Journal
Reading
Abstract
Results
Contd
Conclusions
Both Trab and Ex -PRESS have
equivalent efficacy in lowering IOP,
yet Ex-PRESS had a lower risk of
hypotony and hyphema than Trab.
Nevertheless, whether the cost
of Ex -PRESS was less than that
of Trab should be further
investigated
to
ensure
evidence-based conclusion in
the long run.
Journal Theory
Epidemiology of Glaucoma
Uncontrolled Glaucoma
Uncontrolled glaucoma is the term used to define any
kind of glaucoma that does not respond to medical
or conventional surgical treatment.
The glaucoma may be uncontrolled for various reasons:
Maximum-tolerated medical therapy fails to
adequately reduce lOP.
Glaucomatous optic neuropathy or visual field loss is
progressing despite apparent "adequate" reduction
of IOP with medical therapy.
The patient cannot comply with the necessary
medical regimen.
Medical vs Surgical
treatment
it is not always clear which modality is better.
The treatment of angle-closure glaucoma with
pupillary block and of primary congenital
glaucoma is primarily surgical, either laser or
incisional, with medical therapy playing a
secondary role.
Initial treatment of POAG has commonly been
medical, with surgery undertaken only if medical
treatment fails or is not well tolerated.
The treatment of secondary glaucoma is similar
to that of primary glaucoma, with some
exceptions, and the underlying cause of the
glaucoma should be addressed if possible.
Contd...
Trabeculectomy
Indications
Incisional surgery is indicated in a
patient with OAG when optic nerve
function is decreasing or is likely to
decrease and the patient is already on
maximum-tolerated medical therapy and
is unlikely to achieve a sufficient
reduction in IOP with laser treatment.
In advanced disease, many clinicians
consider filtering surgery earlier.
Complications of trab
video
video
Surgical indications
Complications
Postoperative hypotony
Elevated postoperative IOP
The short and long term complications
known same that exist with filtrating
surgeries, including blebitis,
endophthalmitis, bleb-related
complications, corneal dellen,
endothelial cell loss , and choroidal
expansion.
Efficacy
Systematic Review
Challenges in literature
search
Database Bias
No single database is likely to contain all published studies on
a given subject
Publication Bias
English-language bias
occurs when reviewers exclude papers published in
languages other than English
Citation bias
occurs when studies with significant or positive results are
referenced in other publications, compared with studies with
Quality assesment
Meta Analysis
Contd
Steps of Meta-analysis
Define the Research
Question
Perform the literature
search
Select the studies
Extract the data
Analyze the data
Report the results
Back to Journal
Background
Glaucoma neurodegenerative
disease characterized by progressive
vision loss, is one of the leading
causes of preventable blindness in the
world
Prevalence
1% in people aged 50y
or older and increase
with age
Economic impact
expected to be
heavier due to
increasing
incidence,
prevalence and cost
of glaucoma
Trabeculectomy (Trab)
An alternative to Trab.
It is a small, stainless and non-valved flowrestricting device.
Similar to the traditional Trab, avoid
peripheral iridectomy.
Reduce the likelihood of hyphema and
result in less postoperative inflammation.
Because of the fixed-diameter tube size
and relative stable filtering volume of ExPRESS, the complications of hypotony
caused by over-fluent filtering may be less.
Contd
Subjects
Inclusion Criteria
Methods
Search Strategy for
Identification of Studies
Data
Extraction
Assessment of
Literature Quality
Statistical
Analysis
duplicate
articles were
manually
removed.
All databases
from January
2002 to
November
2014 were
included.
Data Extraction
Two reviewers
(Wang L and
Sha F)
extracted
information
Any disagreements
about data extraction
were discussed in
common with two
reviewers and resolved
finally.
authors
contacted by
emails to
request missing
data to obtain
the accurate
outcomes
Contd
Both RCTs and non-RCTs were
included
The qualities of the related studies were
assessed using the Downs and Black
quality assessment
Two reviewers (Wang L and Sha F) assessed the
literature quality score and disagreements were
resolved by the third reviewer (Guo DD)
Statistical Analysis
Results
Identificati
on
and
selection
for study
Contd
Efficacy analysis
Safety
analysis
Discussions
Economic aspects
Contd
Success rate
Contd
Complications
Contd
Cost Effectiveness
Contd
Study Limitations
Conclusions
Contd
Contd
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