不同切口超声乳化白内障吸除术联合小梁切除术的疗效和耐受性的荟萃分析

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1、不同切口超声乳化白内障吸除术联合小梁切除术的疗效和耐受性的荟萃分析作者：刘鹤南，李迅，聂庆珠，陈晓隆【摘要】目的：评价并比较一切口和二切口超声乳化白内障吸除术联合小梁切除术治疗白内障合并青光眼的疗效和耐受性。方法：按照Cochrane协作网方法全面检索符合纳入标准的比较一切口和二切口超声乳化白内障吸除术联合小梁切除术的临床对照研究，将其进行荟萃分析。临床疗效的评估包括：眼压下降百分比采用标准化均差(SMD)，术后最佳矫正视力≥0.5的患者百分比采用比值比(OR)，手术成功率采用相对危险度(RR)。临床耐受性的评估采用RR。所有结果均以95%可信区间

2、表示。数据分析采用Stata10.1。结果：降低眼压的临床疗效二切口术式明显优于一切口术式，差异具有统计学意义(SMD，0.19;95%CI，0.33到0.04;P=0.01);术后最佳矫正视力≥0.5的患者百分比二切口术式大于一切口术式，但差异不具有统计学意义(OR，0.65;95%CI，0.30到1.39;P=0.26);术后不加用抗青光眼药物达到靶眼压的患者百分比二切口术式大于一切口术式，但差异不具有统计学意义(RR,0.94;95%CI,0.84到1.04;P=0.22);两种术式在术后并发症方面差别无统计学意义。结论：二切口超声乳化

3、白内障吸除术联合小梁切除术临床疗效优于一切口术式。两种术式的术后并发症没有明显差异。32【关键词】超声乳化白内障吸除术联合小梁切除术;一切口;二切口;荟萃分析　INTRODUCTION　　Withtheincreasingelderlypopulationandconcurrentlongevityinlifeexpectancy,thereisanincreaseintheincidenceofcoexistingvisuallysignificantcataractandglaucoma.Oneofthechallengesinthemanag

4、ementofsurgicalprocedureisdifficultyinsolvingthesetwoproblemssimultaneously.Phacoemulsificationalonemaybebeneficialinsomecases,whichresultsinbetterintraocularpressure(IOP)thanplannedextracapsularcataractextractionprocedures,andperformingtheglaucomafilteringsurgeryfirstandtheca

5、taractsurgerylatermaybestserveothers[1].However,thereisawidespreadshifttowardstheuseofcombinedphacotrabeculectomyasthesurgicaltreatmentofchoiceforcoexistingcataractandglaucomainrecentyears[24].　　Phacotrabeculectomycanbeperformedeitherusingonesiteortwositeincisions[5].Theear

6、liestclinicalstudiesofphacotrabeculectomywhichisknownasaonesite32procedurereportedsurgicalresultsusingthesamethescleraltunnelincisionforboththephacoemulsificationandtrabeculectomypartsofthesurgery.Theintroductionofthetemporalincisionforphacoemulsificationhasallowedsurgeonstop

7、erformtwositeprocedure,withaprelimbalfilteringincisionforthetrabeculectomyandaseparateclearcorneaincisionforphacoemulsification[5].Comparingofthetwosurgicalprocedures,previousstudiesgenerallyhadsmallsamplesizesandshowedconflictingresults,whichgreatlyhinderedresearchersdrawing

8、correctconclusions.　　Ametaanalysisofcontrolledclinicaltrials