论文部分内容阅读
目的 将目前有关白内障摘除术治疗原发性闭角型青光眼的文献按照循证医学的要求进行系统评价,以期能为该种治疗方式的临床应用提供较为可靠的证据。设计 系统综述。方法 检索MEDLINE ,中国生物医学文献期刊数据库,至2 0 0 4年9月的英文及中文文献。依据纳入标准和排除标准筛选后剩余文献按照治疗性医学文献证据级别的判定标准进行证据分级,并按照终点指标进行证据评价。主要指标 眼压,前房角,降眼压药物种数,并发症。结果 2 4篇文献入选,Ⅰ～Ⅱ级证据的0篇,Ⅲ级证据的4篇,Ⅳ级证据的2 0篇。原发性闭角型青光眼白内障摘除/超声乳化白内障吸除联合人工晶状体植入术后眼压降低1 3～2 2 7mmHg ,降低幅度超过2 0mmHg的均为原发性急性闭角型青光眼(Ⅲ～Ⅳ级证据)。有对手术成功率报道的文章2篇(Ⅲ级证据)。3篇文献描述了术后房角增宽(Ⅳ级证据) ,5篇文献描述了术后PAS范围减少(Ⅲ～Ⅳ级证据)。9篇文献描述了术前和术后使用降眼压药物种数的变化情况,表明白内障摘除术后,抗青光眼药物的使用种数较术前减少(Ⅳ级证据)。9篇文献报告了术后早期眼压并发症,其中31 2 %出现了术后早期眼压升高(Ⅲ～Ⅳ级证据)。结论 病例系列研究表明晶状体摘除术对于急性闭角型青光眼合并白内障的降眼压幅度高于慢性闭角型青?
Objective To systematically evaluate the current literature on the treatment of primary angle-closure glaucoma with cataract extraction in accordance with the requirements of evidence-based medicine in order to provide more reliable evidence for the clinical application of this treatment. Design System Review. METHODS: MEDLINE and Chinese biomedical literature periodical databases were searched to English and Chinese literature in September 2004. According to the inclusion criteria and the exclusion criteria, the remaining documents were scored according to the criteria of the level of the evidence of the therapeutic medical literature, and the evidence was evaluated according to the endpoint index. The main indicators of intraocular pressure, anterior chamber angle, lowering intraocular pressure drug species, complications. RESULTS: Forty-two literatures were included, 0 for grade Ⅰ ~ Ⅱ, 4 for grade Ⅲ and 20 for grade Ⅳ. Primary angle-closure glaucoma cataract extraction / phacoemulsification cataract extraction combined intraocular lens implantation IOP decreased 13 ~ 227mmHg, decreased more than 20mmHg are primary acute angle-closure glaucoma (Ⅲ ~ Ⅳ grade evidence). There are 2 articles reported on the success rate of surgery (Ⅲ grade evidence). Three articles described postoperative widening of the angle of the chamber (Level IV evidence) and five articles describing the reduction in postoperative PAS (Level III to IV evidence). Nine articles described changes in the number of ophthalmic antihypertensive drugs preoperatively and postoperatively, indicating that the number of anti-glaucoma medications used after cataract extraction has been reduced compared to preoperative values (level IV). Nine articles reported early postoperative intraocular pressure complications, of which 31.2% presented with an elevated intraocular pressure (grade III-IV evidence) postoperative. Conclusions The series of case studies show that the ocular surface tension reduction for acute angle-closure glaucoma with cataract is higher than that for chronic angle-closure glaucoma.