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目的从循证医学角度回顾和评价慢性闭角型青光眼(CACG)治疗方法的文献,了解该领域现状,并对今后的研究工作提出建议。设计系统综述。研究对象与CACG治疗方法有关的中英文文献。方法检索MEDLINE、EMBASE、Cochrane组织(1966～2006年)相关的英文文献以及中国期刊全文数据库收录的中文核心刊物发表的相关文献(1979～2006年),包括随机对照临床研究(RCT)、非随机对照研究、前瞻性病例分析和病例数大于50例的回顾性病例分析,并对相关文献进行手工检索,以免遗漏。入选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和评价。主要指标治疗前后眼压变化、眼压控制成功率、周边前粘连的进展、视野损害的进展、视力变化、抗青光眼药物种数的增减、超声生物显微镜参数的变化以及并发症情况。结果共32篇英文文献和16篇中文文献入选,报道了47项研究。英文文献中共有5项RCT,其中包括2项多中心、双盲RCT,4项其他类型的对照研究,22项病例分析。中文文献包括1项RCT、3项其他类型的对照研究和12项病例分析。治疗方法包括激光、手术以及药物治疗三大类。结论缺乏有说服力的高级别证据是最突出的问题。单纯激光周边虹膜切开术(LPI)阻止CACG房角关闭进展的作用不足。有关残余性闭角型青光眼药物治疗的高级别证据报道了拉坦前列素和噻吗心安优异的近期效果,尚需长期随访。激光周边虹膜成形术用于LPI术后残存的非瞳孔阻滞因素、晶状体摘除术用于合并白内障的CACG、睫状体光凝术用于视功能尚存的CACG表现出较好的应用前景,但需要进一步的高级别证据指导手术指征和方案的选择。
Objective To review and evaluate the literature on the treatment of chronic angle-closure glaucoma (CACG) from the perspective of evidence-based medicine, understand the status quo in this field and make recommendations for future research. Design System Review. Study objects and CACG treatment of the relevant Chinese and English literature. METHODS: MEDLINE, EMBASE, Cochrane (1966-2006) English literature and Chinese core journals published in the Chinese Journal Full-text Database (1979-2006) were searched, including randomized controlled clinical study (RCT), non-randomized The control study, prospective case analysis and retrospective case analysis of more than 50 cases were performed, and the relevant literature was manually searched to avoid omission. The selected documents were graded and evaluated according to the standard of evidence of the therapeutic medical literature. Changes of intraocular pressure (IOP) before and after treatment, success rate of intraocular pressure (IOP) control, progress of periocular adhesion, progression of visual field damage, changes of visual acuity, increase and decrease of anti - glaucoma species, changes of ultrasound biological microscope parameters and complications. Results A total of 32 English articles and 16 Chinese articles were selected and 47 studies were reported. There are five RCTs in the English literature, including two multicenter, double-blind RCTs, four other types of controlled studies and 22 case analyzes. Chinese literature includes 1 RCT, 3 other types of controlled studies and 12 case analyzes. Treatment includes laser, surgery and drug treatment in three categories. Conclusion The lack of persuasive high-level evidence is the most prominent issue. Simple laser peripheral iridotomy (LPI) to prevent the CACG angle closure progress is not enough. High-level evidence of drug therapy for residual angle-closure glaucoma reports excellent long-term effects of latanoprost and timolol, and long-term follow-up is warranted. Laser peripheral iridoplasty for the remaining non-pupillary block factors after LPI surgery, cataract extraction for cataract surgery CACG, ciliary body photocoagulation for visual function surviving CACG showed a good prospect, However, further high-level evidence is needed to guide the selection of surgical indications and options.