Novel Glaucoma Procedures A Report by the American Academy of Ophthalmology
Novel Glaucoma Procedures A Report by the American Academy of Ophthalmology
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DOI：
10.1016/j.ophtha.2011.03.028
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发表时间：
2011-07-01
期刊：
影响因子：
13.7
通讯作者：
Smith, Scott D.
中科院分区：
文献类型：
--
作者：
Francis, Brian A.;Singh, Kuldev;Smith, Scott D.
目的：回顾已发表的文献，总结治疗开角型青光眼的新型或新兴手术技术的临床相关信息，并在适当的患者人群背景下描述器械和手术，理论效果，优点和缺点。设计：包括已获得美国食品药品监督管理局许可或目前正在美国进行III期临床试验的器械和手术：Fugo刀片（Medisurg有限公司，Norristown，PA）、Ex-PRESS微型青光眼分流器（Alcon，Inc.，Hunenberg，瑞士）、SOLX Gold Shunt（SOLX Ltd.，Boston，MA）、准分子激光小梁切开术（AIDA，Glautec AG，Nurnberg，德国）、小管成形术（iScience Interventional Corp.，门洛帕克，加利福尼亚州），通过内部途径的小梁切开术（Trabectome，NeoMeetron，Inc.，Tustin，CA）和小梁微旁路支架（iStent，Glaukos Corporation，拉古纳希尔斯，CA）.方法：PubMed和科克伦图书馆数据库的文献检索进行到2009年10月，没有日期或语言限制.主要结果测量：这些检索到192篇引文，其中23篇被认为是主题相关的，并由小组方法学家评定证据质量。所有的研究，但一个，这被评为II级证据，被评为III级evidence.Results：所有的设备研究显示，在眼内压，在某些情况下，青光眼药物的使用有统计学意义的减少。成功和失败的定义因研究而异，计算的比率也是如此。根据手术技术，报告了各种类型的并发症和发生率。在文献回顾和作用机制研究的基础上，作者还总结了各种手术的理论优势和不足。结论：所研究的新型青光眼手术均显示出一定的前景，可作为开角型青光眼治疗中降低眼压的替代疗法。目前还无法得出结论，这些新的程序是否是上级，等于或劣于手术，如小梁切除术或彼此。这些研究为将来现有青光眼手术技术和其他新手术的比较或随机试验提供了基础。
Objective: To review the published literature and summarize clinically relevant information about novel, or emerging, surgical techniques for the treatment of open-angle glaucoma and to describe the devices and procedures in proper context of the appropriate patient population, theoretic effects, advantages, and disadvantages.Design: Devices and procedures that have US Food and Drug Administration clearance or are currently in phase III clinical trials in the United States are included: the Fugo blade (Medisurg Ltd., Norristown, PA), Ex-PRESS mini glaucoma shunt (Alcon, Inc., Hunenberg, Switzerland), SOLX Gold Shunt (SOLX Ltd., Boston, MA), excimer laser trabeculotomy (AIDA, Glautec AG, Nurnberg, Germany), canaloplasty (iScience Interventional Corp., Menlo Park, CA), trabeculotomy by internal approach (Trabectome, NeoMedix, Inc., Tustin, CA), and trabecular micro-bypass stent (iStent, Glaukos Corporation, Laguna Hills, CA).Methods: Literature searches of the PubMed and the Cochrane Library databases were conducted up to October 2009 with no date or language restrictions.Main Outcome Measures: These searches retrieved 192 citations, of which 23 were deemed topically relevant and rated for quality of evidence by the panel methodologist. All studies but one, which was rated as level II evidence, were rated as level III evidence.Results: All of the devices studied showed a statistically significant reduction in intraocular pressure and, in some cases, glaucoma medication use. The success and failure definitions varied among studies, as did the calculated rates. Various types and rates of complications were reported depending on the surgical technique. On the basis of the review of the literature and mechanism of action, the authors also summarized theoretic advantages and disadvantages of each surgery.Conclusions: The novel glaucoma surgeries studied all show some promise as alternative treatments to lower intraocular pressure in the treatment of open-angle glaucoma. It is not possible to conclude whether these novel procedures are superior, equal to, or inferior to surgery such as trabeculectomy or to one another. The studies provide the basis for future comparative or randomized trials of existing glaucoma surgical techniques and other novel procedures.