PMID- 37080625
OWN - NLM
STAT- MEDLINE
DCOM- 20230424
LR  - 20230619
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 13
IP  - 4
DP  - 2023 Apr 20
TI  - Comparison of tube shunt implantation and trabeculectomy for glaucoma: a 
      systematic review and meta-analysis.
PG  - e065921
LID - 10.1136/bmjopen-2022-065921 [doi]
LID - e065921
AB  - OBJECTIVE: To compare the efficacy and safety of tube shunt implantation with 
      trabeculectomy in the treatment of patients with glaucoma. METHODS: A systematic 
      literature search was performed for studies comparing tube with trabeculectomy in 
      patients with glaucoma (final search date: 27 February 2022). Comparisons between 
      tube and trabeculectomy were grouped by the type of tube (Ahmed, Baerveldt, 
      Ex-PRESS and XEN). The primary endpoints included intraocular pressure (IOP), IOP 
      reduction (IOPR), IOPR percentage (IOPR%), complete success rate (CSR), qualified 
      success rate (QSR) and adverse events (AEs). RESULTS: Forty-nine studies were 
      included in this meta-analysis and presented data for 3795 eyes (Ahmed: 670, 
      Baerveldt: 561, Ex-PRESS: 473, XEN: 199, trabeculectomy: 1892). Ahmed and 
      Ex-PRESS were similar to trabeculectomy in terms of IOP outcomes and success rate 
      (Ahmed vs trabeculectomy: IOPR%: mean difference (MD)=1.34 (-5.35, 8.02), p=0.69; 
      Ex-PRESS vs trabeculectomy: IOPR%: MD=0.12 (-3.07, 3.31), p=0.94). The IOP 
      outcomes for Baerveldt were worse than those for trabeculectomy (IOPR%: MD=-7.51 
      (-10.68, -4.35), p<0.00001), but the QSR was higher. No significant difference 
      was shown for the CSR. XEN was worse than trabeculectomy in terms of IOP outcomes 
      (IOPR%: MD=-7.87 (-13.55, -2.18), p=0.007), while the success rate was similar. 
      Ahmed and Ex-PRESS had a lower incidence of AEs than trabeculectomy. Baerveldt 
      had a lower incidence of bleb leakage/wound leakage, hyphaema and hypotonic 
      maculopathy than trabeculectomy but a higher incidence of concurrent cataracts, 
      diplopia/strabismus and tube erosion. The incidence of AEs was similar for the 
      XEN and trabeculectomy procedures. CONCLUSION: Compared with trabeculectomy, both 
      Ahmed and Ex-PRESS appear to be associated with similar ocular hypotensive 
      effects and lower incidences of AEs. However, Baerveldt and XEN cannot achieve 
      sufficient reductions in IOP outcomes similar to those of trabeculectomy. 
      PROSPERO REGISTRATION NUMBER: CRD42021257852.
CI  - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Luo, Nachuan
AU  - Luo N
AD  - Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang 
      University, Nanchang, China.
AD  - Department of Ophthalmology, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, China.
AD  - Jiangxi Medical College, Nanchang University, Nanchang, China.
FAU - Liu, Miaowen
AU  - Liu M
AD  - Department of Ophthalmology, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, China.
AD  - Jiangxi Medical College, Nanchang University, Nanchang, China.
FAU - Hao, Meiqi
AU  - Hao M
AD  - Department of Ophthalmology, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, China.
AD  - Jiangxi Medical College, Nanchang University, Nanchang, China.
FAU - Xu, Ruoxin
AU  - Xu R
AD  - Department of Ophthalmology, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, China.
AD  - Jiangxi Medical College, Nanchang University, Nanchang, China.
FAU - Wang, Fei
AU  - Wang F
AD  - Department of Ophthalmology, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, China.
AD  - Jiangxi Medical College, Nanchang University, Nanchang, China.
FAU - Zhang, Wenxiong
AU  - Zhang W
AUID- ORCID: 0000-0003-2962-0847
AD  - Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang 
      University, Nanchang, China zwx123dr@126.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20230420
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - Humans
MH  - *Trabeculectomy/methods
MH  - *Glaucoma Drainage Implants/adverse effects
MH  - Treatment Outcome
MH  - *Glaucoma/surgery/etiology
MH  - Intraocular Pressure
PMC - PMC10273552
OTO - NOTNLM
OT  - Adverse events
OT  - Glaucoma
OT  - Ophthalmology
COIS- Competing interests: None declared.
EDAT- 2023/04/21 00:42
MHDA- 2023/04/24 06:42
PMCR- 2023/04/20
CRDT- 2023/04/20 20:53
PHST- 2023/04/24 06:42 [medline]
PHST- 2023/04/21 00:42 [pubmed]
PHST- 2023/04/20 20:53 [entrez]
PHST- 2023/04/20 00:00 [pmc-release]
AID - bmjopen-2022-065921 [pii]
AID - 10.1136/bmjopen-2022-065921 [doi]
PST - epublish
SO  - BMJ Open. 2023 Apr 20;13(4):e065921. doi: 10.1136/bmjopen-2022-065921.