Intervention Review

Aqueous shunts for glaucoma

  1. Don Minckler1,*,
  2. Satyanarayana S Vedula2,
  3. Tianjing Li2,
  4. Milan Mathew3,
  5. Ramesh Ayyala4,
  6. Brian Francis5

Editorial Group: Cochrane Eyes and Vision Group

Published Online: 19 APR 2006

Assessed as up-to-date: 30 JAN 2006

DOI: 10.1002/14651858.CD004918.pub2


How to Cite

Minckler D, Vedula SS, Li T, Mathew M, Ayyala R, Francis B. Aqueous shunts for glaucoma. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004918. DOI: 10.1002/14651858.CD004918.pub2.

Author Information

  1. 1

    University of California, Irvine, Department of Ophthalmology, Irvine, CA, USA

  2. 2

    Johns Hopkins Bloomberg School of Public Health, Cochrane Eyes and Vision Group US Project, Baltimore, MD, USA

  3. 3

    Memorial Hospital of Rhode Island, Pawtucket, USA

  4. 4

    Tulane University School of Medicine, Department of Ophthalmology, New Orleans, USA

  5. 5

    Los Angeles, USA

*Don Minckler, Department of Ophthalmology, University of California, Irvine, 118 Med Surge I, Irvine, CA, 92697-4375, USA. minckler@uci.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 APR 2006

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Aqueous shunts are employed for intraocular pressure (IOP) control in primary and secondary glaucomas that fail medical, laser, and other surgical therapies.

Objectives

This review compares aqueous shunts for IOP control and safety.

Search methods

We searched CENTRAL, MEDLINE, PubMed, EMBASE, NRR in January 2006, LILACS to February 2004 and reference lists of included trials.

Selection criteria

We included all randomized and quasi-randomized trials in which one arm of the study involved shunts.

Data collection and analysis

Two authors independently extracted data for included studies and a third adjudicated discrepancies. We contacted investigators for missing information. We used fixed-effect models and summarized continuous outcomes using mean differences.

Main results

We included fifteen trials with a total of 1153 participants with mixed diagnoses. Five studies reported details sufficient to verify the method of randomization but only two had adequate allocation concealment. Data collection and follow-up times were variable.

Meta-analysis of two trials comparing Ahmed implant with trabeculectomy found trabeculectomy resulted in lower mean IOPs 11 to 13 months later (mean difference 3.81 mm Hg, 95% CI 1.94 to 5.69 mm Hg). Meta-analysis of two trials comparing double-plate Molteno implant with the Schocket shunt was not done due to substantial heterogeneity. One study comparing ridged with standard double-plate Molteno implants found no clinically significant differences in outcome. Two trials investigating the effectiveness of adjunctive mitomycin (MMC) with the Molteno and Ahmed implants found no evidence of benefit with MMC. Two trials that investigated surgical technique variations with the Ahmed found no benefit with partial tube ligation or excision of Tenon's capsule. One study concluded there were outcome advantages with a double versus a single-plate Molteno implant and one trial comparing the 350 mm2 and 500 mm2 Baerveldt shunts found no clinically significant advantage of the larger device but neither of these trials included all patients randomized. One study suggested improved clinical outcome when MMC was employed with a newly described shunt including ultrasound supporting the conclusion. One small study did not demonstrate an outcome advantage to systemic steroid use postoperatively with single-plate Molteno shunts. One study comparing endocyclophotocoagulation (ECP) with Ahmed implant in complicated glaucomas found no evidence of better IOP control with Ahmed implant over ECP.

Authors' conclusions

Relatively few randomized trials have been published on aqueous shunts and methodology and data quality among them is poor. To date there is no evidence of superiority of one shunt over another.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Aqueous shunts for glaucoma

Glaucoma is a leading cause of blindness worldwide. Treatments for glaucoma include the use of eye drops, laser treatment, and a variety of surgical operations. Surgery is usually considered only after eye drops and lasers have proven to be ineffective. Among surgical operations, aqueous shunts or glaucoma drainage devices which come in a variety of sizes and shapes are often used in complicated cases when traditional types of surgery such as trabeculectomy (making a cleft in the eye wall) have not worked. The typical aqueous shunt includes a tiny rubber tube (drain) that connects the eye fluid chamber to a plate that is attached to the eye wall. The plate or explant stimulates the formation by the body of a space into which eye fluid can drain. This review summarizes previously published randomized and quasi-randomized controlled trial results for aqueous shunts (studies that compare treatment with no treatment or to alternative treatments including a control group). We included 15 trials involving 1153 participants with varied diagnoses of glaucoma. At present there is insufficient evidence to conclude that clinical outcomes of trabeculectomy differ substantially from those of aqueous shunts in similar patients with complicated glaucomas. There is also insufficient evidence to conclude that any specific aqueous shunt is superior to the others currently in widespread use.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

青光眼的房水分流管(Aqueous shunts)

房水分流管用來處理藥物,雷射及其他手術皆無效的原發性與次發性青光眼眼內壓(IOP)。

目標

此回顧比較房水分流管對眼內壓的控制與安全性。

搜尋策略

我們搜尋所有在2006年月的CENTRAL, MEDLINE, PubMed, EMBASE, NRR all in January 2006, LILACS 到2004年四月及被包括的試驗的參考文獻。

選擇標準

我們包含所有的研究有部分包含分流管的randomized 和quasirandomized trials。

資料收集與分析

兩位作者獨立擷取所研究的資料且有第三位意見。我們與研究者連絡來擷取搜尋不全的資料。我們使用 fixedeffect models 及用 mean differences來總結持續性的結果。

主要結論

我們包含15個研究共1153個不同診斷的參與者. 5個研究有詳細的報告來確認隨機選擇的方法但僅有兩個有足夠的隱密分配.資料的收集和追蹤時間變化大.統合分析兩個研究比較亞曼氏植入管(Ahmed implant)與小樑切除術(trabeculectomy)發現小樑切除術在11到13個月後有較低的平均眼內壓(mean difference 3.81 mm Hg, 95% CI 1.94 to 5.69 mm Hg). 統合分析兩個研究比較雙板Molteno 植入管與Schocket 分流管因太多變異而無法施行.有一個研究比較有脊狀線的與標準的雙板Molteno implants發現於臨床上的結果並沒有顯著的差異. 兩個研究探討輔助性的mitomycin (MMC) 與 Molteno 和 Ahmed 植入管發現用MMC並無有效的證據. 有兩個研究探討用Ahmed的不同的手術技術發現部分管子結紮或切除Tenon's capsule並沒有效益. 有一研究結論認為雙片較優於單片Molteno植入管.另一個研究比較350 mm2和500 mm2 Baerveldt 分流管發現較大的裝置並無臨床上顯著的優點.但無一個實驗的所有病人有隨機分配. 有一個實驗顯示當MMC與一新描述的分流管一起使用會促進臨床結果, 包括超音波支持此結論. 有一小研究並無顯示術後使用全身性的類固醇與單片Molteno分流管的結果較佳. 有一研究比較在複雜的青光眼施行 endocyclophotocoagulation (ECP)或與Ahmed植入管發現沒有證據顯示在控制眼內壓上用 Ahmed植入管較優於ECP.

作者結論

對房水分流管(Aqueous shunts)被刊登的隨機試驗 較少且方法上與資料的品質不良. 目前沒有哪一個引流管較好.

翻譯人

本摘要由高雄榮民總醫院王曉萍翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

青光眼的房水分流管。 青光眼是全世界眼盲的主要原因之一.青光眼的治療包括使用眼藥水,雷射治療,及各式的手術治療. 手術通常是在眼藥水與雷射治療證實無效之後才被考慮. 手術技術中,不同的尺寸及形狀之房水分流管或青光眼的引流裝置通常備用於那些傳統手術方式如小樑切除術(trabeculectomy)(在眼壁切一個小裂縫)無法發揮作用的複雜案例. 典型的房水分流管包含一隻小的橡膠管(引流管)接連眼睛液體腔至一托盤可接連眼球壁. 此托盤或外植片體經由主體的刺激型成一個眼睛液體可被引流的空間. 此回顧總結先前被刊登的randomized 及 quasirandomized controlled trial 的對房水分流管的結果(比較治療與沒治療或控制組是非傳統的治療的研究). 我們含括15個研究共1153個不同診斷的青光眼的受驗者.目前並無足夠的證據來下小樑切除術在於相同複雜的青光眼患者的臨床結果大大異於那些房水分流管的結論.也沒有足夠的證據來結論目前普遍使用的任一特殊的房水分流管較優於其他分流管.