0.133 kPa;95%confidence interval (CI) ( -1.43 to -0.27), no significant heterogeneity present ( P =0.82, I2 =0%)].Success rates are equal in two groups [OR =0.70,95%CI =(0.49 to 1.19), no significant heterogeneity present (P=0.58,I2 =0%)].Eyes underwent additional antiglaumatous interventions favored SLT group,OR=1.11 [95%CI =(0.60 to 2.06), significant heterogeneity present, (P=0.08, I2 =61%) ].Conclusions As primary therapy of OAG or OHT , SLT is no more effective than PGA in success rate.IOP reduction affected by SLT is not effective than PGA.Compared with PGA , SLT can reduce the use of anti-glaucoma medications.