Angle-based minimally invasive glaucoma surgery in normal tension glaucoma: A systematic review and meta-analysis

IF 4.9 2区医学 Q1 OPHTHALMOLOGY

Clinical and Experimental Ophthalmology Pub Date : 2024-06-09 DOI:10.1111/ceo.14408

Hnin Hnin Oo FRCOphth(Lond), Ashley Shuen Ying Hong MBBS, Sheng Yang Lim MBBS, Bryan Chin Hou Ang FRCOphth(Lond)

{"title":"Angle-based minimally invasive glaucoma surgery in normal tension glaucoma: A systematic review and meta-analysis","authors":"Hnin Hnin Oo FRCOphth(Lond), Ashley Shuen Ying Hong MBBS, Sheng Yang Lim MBBS, Bryan Chin Hou Ang FRCOphth(Lond)","doi":"10.1111/ceo.14408","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>This systematic review and meta-analysis quantitatively examines the efficacy of angle-based minimally invasive glaucoma surgery (MIGS) in normal tension glaucoma (NTG).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A literature search was performed on Medline, Embase, PubMed, CINAHL and Cochrane Library from inception until 20 December 2022. Pilot, cohort, observational studies and randomised controlled trials including at least 5 subjects undergoing angle-based MIGS (trabecular-bypass devices, excisional trabeculotomy, goniotomy and ab-interno canaloplasty) for NTG, with or without cataract surgery, were included. Meta-analysis of continuous outcome using the meta routine in R version 2022.12.0+353 was performed to determine mean intraocular pressure (IOP) and anti-glaucoma medication (AGM) reduction post-operatively.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of the 846 studies initially identified, 15 studies with a pooled total of 367 eyes which underwent combined phacoemulsification and angle-based MIGS were included for final meta-analysis. Outcomes of the iStent were reported in 5 studies, iStent inject in 7 studies, Hydrus Microstent in 1 study, Kahook Dual Blade in 3 studies, and Trabectome in 2 studies. There was significant reduction in both IOP and AGM post-operatively at 6 months (2.44 mmHg, 95%CI: 1.83–3.06; 1.21 AGM, 95%CI: 0.99–1.44), 12 months (2.28 mmHg, 95%CI: 1.71–2.84; 1.18 AGM, 95%CI: 0.90–1.47), 24 months (2.10 mmHg, 95%CI: 1.51–2.68; 1.26 AGM, 95%CI: 0.85–1.68) and 36 months (2.43 mmHg, 95%CI: 1.71–3.15, 0.87 AGM, 95%CI: 0.21–1.53) (all <i>p</i> < 0.05). Subgroup analysis on combined phacoemulsification-iStent inject surgery demonstrated a reduction in both IOP (2.31 mmHg, 95%CI: 1.07–3.56, <i>p</i> < 0.001) and AGM (1.07 AGM, 95%CI: 0.86–1.29, <i>p</i> < 0.001) at 12 months post-operatively.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Angle-based MIGS combined with phacoemulsification effectively reduces IOP and AGM in NTG eyes for up to 36 months after surgery.</p>\n </section>\n </div>","PeriodicalId":55253,"journal":{"name":"Clinical and Experimental Ophthalmology","volume":"52 7","pages":"740-760"},"PeriodicalIF":4.9000,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ceo.14408","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ceo.14408","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

This systematic review and meta-analysis quantitatively examines the efficacy of angle-based minimally invasive glaucoma surgery (MIGS) in normal tension glaucoma (NTG).

Methods

A literature search was performed on Medline, Embase, PubMed, CINAHL and Cochrane Library from inception until 20 December 2022. Pilot, cohort, observational studies and randomised controlled trials including at least 5 subjects undergoing angle-based MIGS (trabecular-bypass devices, excisional trabeculotomy, goniotomy and ab-interno canaloplasty) for NTG, with or without cataract surgery, were included. Meta-analysis of continuous outcome using the meta routine in R version 2022.12.0+353 was performed to determine mean intraocular pressure (IOP) and anti-glaucoma medication (AGM) reduction post-operatively.

Results

Of the 846 studies initially identified, 15 studies with a pooled total of 367 eyes which underwent combined phacoemulsification and angle-based MIGS were included for final meta-analysis. Outcomes of the iStent were reported in 5 studies, iStent inject in 7 studies, Hydrus Microstent in 1 study, Kahook Dual Blade in 3 studies, and Trabectome in 2 studies. There was significant reduction in both IOP and AGM post-operatively at 6 months (2.44 mmHg, 95%CI: 1.83–3.06; 1.21 AGM, 95%CI: 0.99–1.44), 12 months (2.28 mmHg, 95%CI: 1.71–2.84; 1.18 AGM, 95%CI: 0.90–1.47), 24 months (2.10 mmHg, 95%CI: 1.51–2.68; 1.26 AGM, 95%CI: 0.85–1.68) and 36 months (2.43 mmHg, 95%CI: 1.71–3.15, 0.87 AGM, 95%CI: 0.21–1.53) (all p < 0.05). Subgroup analysis on combined phacoemulsification-iStent inject surgery demonstrated a reduction in both IOP (2.31 mmHg, 95%CI: 1.07–3.56, p < 0.001) and AGM (1.07 AGM, 95%CI: 0.86–1.29, p < 0.001) at 12 months post-operatively.

Conclusions

Angle-based MIGS combined with phacoemulsification effectively reduces IOP and AGM in NTG eyes for up to 36 months after surgery.

Abstract Image

查看原文本刊更多论文

正常张力青光眼的角膜基底微创青光眼手术：系统回顾和荟萃分析。

背景：本系统综述和荟萃分析定量研究了基于角膜的微创青光眼手术（MIGS）对正常张力青光眼（NTG）的疗效：方法：在 Medline、Embase、PubMed、CINAHL 和 Cochrane Library 上进行文献检索，检索时间从开始到 2022 年 12 月 20 日。方法：在 Medline、Embedline、PubMina、ChineseHL 和 Cochrane 图书馆上搜索了从开始到 2022 年 12 月 20 日的文献，包括试验性研究、队列研究、观察性研究和随机对照试验，其中至少有 5 名受试者接受了基于角膜的 MIGS（小梁旁路装置、切除性小梁切开术、声门切开术和腹腔管成形术）治疗 NTG，同时接受或未接受白内障手术。使用R版本2022.12.0+353中的元例程对连续结果进行了元分析，以确定平均眼压（IOP）和术后抗青光眼药物（AGM）的减少量：结果：在最初确定的 846 项研究中，有 15 项研究纳入了最终的荟萃分析，这些研究共涉及 367 只眼睛，这些眼睛接受了联合超声乳化和角基型 MIGS。其中 5 项研究报告了 iStent 的疗效，7 项研究报告了 iStent inject 的疗效，1 项研究报告了 Hydrus Microstent 的疗效，3 项研究报告了 Kahook Dual Blade 的疗效，2 项研究报告了 Trabectome 的疗效。术后 6 个月（2.44 mmHg，95%CI：1.83-3.06；1.21 AGM，95%CI：0.99-1.44）、12 个月（2.28 mmHg，95%CI：1.71-2.84；1.18 AGM，95%CI：0.90-1.47）、24 个月（2.10 mmHg，95%CI：1.51-2.68；1.26 AGM，95%CI：0.85-1.68）和 36 个月（2.43 mmHg，95%CI：1.71-3.15，0.87 AGM，95%CI：0.21-1.53）（均为 p 结论：开角型 MIGS 联合超声乳化术可在术后 36 个月内有效降低 NTG 眼睛的眼压和 AGM。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical and Experimental Ophthalmology 医学-眼科学

CiteScore

7.60

自引率

12.50%

发文量

150

审稿时长

4-8 weeks

期刊介绍： Clinical & Experimental Ophthalmology is the official journal of The Royal Australian and New Zealand College of Ophthalmologists. The journal publishes peer-reviewed original research and reviews dealing with all aspects of clinical practice and research which are international in scope and application. CEO recognises the importance of collaborative research and welcomes papers that have a direct influence on ophthalmic practice but are not unique to ophthalmology.