Surgical and laser interventions for pseudoexfoliation glaucoma systematic review of randomized controlled trials

Eye (Lond). 2021 Jun;35(6):1551-1561. doi: 10.1038/s41433-021-01424-1. Epub 2021 Feb 9.


To assess the comparative effectiveness and safety of different surgical and laser techniques in people with pseudoexfoliation glaucoma (PXFG). We conducted a systematic review including randomized controlled trials (RCT) that compared any pair of surgical or laser treatment versus other type of intervention in PXFG. RCT were identified by a highly sensitive search of electronic databases and two individuals independently assessed trial eligibility, abstracted data and assessed risk of bias. We performed Bayesian Meta-Analysis when outcomes were comparable. The search strategy identified 6171 records. Six studies (262 subjects) were included. Two trials analyzed the same pair of surgical interventions comparing phacoemulsification as solo procedure or combined with trabecular aspiration and we performed meta-analysis. Other RCTs compared the following interventions: trabecular aspiration associated with phacoemulsification versus phacotrabeculectomy, non-penetrating deep sclerectomy associated or not with phacoemulsification, selective versus argon laser trabeculoplasty and one-site versus two-site phacotrabeculectomy. For IOP data, none of the trials reported a difference between pairs of surgical techniques, nor changes in visual acuity or number of post-operative medications. The overall risk of bias is moderate to high. There are no apparent differences in efficacy and safety, although with large uncertainty, between surgical or laser techniques for PXFG. Based on the low-quality evidence from the six studies included in this review, it is not possible to justify the preferential use of non-penetrating surgery, MIGS or trabecular aspiration (with or without cataract surgery) in PXFG. Further research is needed to determine the optimal management of this condition.

摘要: 假剥脱性青光眼的手术和激光治疗: 随机对照试验的系统评价摘要评价不同手术和激光技术治疗假性剥脱性青光眼 (PXFG) 的有效性和安全性。我们对PXFG手术治疗 (或激光治疗) 与其他治疗手段进行对比的随机对照试验(RCT)进行了系统回顾。RCT通过具有高度敏感性的电子数据库进行确定, 两位研究者独立对纳入RCT的标准、摘取的数据进行了评估并且对实验的偏倚进行了评估。当结果具有可比性时, 我们进行贝叶斯荟萃分析。搜索策略共识别6171条实验记录。最后纳入6项研究(262名受试者)。其中有两项试验分析了同一对手术干预, 比较了单一超声乳化术或超声乳化吸除术联合小梁抽吸术的疗效, 我们对此也进行了荟萃分析。其他随机对照试验比较了以下干预措施:与超声乳化术相关的小梁抽吸术与超声小梁切除术、与超声乳化术相关或不相关的非穿透性深巩膜切除术、选择性与氩激光小梁成形术、单点与双点超声小梁切除术。没有一项试验报告了两种手术方法之间存在眼压的差异, 也没有视力或术后使用药物种类的变化。偏倚的总体风险为中到高。尽管手术或激光治疗PXFG存在很大的不确定性, 但是两者的有效性和安全性没有明显差异。基于本综述中六项研究的低质量证据, 不能确保在PXFG中可以优先使用非穿透性手术、MIGS或小梁抽吸术 (伴或不伴白内障手术) 。因此需要进一步的研究来决定在此种情况的最佳治疗手段。.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Glaucoma* / surgery
  • Humans
  • Lasers
  • Phacoemulsification*
  • Randomized Controlled Trials as Topic
  • Trabeculectomy*