Objectives To assess the clinical effectiveness of non-penetrating trabecular surgery versus trabeculectomy for open angle glaucoma. Methods We searched the Cochrane Central Register of Controlled Trials (issue 2, 2007), MEDLINE (1966 to May 2008), EMbase (1980 to May 2008), and CMB-disk (1979 to May 2008). We also hand searched relevant journals and conference proceedings. Data were extracted by two reviewers independently using an extraction form. The Cochrane Collaboration’s RevMan 5.0 software was used for statistical analysis. Results Three RCTs involving 127 participants (144 eyes) with previously untreated open angle glaucoma were included. Meta-analysis showed that compared with non-penetrating trabecular surgery, trabeculectomy increased the proportion of patients with reduced postoperative intraocular pressure (WMD2.78, 95%CI 1.41 to 4.15), improved the operation success rate (RR 0.53, 95%CI 0.37 to 0.77), and reduced the use of postoperative antiglaucoma medication (WMD 0.96, 95%CI 0.84 to 1.08). Non-penetrating trabecular surgery reduced the incidence of postoperative complications (RR 17.00, 95%CI 8.36 to 26.00). Conclusion Since the sample sizes of the included trials are relatively small, and the two procedures are also related to progressive visual field loss and optic disk damage, more well-designed large-scale RCTs are required.
Objective To study prospectively the morphological relations among hemorrhage of optic disc, defect of retinal nerve fiber layer, and peripapillary atrophy in normal-tension glaucoma (NTG). Methods Qualitative and quantitative methods were applied to evaluate the relations among hemorrhage of optic disc, defect of retinal nerve fiber layer, and peripapillary atrophy by using stereo ocular fundus photography and computer analyzer systems. Results In 37 patients (42 eyes) in NTG hemorrhage group, 50 hemorrhagic spots at optic disc was found, including coloboma of retinal nerve fiber layer in 35 eyes (83.3%)(35/42). In 35 patients (40 eyes) in non-hemorrahge group, partial coloboma of retinal nerve fiber layer was found in 21 eyes (52.5%)(21/40). The difference of incidence of coloboma of retinal nerve fiber layer between the two groups was not significant (chi;2=1.403, P=0.236). The incidence of atrophic arc in hemorrhage group differed much from which in non-hemorrhage group (chi;2=7.008, P=0.008). The area of atrophic arc at beta;section in hemorrhage group ［(2.05plusmn;0.88)mm2］ was significantly different from which in non-hemorrhage group［(1.42plusmn;0.53)mm2］(t=-2.618, P=0.012). In the follow-up period, the difference of incidence of disc-rim loss between hemorrhage and non-hemorrhage group was significant, (chi;2=5.802, P=0.016); while the difference of the incidence of visual field defect between the two groups was not. Conclusion In eyes with NTG, hemorrhage of optic disc, coloboma of retinal nerve fiber layer and atrophic arc are closely related. More disc-rim loss and changes of atrophic-arc area in hemorrhage group in the follow-up period suggests that hemorrhage of optic disc is the risk factor of development of NTG. (Chin J Ocul Fundus Dis, 2006, 22: 232-235)
Objective To evaluate the efficacy and safety of latanoprost versus travoprost for primary open-angle glaucoma (OAG) and ocular hypertension (OH). Methods All the randomized controlled trials (RCTs) about treating primary open-angle glaucoma and ocular hypertension with latanoprost and travoprost were collected by searching MEDLINE, EMbase, OVID and CNKI. The assessment of methodological quality and data extraction of the included studies were performed independently by two reviewers, and the meta-analysis was conducted with RevMan 5.0 software. Results A total of 13 RCTs involving 1 433 patients were included. The results of meta-analyses showed that, a) At the second week, travoprost showed greater intraocular pressure (IOP) lowering efficacy compared with latanoprost (WMD= –1.47, 95%CI –2.62 to –0.33). At the first month (WMD= –0.50, 95%CI –1.52 to 0.52) and the sixth month (WMD= –0.12, 95%CI –0.85 to 0.61), the difference of IOP reduction between latanoprost and travoprost group was not significant; and b) The latanoprost-treated group showed fewer reported conjunctival congestion than the travoprost-treated group (OR=0.47, 95%CI 0.35 to 0.63). The difference in adverse events of eye pain (OR=0.55, 95%CI 0.27 to 1.12) and iris or skin depigmentation (OR=1.25, 95%CI 0.53 to 2.92) between latanoprost and travoprost group was not significant. Conclusion Latanoprost and travoprost are comparable in lowering IOP for OAG and OH patients. Latanoprost shows greater ocular tolerability with lower incidence of side effects as conjunctival congestion. This conclusion is not powerful enough in proof due to the medium methodology quality of the included studies, so a large number of high-quality RCTs with large sample are needed for objectively, entirely and precisely evaluating the efficacy.
Objective Methods of evidence-based medicine were used to make an individualized treatment plan concerning newly diagnosed open-angle glaucoma patient. Methods After clinical problems were put forward, evidence was collected from Cochrane Library (Issue 4, 2009), PubMed (1990 -2009), MEDLINE (1990-2009), EMbase (1990-2009), CBM (1990-2009), and CNKI (1990-2009) according to the search strategy. Subject words were open-angle glaucoma, timolol, latanoprost, trabeculectomy, intraocular pressure, randomized controlled trials, human, meta-analysis, systematic review. Results A total of 221 randomized controlled trials, and 19 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data. After one year follow-up, the plan was proved optimal. Conclusion The treatment efficacy in newly diagnosed open-angle glaucoma has been improved by determining an individualized treatment plan according to evidence-based methods.
Objective To assess the efficacy and safety of a dorzolamide/timolol combination versus latanoprost in the treatment of open-angle glaucoma. Method We searched for randomized control trials concerning a dorzolamide/timolol combination versus latanoprost in the treatment of open-angle glaucoma,in electronic databases , and handsearched some related journals. The quality was evaluated and meta-analysis was conducted using the software RevMan 5.0. Results Six randomized control trials involving 361 patients and 361 eyes were identified. The Meta-analysis showed that at the end of study, there was a statistically significant difference between the two study groups with WMD – 0.49, and 95%CI – 1.06 to 0.07 ( P=0.09) in lowering intraocular pressure; there was no statistically significant difference between the two groups with WMD 1.43 and 95%CI 0.49 to 4.21 (P=0.53); and there was no statistically significant differences between the two groupswith WMD 0.40 and 95%CI 0.13 to 1.26 (P=0.12) in incidence of headache. Conclusion Compared with latanoprost, dorzolamide-timolol combination have increased efficacu in lowering intraocular pressure (IOP).If we want a more reliable result ,we need a large number of multi-centre,double-blinded randomized control trials.
ObjectiveTo systematically review the association between myopia and open-angle glaucoma (OAG). MethodsForeign and domestic articles published from January 2000 to May 2013 were searched in PubMed, EMbase, WanFang Data, VIP and CNKI for observational studies on the association between myopia and OAG. According to the inclusion and exclusion criteria, the studies were screened, the data were extracted, and the method quality of included studies was assessed. Then meta-analysis was performed using Stata 12.0 software. ResultsEleven cross-sectional studies including 45 996 participants were finally included. The results of meta-analysis showed that, myopia increased the risk of OAG. Besides, the results of subgroup analysis by the severity of myopia showed that, low-degree myopia (more than-3.00 D) increased 1.52 times the risk (OR=1.52, 95%CI 1.23 to 1.88) while middle/high-degree myopia (no more than-3.00 D) increased 2.41 times (OR=2.41, 95%CI 1.91 to 3.03). ConclusionIndividuals with myopia have increased risk of OAG.
ObjectiveTo systematically review the efficacy and safety of phacoemulsification combined with trabeculectomy versus simple phacoemulsification for primary angle closure glaucoma with cataract.MethodsDatabases including PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about phacoemulsification combined with trabeculectomy vs. simple phacoemulsification for primary angle closure glaucoma with cataract from inception to May 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software.ResultsA total of eight studies involving 679 patients were included. The results of meta-analysis showed that: there were no significant differences between two groups in postoperative visual acuity (MD=0.00, 95%CI –0.10 to 0.09, P=0.98), postoperative anterior chamber depth (MD=0.14, 95%CI –0.17 to 0.45, P=0.37) and adverse reactions rates (optic nerve injury: RR=1.56, 95%CI 0.70 to 3.47, P=0.28; visual field defect: RR=1.43, 95%CI 0.70 to 2.92, P=0.33; corneal edema: RR=0.57, 95%CI 0.25 to 1.32, P=0.19).ConclusionCurrent evidence shows that phacoemulsification combined with trabeculectomy and simple phacoemulsification has the similar efficacy and safety for primary angle closure glaucoma with cataract. Due to limited quantity and quality of the included studies, the above conclusions still need to be verified by more high quality studies.
There are so many biomechanical risk factors related with glaucoma and their relationship is much complex. This paper reviewed the state-of-the-art research works on glaucoma related mechanical effects. With regards to the development perspectives of studies on glaucoma biomechanics, a completely novel biomechanical evaluation factor -- Fractional Flow Reserve (FPR) for glaucoma was proposed, and developing clinical application oriented glaucoma risk assessment algorithm and application system by using the new techniques such as artificial intelligence and machine learning were suggested.
ObjectivesTo systematically review the association between the SIX6 gene rs10483727 mutation and primary open angle glaucoma (POAG).MethodsPubMed, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect case-control studies on the SIX6 gene rs10483727 polymorphism and primary open angle glaucoma from inception to December 28th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by Stata 12.0 software.ResultsSeventeen case-control studies in 16 papers were included, involving 9 886 patients and 19 663 controls. The results of meta-analysis showed that rs10483727 polymorphism in SIX6 gene was associated with the risk of POAG in the Asians and Caucasians. However, no association was found in the Africans.ConclusionsThe current evidence shows that rs10483727 polymorphism in SIX6 gene is associated with the risk of POAG in the Asians and Caucasians.
At present, there are few in vivo experimental studies on anterior chamber flow field, and the relevant technologies are not mature. This study explores the experimental method and key techniques of particle image velocimetry (PIV) for the in vivo measurement of anterior chamber flow field with slow flow velocity in the rabbit with acute intraocular hypertension. The experimental process can be divided into three parts: model construction of rabbit eye with acute intraocular hypertension, in vivo eyeball preparation, and PIV setup. The following key techniques were mainly investigated: the optimal injection strategy of fluorescent particles and the correction strategy for image acquisition errors caused by the effects of image refraction and respiration. The results showed that the best injection method was that 15 μL of fluorescent particles solution was slowly injected into the anterior chamber through the lower part of iris and then the rabbit was released and waited for 13 h. In this way particles were completely distributed in the anterior chamber with the help of the aqueous humor circulation, and then in vivo PIV experiment could be performed. The eyeball should be covered with a square flume filled with ultrasonic coupling gel for the sake of imaging during the experiment. The Maximal Information Coefficient algorithm could be applied to correct the measured results before post-processing calculation. The results indicated that feasible injection strategy of fluorescent particles and the correction strategy for image acquisition are critical to obtain nice experiment effects for the in vivo PIV measurement of anterior chamber flow field in the rabbit with acute intraocular hypertension.