Real-time PCR in infectious uveitis Donor eyes - Conselho ...

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META-ANALYSIS OF BETA RADIATION AUGMENTATION FOR TRABECULECTOMY - RESULTS IN DISTINCT ETHNIC GROUPS SETTING AND PARTICIPANTS The three selected studies (15-17) included trials with a total of 457 randomized participants. All participants had newly diagnosed open-angle glaucoma with no prior surgical treatment. MAIN OUTCOMES The primary outcome measure in all the trials was the rate of failure to maintain the IOP
FENDI LI, ET AL. Table 2. Postoperative complications in the trials included in this meta-analysis England (15) New Zealand (16) South Africa (17) Control BRT (750 cGy) Control BRT (750 cGy) Control BRT (1000 cGy) Hyphema 4 (18%) 9 (23.0%.) 15 (44.1%) 16 (51.6%) - - Hypotony 2 (09%) 2 (25.0%) - - 2 (1.2%) 06 (0,3.6%) Shallow anterior chamber - - 06 (17.6%) 09 (29.0%) 3 (1.9%) 02 (0,1.2%) Bleb leak 1 (05%) 2 (25.0%) 02 (05.8%) - - - Choroidal effusion 1 (05%) 1 (22.5%) 02 (05.8%) 05 (16.1%) - - Endophthalmitis - 1 (22.5%) - - - - Uveitis - - - - 4 (2.5%) 7 (04.2%) Suprachoroidal hemorrage - - - - 1 (0.6%) - Cataract NA NA 04 (12.1%) 07 (24.1%) 5 (3.4%) 18 (11.9%) BRT= trabeculectomy plus beta irradiation group; Control= trabeculectomy group; NA= not available; (15) = Rehman et al., 2002; (16) = Barnes et al., 2000; (17) = Kirwan et al., 2006. Figure 2. Comparison of surgical failure rate at the of 12 months follow-up, between TREC and BRT/TREC arms. (15) = Rehman et al., 2002; (16) = Barnes et al., 2000; (17) = Kirwan et al., 2006. complication was observed between BRT/TREC arm and control arm: hyphema (p=0.835), hypotony (P=0.541), shallow anterior chamber (P=0.726), bleb leak (P=0.485) and choroidal effusion (P=0.473). There was no significant difference in visual acuity reduction (OR=0.84, 95% CI: 0.5 - 1.3, P=0.43) between the two arms. Moreover, no decrease in visual acuity was observed in either group during the study period. The BRT/TREC group experienced a higher incidence of cataract considering the need for extraction than did the TREC group (25/195 - 12.8% versus 9/190 - 4.7% participants), however this difference was not statistically significant (OR=1.85, 95% CI: 0.82 - 4.16, P=0.13). DISCUSSION The use of BRT in glaucoma surgery has been investigated by several authors (6,14-20) but all reports included small numbers of patients, and the irradiation tended to be used in mixed groups of patients with poor prognosis. There are no convincing data from these studies indicating that BRT improves the IOP control posttrabeculectomy, which explains why this technique has not gained popularity. In our study, combining the results of three randomized trials (457 patients), we were able to demonstrate a significant positive adjunctive effect of BRT in eyes undergoing TREC. The mean difference between the IOP reduction from baseline obtained in BRT-treated eyes and the control group at one year follow-up was 1.64 mmHg (P=0.002). We did not find any significant difference in the analysis of each complication regarding radiotherapy adjunctive treatment. However, the radiation group experienced a higher incidence of cataract requiring extraction than did the control group (12.8% versus 4.7% respectively; P=0.13). We are not aware if this difference would be significant with an increment of sample size. The calculated amount of radiation reaching the germinal epithelium of lenses in all trials was probably less than the minimum dosage reported to cause cataract (200 cGy) (27,28) . Radiation-induced cataract has a characteristic pattern of cortical opacity, starting at the site of application (29) , which was not observed in the patients of those studies. A possible limitation of the present study could be related to differences in the clinical characteristics of patients included in the groups. Although Rehman et al. (15) and Barnes et al. (16) have compared basically patients on maximal tolerated medical therapy, Kirwan et al. (17) performed surgeries in both patients on maximal therapy and those without previous treatment (Table 1). These details could explain differences in the surgical results and represent a potential heterogeneity, however a division in subgroups for statistical purposes could be also a source of bias. Moreover, this analysis was not possible due to the lack of detailed data (17) (Table 3). Arq Bras Oftalmol. 2011;74(4):300-5 303
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