超声睫状体成形术治疗青光眼的有效性和安全性：Meta分析
Efficacy and Safety of Ultrasonic Cycloplasty in the Treatment of Glaucoma: A Meta-Analysis
DOI: 10.12677/acm.2024.14102624, PDF,   
作者: 徐应鹏, 汤永强*：重庆医科大学附属第二医院眼科，重庆
关键词: 超声睫状体成形术；青光眼；Meta分析；有效性；安全性；Ultrasound Cycloplasty； Glaucoma； Meta Analysis； Effectiveness； Safety
摘要: 目的：评估超声睫状体成形术(Ultrasonic Cycloplasty, UCP)治疗青光眼的有效性和安全性。方法：从Pubmed、Embae、Web of sience数据库搜索相关文献，纳入符合纳入标准的文献，使用Review Manage 5.4 (Cochrane Collaboration)和Stata Corp LLC (version 17, USA)进行Meta分析。结果：检索得到305篇文献，经过筛查后最终有18篇文章被纳入本次Meta分析。总的来说，超声睫状体成形术(UCP)治疗青光眼是有效、安全的。UCP治疗青光眼的成功率高，[相对危险度(Relative Risk, RR)：2.21 95% CI, (1.59, 2.80)，P < 0.00001，I2 = 77%]。UCP治疗青光眼术后IOP降低的效果明显，[加权平均差值(Weighted Mean Difference, WMD)：10.09 95% CI, (8.74, 11.44)，P < 0.00001，I2 = 75%]。UCP手术是安全可靠的，长期或严重并发症较少，且明显少于短期或轻度并发症，[相对危险度(RR)：0.23 95% CI，(0.11, 0.48)，P < 0.00001，I2 = 91%]。其次，UCP治疗青光眼术后降眼压药物的使用数量减少[加权平均差值(WMD)：1.11 95% CI, (0.67, 1.55)，P < 0.00001，I2 = 91%]。但是，UCP治疗青光眼对最佳矫正视力(Best Corrected Visual Acuity, BCVA)无明显改善，[加权平均差值(WMD)：−0.01 95% CI，(−0.08, 0.05)，P = 0.91，I2 = 0%]。结论：UCP治疗青光眼是安全可靠、舒适、有效的，它可以有效降低青光眼患者的IOP及降压眼药物的数量，术后长期或严重并发症较少。
Abstract: Objective: To evaluate the efficacy and safety of ultrasonic cycloplasty (UCP) in the treatment of glaucoma. Methods: The relevant literature was searched from Pubmed, Embae and Web of sience databases. After Literature screening, a Meta-analysis was performed by Review Manage 5.4 (Cochrane Collaboration) and Stata Corp LLC (version 17, USA) and software. Results: A total of 305 articles were retrieved, and 18 articles met the inclusion criteria were included in the Meta-analysis. In general, ultrasonic cycloplasty (UCP) is effective and safe for the treatment of glaucoma. UCP had a high success rate in the treatment of glaucoma [Relative Risk (RR): 2.21 95% CI, (1.59, 2.80), P < 0.00001, I2 = 77%]. UCP significantly reduced IOP [Weighted Mean Difference (WMD): 10.09 95% CI, (8.74, 11.44), P < 0.00001, I2 = 75%]. Secondly, UCP is safe and reliable with few long-term or serious complications [Relative Risk (RR): 0.23 95% CI, (0.11, 0.48), P < 0.00001, I2 = 91%]. UCP can effectively reduce the number of postoperative anti-glaucoma medications [Weighted Mean Difference (WMD): 1.11 95% CI, (0.67, 1.55), P < 0.00001, I2 = 91%]. However, UCP did not significantly improve the best corrected visual acuity (BCVA) [weighted mean difference (WMD): −0.01 95% CI, (−0.08, 0.05), P = 0.91, I2 = 0%]. Conclusion: UCP is safe, reliable, comfortable and effective in the treatment of glaucoma. It can effectively reduce IOP and the number of postoperative antihypertensive eye drugs, with fewer long-term or serious complications.
文章引用：徐应鹏, 汤永强. 超声睫状体成形术治疗青光眼的有效性和安全性：Meta分析[J]. 临床医学进展, 2024, 14(10): 84-97. https://doi.org/10.12677/acm.2024.14102624

参考文献

[1] Tham, Y.C., Li, X., Wong, T.Y., et al. (2014) Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis. Ophthalmology, 121, 2081-2090.
[2] 刘乐乐, 孔香云, 申家泉. 睫状体分泌功能减弱性手术在青光眼治疗中的进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 123-128.
[3] Wu, T., Li, J. and Lu, P. (2023) Efficacy and Safety of Ultrasound Cycloplasty for the Treatment of Glaucoma: A Meta-analysis. International Journal of Ophthalmology, 16, 1317-1325. [Google Scholar] [CrossRef] [PubMed]
[4] Cheung, J.J.C., Li, K.K.W. and Tang, S.W.K. (2017) Retrospective Review on the Outcome and Safety of Transscleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma in Chinese Patients. International Ophthalmology, 39, 41-46. [Google Scholar] [CrossRef] [PubMed]
[5] Klug, E., Chachanidze, M., Nirappel, A., Chang, E.K., Hall, N., Chang, T.C., et al. (2021) Outcomes of Phacoemulsification and Endoscopic Cyclophotocoagulation Performed with Dual Blade Ab Interno Trabeculectomy or Trabecular Micro-Bypass Stent Insertion. Eye, 36, 424-432. [Google Scholar] [CrossRef] [PubMed]
[6] Aptel, F., Charrel, T., Palazzi, X., Chapelon, J., Denis, P. and Lafon, C. (2010) Histologic Effects of a New Device for High-Intensity Focused Ultrasound Cyclocoagulation. Investigative Ophthalmology & Visual Science, 51, 5092-5098. [Google Scholar] [CrossRef] [PubMed]
[7] Mastropasqua, R., Agnifili, L., Fasanella, V., Toto, L., Brescia, L., Di Staso, S., et al. (2016) Uveo-Scleral Outflow Pathways after Ultrasonic Cyclocoagulation in Refractory Glaucoma: An Anterior Segment Optical Coherence Tomography and in Vivo Confocal Study. British Journal of Ophthalmology, 100, 1668-1675. [Google Scholar] [CrossRef] [PubMed]
[8] 潘英姿, 方圆. 青光眼外路睫状体手术: 从破坏性手术到微创手术[J]. 中华眼科杂志, 2024, 60(5): 403-407.
[9] Zhou, L.F., et al. (2020) Efficacy and Safety of Single Ultrasound Cyclo-Plasty to Treat Refractory Glaucoma: Results at 1 Year. European Journal of Ophthalmology, 32, 268-274. [Google Scholar] [CrossRef] [PubMed]
[10] Bolek, B., Wylęgała, A. and Wylęgała, E. (2022) Ultrasound Ciliary Plasty in Glaucoma Treatment: A Long-Term Follow-Up Study. Acta Ophthalmologica, 101, 293-300. [Google Scholar] [CrossRef] [PubMed]
[11] Almobarak, F.A., Alrubean, A., Alsarhani, W.K., Aljenaidel, A. and Osman, E.A. (2023) Two-Year Outcomes of Ultrasound Cyclo-Plasty as a First Procedure in Glaucoma. Seminars in Ophthalmology, 38, 482-489. [Google Scholar] [CrossRef] [PubMed]
[12] Aptel, F., Denis, P., Rouland, J., Renard, J. and Bron, A. (2015) Multicenter Clinical Trial of High-Intensity Focused Ultrasound Treatment in Glaucoma Patients without Previous Filtering Surgery. Acta Ophthalmologica, 94, e268-e277. [Google Scholar] [CrossRef] [PubMed]
[13] Denis, P., Aptel, F., Rouland, J., Nordmann, J., Lachkar, Y., Renard, J., et al. (2015) Cyclocoagulation of the Ciliary Bodies by High-Intensity Focused Ultrasound: A 12-Month Multicenter Study. Investigative Ophthalmology & Visual Science, 56, 1089-1096. [Google Scholar] [CrossRef] [PubMed]
[14] Yu, Q., Liang, Y., Ji, F. and Yuan, Z. (2020) Comparison of Ultrasound Cycloplasty and Transscleral Cyclophotocoagulation for Refractory Glaucoma in Chinese Population. BMC Ophthalmology, 20, Article No. 387. [Google Scholar] [CrossRef] [PubMed]
[15] Marques, R.E., Ferreira, N.P., Sousa, D.C., Barata, A.D., Sens, P., Marques-Neves, C., et al. (2020) High Intensity Focused Ultrasound for Glaucoma: 1-Year Results from a Prospective Pragmatic Study. Eye, 35, 484-489. [Google Scholar] [CrossRef] [PubMed]
[16] Ruixue, W., Wenjun, D., Le, J., Fangfang, F., Ning, L., Xiaoya, C., et al. (2023) A Comparative Study of Ultrasound Cycloplasty and Endoscopic Cyclophotocoagulation in the Treatment of Secondary Glaucoma. Scientific Reports, 13, Article No. 23073. [Google Scholar] [CrossRef] [PubMed]
[17] Aptel, F., Dupuy, C. and Rouland, J. (2014) Treatment of Refractory Open-Angle Glaucoma Using Ultrasonic Circular Cyclocoagulation: A Prospective Case Series. Current Medical Research and Opinion, 30, 1599-1605. [Google Scholar] [CrossRef] [PubMed]
[18] Morais Sarmento, T., Figueiredo, R., Garrido, J., Passos, I., Rebelo, A.L. and Candeias, A. (2021) Ultrasonic Circular Cyclocoagulation Prospective Safety and Effectiveness Study. International Ophthalmology, 41, 3047-3055. [Google Scholar] [CrossRef] [PubMed]
[19] Bolek, B., Wylęgała, A. and Wylęgała, E. (2020) Assessment of Scleral and Conjunctival Thickness of the Eye after Ultrasound Ciliary Plasty. Journal of Ophthalmology, 2020, Article ID: 9659014. [Google Scholar] [CrossRef] [PubMed]
[20] Marques, R.E., Sousa, D.C., Vandewalle, E., Somers, A., Melamed, S., Nardi, M., et al. (2020) The Effect of Glaucoma Treatment Using High-Intensity Focused Ultrasound on Total and Corneal Astigmatism: A Prospective Multicentre Study. Acta Ophthalmologica, 98, 833-840. [Google Scholar] [CrossRef] [PubMed]
[21] Deb-Joardar, N. and Reddy, K. (2018) Application of High Intensity Focused Ultrasound for Treatment of Open-Angle Glaucoma in Indian Patients. Indian Journal of Ophthalmology, 66, 517-523. [Google Scholar] [CrossRef] [PubMed]
[22] Rouland, J. and Aptel, F. (2021) Efficacy and Safety of Ultrasound Cycloplasty for Refractory Glaucoma: A 3-Year Study. Journal of Glaucoma, 30, 428-435. [Google Scholar] [CrossRef] [PubMed]
[23] Mercieca, K., Shevade, B. and Anand, N. (2015) Outcomes of Combined Phacoemulsification and Deep Sclerectomy: A 10-Year UK Single-Centre Study. Eye, 29, 1495-1503. [Google Scholar] [CrossRef] [PubMed]
[24] Torky, M.A., Alzafiri, Y.A., Abdelhameed, A.G. and Awad, E.A. (2021) Phaco-UCP; Combined Phacoemulsification and Ultrasound Ciliary Plasty versus Phacoemulsification Alone for Management of Coexisting Cataract and Open Angle Glaucoma: A Randomized Clinical Trial. BMC Ophthalmology, 21, Article No. 53. [Google Scholar] [CrossRef] [PubMed]
[25] Fan, F., Liu, D., Xu, T., Wang, R., Chen, X. and Li, S. (2023) Comparison of the Efficacy and Safety of Ultrasonic Cycloplasty vs Valve Implantation and Anti-VEGF for the Treatment of Fundus Disease-Related Neovascular Glaucoma. International Journal of Ophthalmology, 16, 897-903. [Google Scholar] [CrossRef] [PubMed]
[26] Hu, D., Tu, S., Zuo, C. and Ge, J. (2018) Short-Term Observation of Ultrasonic Cyclocoagulation in Chinese Patients with End-Stage Refractory Glaucoma: A Retrospective Study. Journal of Ophthalmology, 2018, Article ID: 4950318. [Google Scholar] [CrossRef] [PubMed]
[27] Torky, M.A., Al Zafiri, Y.A., Hagras, S.M., et al. (2019) Safety and Efficacy of Ultrasound Ciliary Plasty as a Primary Intervention in Glaucoma Patients. International Journal of Ophthalmology, 12, 597-602.
[28] Giannaccare, G., Pellegrini, M., Bernabei, F., Urbini, L., Bergamini, F., Ferro Desideri, L., et al. (2021) A 2-Year Prospective Multicenter Study of Ultrasound Cyclo Plasty for Glaucoma. Scientific Reports, 11, Article No. 12647. [Google Scholar] [CrossRef] [PubMed]
[29] Almobarak, F.A., Alrubean, A., Alsarhani, W.K., Aljenaidel, A. and Osman, E.A. (2023) Outcomes of Ultrasound Cyclo Plasty in Primary Angle Closure Glaucoma. Journal of Glaucoma, 32, 407-413. [Google Scholar] [CrossRef] [PubMed]
[30] Liu, H.T., Zhang, Q., Jiang, Z.X., et al. (2020) Efficacy and Safety of High-Dose Ultrasound Cyclo-Plasty Procedure in Refractory Glaucoma. International Journal of Ophthalmology, 13, 1391-1396. [Google Scholar] [CrossRef] [PubMed]
[31] Almobarak, F.A., Alrubean, A., Alsarhani, W.K. and Aljenaidel, A. (2024) Ultrasound Cyclo Plasty in Advanced Glaucoma: Intermediate-Term Success, Predictors for Failure and Complications. European Journal of Ophthalmology. [Google Scholar] [CrossRef] [PubMed]
[32] Leshno, A., Rubinstein, Y., Singer, R., Sher, I., Rotenstreich, Y., Melamed, S., et al. (2020) High-Intensity Focused Ultrasound Treatment in Moderate Glaucoma Patients: Results of a 2-Year Prospective Clinical Trial. Journal of Glaucoma, 29, 556-560. [Google Scholar] [CrossRef] [PubMed]
[33] Paul, C., Divya, J., Sengupta, S., Kamal, R., Paul, A. and Mitra, I. (2022) Efficacy and Safety of Ultrasound Cycloplasty in Indian Eyes with Open-Angle Glaucoma. Indian Journal of Ophthalmology, 70, 4168-4171. [Google Scholar] [CrossRef] [PubMed]
[34] Melamed, S., Goldenfeld, M., Cotlear, D., Skaat, A. and Moroz, I. (2015) High-Intensity Focused Ultrasound Treatment in Refractory Glaucoma Patients: Results at 1 Year of Prospective Clinical Study. European Journal of Ophthalmology, 25, 483-489. [Google Scholar] [CrossRef] [PubMed]

为你推荐