Surgical strategies for coexisting glaucoma and cataract - An evidence-based update
Surgical strategies for coexisting glaucoma and cataract - An evidence-based update
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DOI：
10.1016/s0161-6420(02)01267-8
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发表时间：
2002-10-01
期刊：
影响因子：
13.7
通讯作者：
Bass, EB
中科院分区：
文献类型：
--
作者：
Friedman, DS;Jampel, HD;Bass, EB
目的：为了评估短期和长期的控制眼内压（IOP）与不同的手术治疗策略共存的白内障和glaucoma.Design：Systematic literature review and analysis.Method：我们进行了一项搜索已发表的文献，以确定所有符合条件的文章有关的手术治疗共存的白内障和青光眼在成人。一名研究人员将每篇文章的内容摘录到一个定制的表格上。另一名调查员证实了调查结果。证据支持不同的方法进行了分级的共识为好，公平，弱，或insufficient.Main结果措施：短期（24小时或更少）和长期（超过24小时）IOP control.Results：证据是好的，长期的IOP降低更多的青光眼和白内障联合手术比单独的白内障手术。平均而言，联合组的IOP低3至4 mmHg，所需药物较少。仅囊外白内障摘除术（ECCE）导致IOP短期升高的证据不足，不足以确定超声乳化白内障摘除术（PECE）对青光眼患者IOP的短期影响。与单独的ECCE或PECE相比，ECCE或PECE联合切口青光眼手术的短期IOP控制效果更好的证据不足。ECCE或PECE后长期IOP降低2 - 4 mmHg的证据也很弱（但一致）。最后，有微弱的证据表明，联合PECE和小梁切除术产生的长期眼压控制略差于单纯小梁切除术，并有公平的证据表明，同样是真实的ECCE结合trabeculectomy.Conclusions：有强有力的证据表明，更好的长期控制眼压与青光眼和白内障联合手术相比，单独的白内障手术。关于白内障和青光眼手术治疗策略的其他问题，现有证据有限或相互矛盾。(C)2002年，美国眼科学会。
Objective: To assess short- and long-term control of intraocular pressure (IOP) with different surgical treatment strategies for coexisting cataract and glaucoma.Design: Systematic literature review and analysis.Method: We performed a search of the published literature to identify all eligible articles pertaining to the surgical management of coexisting cataract and glaucoma in adults. One investigator abstracted the content of each article onto a custom-designed form. A second investigator corroborated the findings. The evidence supporting different approaches was graded by consensus as good, fair, weak, or insufficient.Main Outcome Measures: Short-term (24 hours or fewer) and long-term (more than 24 hours) IOP control.Results: The evidence was good that long-term IOP is lowered more by combined glaucoma and cataract operations than by cataract operations alone. On average, the IOP was 3 to 4 mmHg lower in the combined groups with fewer medications required. The evidence was weak that extracapsular cataract extraction (ECCE) alone results in short-term increase in IOP and was insufficient to determine the short-term impact of phacoemulsification cataract extraction (PECE) on IOP in glaucoma patients. The evidence was weak that short-term IOP control was better with ECCE or PECE combined with an incisional glaucoma procedure compared with ECCE or PECE alone. The evidence was also weak (but consistent) that long-term IOP is lowered by 2 to 4 mmHg after ECCE or PECE. Finally, there was weak evidence that combined PECE and trabeculectomy produces slightly worse long-term IOP control than trabeculectomy alone, and there was fair evidence that the same is true for ECCE combined with trabeculectomy.Conclusions: There is strong evidence for better long-term control of IOP with combined glaucoma and cataract operations compared with cataract surgery alone. For other issues regarding surgical treatment strategies for cataract and glaucoma, the available evidence is limited or conflicting. (C) 2002 by the American Academy of Ophthalmology.