Non-penetrating filtration surgery versus trabeculectomy in postoperative astigmatism: a Meta-analysis

Non-penetrating filtration surgery versus trabeculectomy in postoperative astigmatism: a Meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Non-penetrating filtration surgery versus trabeculectomy in postoperative astigmatism: a Meta-analysis Xiangting Peng, Qiying Ling, Xuanchu Duan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4617236/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Aug, 2024 Read the published version in BMC Ophthalmology → Version 1 posted 4 You are reading this latest preprint version Abstract Objective Trabeculectomy and non-penetrating trabecular surgery are common operations for glaucoma. This meta-analysis aims to compare the effect of trabeculectomy and non-penetrating trabecular surgery in postoperative astigmatism of patients with glaucoma. Methods We searched the PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure to identify studies that, compared between trabeculectomy and non-penetrating trabecular surgery in patients with glaucoma. The time frame for the search was from the time of construction to April 2024. There were no restrictions regarding study type or type of glaucoma. The primary endpoint was the surgically induced astigmatism assessed 6 months after operation. Results Five eligible studies were included in this meta-analysis and presented data for 359 eyes with various types of glaucoma at different stages. The results revealed an increase in astigmatism in patients with glaucoma after trabeculectomy and non-penetrating trabecular surgery. Trabeculectomy had a higher incidence of astigmatism than in the non-penetrating trabecular surgery group at or around 6 months postoperatively, and the difference was statistically significant. (SMD = 0.51, 95% CI = 0.19 to 0.83, P = 0.002). Conclusion Our results demonstrated that both trabeculectomy and non-penetrating trabecular surgery could increase astigmatism until 6 months after operation. Moreover, non-penetrating trabecular surgery group seems to have less influence on astigmatism. Studies with longer follow-up durations and larger sample sizes are necessary in the future. Trial registration number CRD42024517708 Trabeculectomy Non-penetrating trabecular surgery Astigmatism glaucoma Meta-Analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Glaucoma is the second most common blinding disease of the eye, which is characterized by visual field defects and progressive optic nerve damage caused by elevated intraocular pressure (IOP). The number of patients with glaucoma is increasing year by year, and it is expected to reach 95.4 million worldwide in 2030 and 111.8 million in 2040 [ 1 ] , which will bring a huge social and economic burden. Filtration surgery is indicated when medication and laser therapies are insufficient to control IOP, and when the rate of deterioration of visual function is rapid enough to damage the patient’s quality of life [ 2 ] . Trabeculectomy (Trab) is considered as the gold standard. However, it is associated with significant postoperative complications such as hyphaema, shallow or flat anterior chamber, hypotony, choroidal detachment, and hypotony maculopathy leading to failure of glaucoma surgery [ 3 ] . To minimize these complications, non-penetrating trabecular surgery (NPTS) has been increasingly performed in recent years, including deep sclerectomy (DS), canaloplasty (CP), and viscocanalostomy (VCO), along with a combination of implants and antimetabolites [ 4 ] . With the continuous development of medical technology and newer equipment, glaucoma patients' expectations of surgical treatment are no longer satisfied with IOP reduction, but they also expect to have better vision to fulfill their life needs. Previous studies have found that surgically induced astigmatism (SIA) is an important factor that influences the quality of the vision and visual rehabilitation of patients with glaucoma [ 5 ] . However, different surgical procedures do not affect corneal astigmatism in the same way. Understanding and comparing the effects of Trab and NPTS on postoperative astigmatism may help to prevent or reduce the occurrence of astigmatism in the postoperative period. Few studies have directly compared the two operations. Consequently, this paper conducts a meta-analysis to evaluate the astigmatism after operation for glaucoma treatment. METHODS Search strategy In this study, A computerized search of PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure was performed and literature on non-penetrating trabecular surgery and trabeculectomy in postoperative astigmatism of patients with glaucoma was searched. Search entries were adjusted according to the different databases. The time frame for the search was from the time of construction to April 2024. The search strategy for PubMed was as follows:(((("Glaucoma"[Mesh]) OR (GLAUCOMA)) AND (("Trabeculectomy"[Mesh]) OR (Trabeculectomy))) AND (((((nonpenetrating glaucoma surgery) OR (non-penetrating trabecular surgery)) OR (deep sclerectomy)) OR (canaloplasty)) OR (viscocanalostomy))) AND (("Astigmatism"[Mesh]) OR (astigmatism)) Study selection Inclusion Criteria All study types except case reports or reviews (e.g. randomized controlled trials (RCTs), retrospective or prospective cohort studies, and case-control studies); A comparative study of Trab and non-penetrating trabecular surgery; Research subject: all kinds of glaucoma; Research content: Astigmatism assessed 6 months after operation Study population: Adult glaucoma patients of all types; Without gender, race, age, and surgical history restrictions; Exclusion Criteria Animal research, case reports, reviews, clinical trials without results, and conference abstract Duplicate publication Combined with other surgeries Without a control group Incomplete data on endpoint indicators that could not be statistically calculated. Data extraction Two investigators independently assessed eligibility and extracted data. The following data were extracted from each study: article characteristics ( country, authors, publication year), study design (RCT, prospective study, and respective study), interventions, participants' characteristics (number of eyes, age, type of glaucoma, baseline astigmatism), duration of follow-up, and astigmatism measurement. Any disagreements were resolved jointly by discussion. Quality evaluation Literature quality was evaluated using the Cochrane Handbook of Systematic Reviews of Interventions (version 5.1.0) for prospective controlled trials, and the Newcastle-Ottawa Scale (NOS) Literature Quality Assessment Scale for cohort and case-control studies. Measurement Outcome To improve the validity of data evaluation, the outcome measure in this paper is the SIA assessed 6 month after operation. When some studies only reported the baseline and endpoint astigmatism, their increase of astigmatism(astigmatismI), and standard deviation (SD) of the astigmatismI (SD astigmatismI ) were calculated using the following formulas: astigmatismI = astigmatism endpoint − astigmatism baseline, SD astigmatismI = (SD 2 baseline + SD 2 endpoint − SD baseline * SD endpoint ) 1/2 Statistical analysis The analysis was performed by RevMan 5.4 software and Stata 12.0 software. The Cochran Q test was used to test heterogeneity, and the fixed-effects model was used to analyze studies with good homogeneity, while the random-effects model was used to analyze studies with more obvious heterogeneity. AstigmatismI was a continuous variable, standardized mean difference (SMD) was used as the effect indicator, and P < 0.05 was considered a statistically significant difference. In this study, literature was excluded from sensitivity analysis using the one-by-one exclusion method. The results of the META analysis are shown as forest plots. RESULTS Study Characteristics and Quality Assessment In all, 26 articles were initially identified through the search strategy described in the Methods section and 15 remained after duplicates were removed. After screening the titles and abstracts, 5 irrelevant studies were excluded. The remaining 10 papers were read in full, and 5 papers were finally included for META analysis based on the inclusion and exclusion criteria [ 6 ][ 7 ][ 8 ][ 9 ]10] (shown in Fig. 1 ). A total of 359 eyes were included in this study, which included 173 eyes in trabeculectomy group and 186 eyes in the NPTS group. The follow-up ranged from 6 months to 12 months. The characteristics of the included studies are detailed in Table 1 . The quality assessment is shown in Figs. 2 , Figs. 3 , and Table 2 . Table 1 Baseline characteristics of included studies Author/year Egrilmez 2004 [ 6 ] El-Saied 2014 [ 7 ] Hong 2012 [ 8 ] Jankowska 2018 [ 9 ] Taruttis 2018 [ 10 ] Research type RCT RCT Cohort study Cohort study Cohort study type of glaucoma OAG POAG POAG, secondary glaucoma POAG, XFG POAG, PXG Samples Trab: 11 eyes NPTS: 19 eyes Trab: 60 eyes NPTS: 60 eyes Trab: 6 eyes NPTS: 9 eyes NPTS: 65 eyes Trab: 66 eyes NPTS: 31 eyes Trab: 32 eyes follow-up time (m) 6 6 12 12 12 outcome measure Astigmatism assessed 6 months after operation Astigmatism assessed 6 months after operation Astigmatism assessed 6 months after operation Astigmatism assessed 6 months after operation Astigmatism assessed 6 months after operation RCT: randomized controlled trial; OAG: open-angle glaucoma; POAG: primary open angle glaucoma; XFG: exfoliative glaucoma; PXG: pseudoexfoliation glaucoma; Trab: Trabeculectomy; NPTS: non-penetrating trabecular surgery Table 2 Quality assessment of all included studies Study Type Selection Comparability Outcome Randomization Masking Accountability Quality of all patients Quality (score) RCT Egrilmez 2004 [ 6 ] 2 0 1 3 El-Saied 2014 [ 7 ] 2 0 1 3 Cohort study Hong 2012 [ 8 ] Retrospective 4 1 1 6 Jankowska 2018 [ 9 ] Prospective 4 2 2 8 Taruttis 2018 [ 10 ] Retrospective 4 2 1 7 For RCTs, study scores ≥ 3 points were defined as high quality. For cohort studies, high-quality studies (score 8–9 points) and medium-quality studies (score 6–7 points) were included, while low-quality studies (score ≤ 5 points) were excluded. Comparison of two operations for the change value of astigmatism at 6 months postoperatively All five papers reported baseline astigmatism before surgery and astigmatism 6 months after operation. The original data showed that both Trab and NPTS resulted in an increase in astigmatism in patients with glaucoma after surgery. The amount of increase in astigmatism was greater in the Trab group than in the NPTS group at or around 6 months postoperatively, and the difference was statistically significant. (SMD = 0.51, 95% CI = 0.19 to 0.83, P = 0.002); the test for heterogeneity showed that all were homogeneous studies (I 2 = 46%, P = 0.12) (Fig. 4 ). Sensitivity analysis and assessment of reporting biases To evaluate the stability and reliability of the results of the META analysis, the META analysis was repeated after deleting each study in turn. Using the AstigmatismI as the analysis index and the fixed-effects model, the results showed that the data from deleting any of the studies were not significantly different from the results before deletion. The results showed that the evaluation results of the current study were stable and credible. Due to the small number of literature included in this study (less than 10), publication bias analysis was not done. DISCUSSION Glaucoma is an important public health concern. Its irreversibility and the demographic changes of an ageing population add to the problem. SIA contributes to the factors behind patients complaining of reduction of vision after successful glaucoma surgery [ 11 ] . Therefore, it’s important to have an accurate evaluation of astigmatism preoperatively and postoperatively. The main apparent advantages of the nonpenetrating filter main apparent advantages of the non-penetrating filtering surgeries compared with conventional trabeculectomy relate to the fact that the globe is not perforated during the procedure because a thin layer of trabecular meshwork tissue is left intact [ 12 ] . This should result in less early postoperative hypotony and associated complications such as choroidal effusion and, possibly, inflammation With no penetration of the eye, peripheral iridectomy is not performed, resulting in less hyphema because no intraocular tissue is cut [ 13 ] . In theory, these advantages should lead to a shorter visual rehabilitation period for the patient. Several limitations should be acknowledged. (1) The 5 papers' definite inclusion/exclusion criteria were used, but the randomization techniques were not detailed. (2) The number of papers and sample sizes covered by the study might compromise the validity of the study. Therefore, more clinical studies are needed to support the conclusion of the study. (3)SIA is a vector, that not only has a magnitude but also has an axis, the calculation of its change should take the axial change into account [ 14 ] . However, one of the above studies only showed the magnitude, so we can only take a simple method, that is, to analyze the change of the magnitude of astigmatism, which is very easy to calculate but a little inaccurate. CONCLUSION In summary, the result of this meta-analysis suggested that both NPTS and trabeculectomy could significantly induce astigmatism. Compared with the conventional trabeculectomy, Non-penetrating trabeculectomy induces less astigmatism at 6 months postoperatively. More research is needed to investigate the specific effects and mechanisms of astigmatism induced by these two types of surgeries. The shortcomings associated with the two operations also await further improvement. Due to the limited number of included publications, our results need to be interpreted with caution critical to consideration. Abbreviations IOP : intraocular pressure ; Trab:Trabeculectomy; NPTS: non-penetrating trabecular surgery; DS:deep sclerectomy; CP: canaloplasty; VCO: viscocanalostomy; SIA: surgically induced astigmatism; AstigmatismI: increase of astigmatism; Mesh: Medical subject headings; NOS: Newcastle-Ottawa Scale; SD astigmatismI: standard deviation of the astigmatismI; SMD: standardized mean difference; RCT: randomized controlled trial; OAG: open-angle glaucoma; POAG: primary open angle glaucoma; XFG:exfoliative glaucoma; PXG:pseudoexfoliation glaucoma Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials All data needed to evaluate the conclusions in the paper are present in the paper or the Supplementary Materials. Competing interests The authors declare that they have no conflicts of interest. Funding This work was supported by the National Natural Science Foundation of China (Grant No. 81970801 to XD), Hunan Engineering Research Center for Glaucoma with Artificial Intelligence in Diagnosis and Application of New Materials(Grant No.2023TP2225 to XD), Natural Science Foundation of Hunan Province, China (Grant No. 2023JJ70014 to XD)， Changsha Municipal Natural Science Foundation(No.kq2208495) and Science and Technology Foundation of Aier Eye Hospital Group, China (Grant No. AR2206D5 to XD and Aier Glaucoma Institute) Authors’ Contributions Conception of the work were performed by Xuanchu Duan. Article evaluation were performed by Xianfting Peng and Qiying Ling. Data analysis were performed by Xiangting Peng. Results interpretation were performed by Xiangting P and Qiying Ling. Drafting the article were performed byXiangting Peng. Critical revision of the manuscript were performed by Xiangting P and Qiying Ling. Final approval of the manuscript: all the authors. Authors’ information 1 Aier Eye Hospital, Jinan University, No. 191, huanshi Middle Road, Yuexiu District, Guangzhou, 510071, Guangdong PR China 2 Aier Eye Hospital, Jinan University, Guangzhou, Guangdong Province, China. 3 Changsha Aier Eye Hospital, Changsha, Hunan Province, China 4 Aier Glaucoma Institute, Hunan Engineering Research Center for Glaucoma with Artificial Intelligence in Diagnosis and Application of New Materials, Changsha Aier Eye Hospital, No.188 South Furong Road，Changsha, Hunan，China，410015. References Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014 Nov;121(11):2081-90. doi: 10.1016/j.ophtha.2014.05.013. Epub 2014 Jun 26. PMID: 24974815. Mattox C. Glaucoma filtration surgery and antimetabolites. Ophthalmic Surg Lasers. 1995 Sep-Oct;26(5):473-80. PMID: 8963862. Dietlein TS. Perspektiven in der Glaukomchirurgie [Perspectives in glaucoma surgery]. Ophthalmologe. 2002 Feb;99(2):74-84. German. Mendrinos E, Mermoud A, Shaarawy T. Nonpenetrating glaucoma surgery. Surv Ophthalmol. 2008 Nov-Dec;53(6):592-630. doi: 10.1016/j.survophthal.2008.08.023. PMID: 19026321. Chan HHL, Kong YXG. Glaucoma surgery and induced astigmatism: a systematic review. Eye Vis (Lond). 2017 Nov 17;4:27. doi: 10.1186/s40662-017-0090-x. PMID: 29177182; PMCID: PMC5691392. Egrilmez S, Ates H, Nalcaci S, Andac K, Yagci A. Surgically induced corneal refractive change following glaucoma surgery: nonpenetrating trabecular surgeries versus trabeculectomy. J Cataract Refract Surg. 2004 Jun;30(6):1232-9. doi: 10.1016/j.jcrs.2003.11.055. PMID: 15177597. El-Saied HM, Foad PH, Eldaly MA, Abdelhakim MA. Surgically induced astigmatism following glaucoma surgery in Egyptian patients. J Glaucoma. 2014 Mar;23(3):190-3. doi: 10.1097/IJG.0000000000000035. PMID: 24326967. Lee Y J, Hong S, Kim C Y, et al. Comparison of surgically induced corneal astigmatism following trabeculectomy and deep sclerectomy with collagen implant[J]. J Korean Ophthalmol Soc, 2012, 53: 94-102. Jankowska-Szmul J, Dobrowolski D, Wylegala E. CO2 laser-assisted sclerectomy surgery compared with trabeculectomy in primary open-angle glaucoma and exfoliative glaucoma. A 1-year follow-up. Acta Ophthalmol. 2018 Aug;96(5):e582-e591. doi: 10.1111/aos.13718. Epub 2018 Apr 14. PMID: 29655275. Taruttis T, Chankiewitz E, Hammer T. Vergleich von Trabekulektomie und Kanaloplastik : Drucksenkender Effekt und postoperatives Komplikations- und Interventionsspektrum [Comparison of trabeculectomy and canaloplasty : Pressure reducing effect and postoperative interventions/complications]. Ophthalmologe. 2018 Feb;115(2):137-144. German. doi: 10.1007/s00347-017-0449-3. PMID: 28210791. Claridge KG, Galbraith JK, Karmel V, Bates AK. The effect of trabeculectomy on refraction, keratometry and corneal topography. Eye (Lond). 1995;9 ( Pt 3):292-8. doi: 10.1038/eye.1995.57. PMID: 7556735. Detry-Morel M, Pourjavan S, Detry MB. Comparative safety profile between "modern" trabeculectomy and non-penetrationg deep sclerectomy. Bull Soc Belge Ophtalmol. 2006;(300):43-54. PMID: 16903511. Hamard P, Lachkar Y. La chirurgie filtrante non perforante: évolution du concept, réalisation, résultats [Non penetrating filtering surgery, evolution and results]. J Fr Ophtalmol. 2002 May;25(5):527-36. French. PMID: 12048520. Alpins NA. A new method of analyzing vectors for changes in astigmatism. J Cataract Refract Surg. 1993 Jul;19(4):524-33. doi: 10.1016/s0886-3350(13)80617-7. PMID: 8355160. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Aug, 2024 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 24 Jun, 2024 Editor assigned by journal 24 Jun, 2024 Submission checks completed at journal 24 Jun, 2024 First submitted to journal 21 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4617236","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318334889,"identity":"6481e860-1fb7-42fd-851e-96c0c5b5a89a","order_by":0,"name":"Xiangting Peng","email":"","orcid":"","institution":"Jinan University","correspondingAuthor":false,"prefix":"","firstName":"Xiangting","middleName":"","lastName":"Peng","suffix":""},{"id":318334891,"identity":"8a135db0-f5a9-44cb-9240-bbc932fb6cb0","order_by":1,"name":"Qiying Ling","email":"","orcid":"","institution":"Jinan University","correspondingAuthor":false,"prefix":"","firstName":"Qiying","middleName":"","lastName":"Ling","suffix":""},{"id":318334892,"identity":"1c33f36c-8fd7-4363-b70f-3c1482c6b886","order_by":2,"name":"Xuanchu Duan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYDCCA1CSH8JlJkGLZAPJWgwOEKuF70bys8c8NXcSNx8//kyCocI6sYH97AG8WiRvpJkbzjj2LHHbmRwzCYYz6YkNPHkJeLUY3Egwk/jYcDhx2w0eNgnGtsOJDRI8BgS0pH+TSARq2TyD/ZkE4z+itORAbNkgwWAmwdhAhBbJM2/KJGccO2w840yOsUXCsXTjNp4c/Fr4jqdvk+apOSzb33784Y0PNday/exn8GtBBQlAzEaC+lEwCkbBKBgFOAAAgwRJwxhkGY8AAAAASUVORK5CYII=","orcid":"","institution":"Jinan University","correspondingAuthor":true,"prefix":"","firstName":"Xuanchu","middleName":"","lastName":"Duan","suffix":""}],"badges":[],"createdAt":"2024-06-21 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studies\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.Flowchartdepictingtheselectionofincludedstudies.png","url":"https://assets-eu.researchsquare.com/files/rs-4617236/v1/c1df283fb4113c8c6e439d94.png"},{"id":60620439,"identity":"95620858-52c0-4013-9051-f84f11fe8b42","added_by":"auto","created_at":"2024-07-18 20:52:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30358,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMethodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.Methodologicalqualitygraph.png","url":"https://assets-eu.researchsquare.com/files/rs-4617236/v1/4fcdba220af4932fdc404b06.png"},{"id":60620438,"identity":"259ce24f-fa02-4490-9f72-a53ec0315912","added_by":"auto","created_at":"2024-07-18 20:52:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52607,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRisk of bias summary: review authors' judgments about each risk of bias item for each included study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure3.Riskofbiassummary.png","url":"https://assets-eu.researchsquare.com/files/rs-4617236/v1/d57cacb70ce2824a39f53e89.png"},{"id":60620441,"identity":"61fb9215-d996-4188-bd06-43d068861fef","added_by":"auto","created_at":"2024-07-18 20:52:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":232908,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot of comparison: trabeculectomy versus Non-penetrating filtration surgery, outcome: astigmatism at 6 months postoperatively\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure4Forestplotofcomparison.png","url":"https://assets-eu.researchsquare.com/files/rs-4617236/v1/dc6809522689107eaf3a0f1d.png"},{"id":63821131,"identity":"e590b5d9-bab9-4337-bc13-44ea2eedbb62","added_by":"auto","created_at":"2024-09-02 16:12:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":919428,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4617236/v1/7e9e70bf-f081-4aac-88d9-8ebe7e8a0539.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Non-penetrating filtration surgery versus trabeculectomy in postoperative astigmatism: a Meta-analysis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eGlaucoma is the second most common blinding disease of the eye, which is characterized by visual field defects and progressive optic nerve damage caused by elevated intraocular pressure (IOP). The number of patients with glaucoma is increasing year by year, and it is expected to reach 95.4\u0026nbsp;million worldwide in 2030 and 111.8\u0026nbsp;million in 2040\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, which will bring a huge social and economic burden. Filtration surgery is indicated when medication and laser therapies are insufficient to control IOP, and when the rate of deterioration of visual function is rapid enough to damage the patient\u0026rsquo;s quality of life\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Trabeculectomy (Trab) is considered as the gold standard. However, it is associated with significant postoperative complications such as hyphaema, shallow or flat anterior chamber, hypotony, choroidal detachment, and hypotony maculopathy leading to failure of glaucoma surgery\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. To minimize these complications, non-penetrating trabecular surgery (NPTS) has been increasingly performed in recent years, including deep sclerectomy (DS), canaloplasty (CP), and viscocanalostomy (VCO), along with a combination of implants and antimetabolites\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWith the continuous development of medical technology and newer equipment, glaucoma patients' expectations of surgical treatment are no longer satisfied with IOP reduction, but they also expect to have better vision to fulfill their life needs. Previous studies have found that surgically induced astigmatism (SIA) is an important factor that influences the quality of the vision and visual rehabilitation of patients with glaucoma\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. However, different surgical procedures do not affect corneal astigmatism in the same way. Understanding and comparing the effects of Trab and NPTS on postoperative astigmatism may help to prevent or reduce the occurrence of astigmatism in the postoperative period. Few studies have directly compared the two operations. Consequently, this paper conducts a meta-analysis to evaluate the astigmatism after operation for glaucoma treatment.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch strategy\u003c/h2\u003e \u003cp\u003eIn this study, A computerized search of PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure was performed and literature on non-penetrating trabecular surgery and trabeculectomy in postoperative astigmatism of patients with glaucoma was searched. Search entries were adjusted according to the different databases. The time frame for the search was from the time of construction to April 2024.\u003c/p\u003e \u003cp\u003eThe search strategy for PubMed was as follows:((((\"Glaucoma\"[Mesh]) OR (GLAUCOMA)) AND ((\"Trabeculectomy\"[Mesh]) OR (Trabeculectomy))) AND (((((nonpenetrating glaucoma surgery) OR (non-penetrating trabecular surgery)) OR (deep sclerectomy)) OR (canaloplasty)) OR (viscocanalostomy))) AND ((\"Astigmatism\"[Mesh]) OR (astigmatism))\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy selection\u003c/h2\u003e \u003cp\u003e \u003cb\u003eInclusion Criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAll study types except case reports or reviews (e.g. randomized controlled trials (RCTs), retrospective or prospective cohort studies, and case-control studies);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA comparative study of Trab and non-penetrating trabecular surgery;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eResearch subject: all kinds of glaucoma;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eResearch content: Astigmatism assessed 6 months after operation\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStudy population: Adult glaucoma patients of all types;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWithout gender, race, age, and surgical history restrictions;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eExclusion Criteria\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAnimal research, case reports, reviews, clinical trials without results, and conference abstract\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDuplicate publication\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCombined with other surgeries\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWithout a control group\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIncomplete data on endpoint indicators that could not be statistically calculated.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData extraction\u003c/h2\u003e \u003cp\u003eTwo investigators independently assessed eligibility and extracted data. The following data were extracted from each study: article characteristics ( country, authors, publication year), study design (RCT, prospective study, and respective study), interventions, participants' characteristics (number of eyes, age, type of glaucoma, baseline astigmatism), duration of follow-up, and astigmatism measurement. Any disagreements were resolved jointly by discussion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eQuality evaluation\u003c/h2\u003e \u003cp\u003eLiterature quality was evaluated using the Cochrane Handbook of Systematic Reviews of Interventions (version 5.1.0) for prospective controlled trials, and the Newcastle-Ottawa Scale (NOS) Literature Quality Assessment Scale for cohort and case-control studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement Outcome\u003c/h2\u003e \u003cp\u003eTo improve the validity of data evaluation, the outcome measure in this paper is the SIA assessed 6 month after operation. When some studies only reported the baseline and endpoint astigmatism, their increase of astigmatism(astigmatismI), and standard deviation (SD) of the astigmatismI (SD\u003csub\u003eastigmatismI\u003c/sub\u003e) were calculated using the following formulas:\u003c/p\u003e \u003cp\u003eastigmatismI\u0026thinsp;=\u0026thinsp;astigmatism\u003csub\u003eendpoint\u003c/sub\u003e \u0026minus; astigmatism\u003csub\u003ebaseline,\u003c/sub\u003e\u003c/p\u003e \u003cp\u003eSD\u003csub\u003eastigmatismI\u003c/sub\u003e = (SD\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ebaseline\u003c/sub\u003e\u0026thinsp;+\u0026thinsp;SD\u003csup\u003e2\u003c/sup\u003e\u003csub\u003eendpoint\u003c/sub\u003e\u0026thinsp;\u0026minus;\u0026thinsp;SD\u003csub\u003ebaseline *\u003c/sub\u003e SD\u003csub\u003eendpoint\u003c/sub\u003e)\u003csup\u003e1/2\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe analysis was performed by RevMan 5.4 software and Stata 12.0 software. The Cochran Q test was used to test heterogeneity, and the fixed-effects model was used to analyze studies with good homogeneity, while the random-effects model was used to analyze studies with more obvious heterogeneity. AstigmatismI was a continuous variable, standardized mean difference (SMD) was used as the effect indicator, and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered a statistically significant difference. In this study, literature was excluded from sensitivity analysis using the one-by-one exclusion method. The results of the META analysis are shown as forest plots.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003eStudy Characteristics and Quality Assessment\u003c/h2\u003e\n \u003cp\u003eIn all, 26 articles were initially identified through the search strategy described in the \u003cspan\u003eMethods\u003c/span\u003e section and 15 remained after duplicates were removed. After screening the titles and abstracts, 5 irrelevant studies were excluded. The remaining 10 papers were read in full, and 5 papers were finally included for META analysis based on the inclusion and exclusion criteria\u003csup\u003e[\u003cspan\u003e6\u003c/span\u003e][\u003cspan\u003e7\u003c/span\u003e][\u003cspan\u003e8\u003c/span\u003e][\u003cspan\u003e9\u003c/span\u003e]10]\u003c/sup\u003e (shown in Fig. \u003cspan\u003e1\u003c/span\u003e). A total of 359 eyes were included in this study, which included 173 eyes in trabeculectomy group and 186 eyes in the NPTS group. The follow-up ranged from 6 months to 12 months. The characteristics of the included studies are detailed in Table \u003cspan\u003e1\u003c/span\u003e. The quality assessment is shown in Figs. \u003cspan\u003e2\u003c/span\u003e, Figs. \u003cspan\u003e3\u003c/span\u003e, and Table \u003cspan\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBaseline characteristics of included studies\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003eAuthor/year\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eEgrilmez 2004\u003csup\u003e[\u003cspan\u003e6\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eEl-Saied\u003cbr\u003e2014\u003csup\u003e[\u003cspan\u003e7\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eHong\u003cbr\u003e2012\u003csup\u003e[\u003cspan\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eJankowska 2018\u003csup\u003e[\u003cspan\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eTaruttis 2018\u003csup\u003e[\u003cspan\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003eResearch type\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eRCT\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eRCT\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eCohort study\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eCohort study\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eCohort study\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003etype of glaucoma\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eOAG\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003ePOAG\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003ePOAG, secondary glaucoma\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003ePOAG, XFG\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003ePOAG, PXG\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003eSamples\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eTrab: 11 eyes\u003cbr\u003eNPTS: 19 eyes\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eTrab: 60 eyes\u003cbr\u003eNPTS: 60 eyes\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eTrab: 6 eyes\u003cbr\u003eNPTS: 9 eyes\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eNPTS: 65 eyes\u003cbr\u003eTrab: 66 eyes\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eNPTS: 31 eyes\u003cbr\u003eTrab: 32 eyes\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003efollow-up time (m)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e12\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e12\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e12\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003eoutcome measure\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eAstigmatism assessed 6 months after operation\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eAstigmatism assessed 6 months after operation\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eAstigmatism assessed 6 months after operation\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eAstigmatism assessed 6 months after operation\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eAstigmatism assessed 6 months after operation\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003eRCT: randomized controlled trial; OAG: open-angle glaucoma; POAG: primary open angle glaucoma; XFG: exfoliative glaucoma; PXG: pseudoexfoliation glaucoma; Trab: Trabeculectomy; NPTS: non-penetrating trabecular surgery\u003cbr\u003e\n \u003cdiv\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eQuality assessment of all included studies\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003eStudy\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eType\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eSelection\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eComparability\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eOutcome\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eRandomization\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eMasking\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eAccountability Quality of all patients\u003cbr\u003e\u003c/th\u003e\n \u003cth align=\"left\"\u003eQuality\u003cbr\u003e(score)\u003cbr\u003e\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003eRCT\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eEgrilmez 2004\u003csup\u003e[\u003cspan\u003e6\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eEl-Saied\u003cbr\u003e2014\u003csup\u003e[\u003cspan\u003e7\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u003cstrong\u003eCohort study\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eHong\u003cbr\u003e2012\u003csup\u003e[\u003cspan\u003e8\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eRetrospective\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eJankowska 2018\u003csup\u003e[\u003cspan\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eProspective\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003eTaruttis 2018\u003csup\u003e[\u003cspan\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003eRetrospective\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd align=\"char\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003eFor RCTs, study scores\u0026thinsp;\u0026ge;\u0026thinsp;3 points were defined as high quality. For cohort studies, high-quality studies (score 8\u0026ndash;9 points) and medium-quality studies (score 6\u0026ndash;7 points) were included, while low-quality studies (score\u0026thinsp;\u0026le;\u0026thinsp;5 points) were excluded.\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003eComparison of two operations for the change value of astigmatism at 6 months postoperatively\u003c/h2\u003e\n \u003cp\u003eAll five papers reported baseline astigmatism before surgery and astigmatism 6 months after operation. The original data showed that both Trab and NPTS resulted in an increase in astigmatism in patients with glaucoma after surgery. The amount of increase in astigmatism was greater in the Trab group than in the NPTS group at or around 6 months postoperatively, and the difference was statistically significant. (SMD\u0026thinsp;=\u0026thinsp;0.51, 95% CI\u0026thinsp;=\u0026thinsp;0.19 to 0.83, P\u0026thinsp;=\u0026thinsp;0.002); the test for heterogeneity showed that all were homogeneous studies (I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;46%, P\u0026thinsp;=\u0026thinsp;0.12) (Fig. \u003cspan\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eSensitivity analysis and assessment of reporting biases\u003c/h2\u003e\n \u003cp\u003eTo evaluate the stability and reliability of the results of the META analysis, the META analysis was repeated after deleting each study in turn. Using the AstigmatismI as the analysis index and the fixed-effects model, the results showed that the data from deleting any of the studies were not significantly different from the results before deletion. The results showed that the evaluation results of the current study were stable and credible. Due to the small number of literature included in this study (less than 10), publication bias analysis was not done.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eGlaucoma is an important public health concern. Its irreversibility and the demographic changes of an ageing population add to the problem. SIA contributes to the factors behind patients complaining of reduction of vision after successful glaucoma surgery\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Therefore, it\u0026rsquo;s important to have an accurate evaluation of astigmatism preoperatively and postoperatively.\u003c/p\u003e \u003cp\u003eThe main apparent advantages of the nonpenetrating filter main apparent advantages of the non-penetrating filtering surgeries compared with conventional trabeculectomy relate to the fact that the globe is not perforated during the procedure because a thin layer of trabecular meshwork tissue is left intact\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. This should result in less early postoperative hypotony and associated complications such as choroidal effusion and, possibly, inflammation With no penetration of the eye, peripheral iridectomy is not performed, resulting in less hyphema because no intraocular tissue is cut\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. In theory, these advantages should lead to a shorter visual rehabilitation period for the patient.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. (1) The 5 papers' definite inclusion/exclusion criteria were used, but the randomization techniques were not detailed. (2) The number of papers and sample sizes covered by the study might compromise the validity of the study. Therefore, more clinical studies are needed to support the conclusion of the study. (3)SIA is a vector, that not only has a magnitude but also has an axis, the calculation of its change should take the axial change into account\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. However, one of the above studies only showed the magnitude, so we can only take a simple method, that is, to analyze the change of the magnitude of astigmatism, which is very easy to calculate but a little inaccurate.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn summary, the result of this meta-analysis suggested that both NPTS and trabeculectomy could significantly induce astigmatism. Compared with the conventional trabeculectomy, Non-penetrating trabeculectomy induces less astigmatism at 6 months postoperatively. More research is needed to investigate the specific effects and mechanisms of astigmatism induced by these two types of surgeries. The shortcomings associated with the two operations also await further improvement. Due to the limited number of included publications, our results need to be interpreted with caution critical to consideration.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIOP\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eintraocular pressure ; Trab:Trabeculectomy; NPTS: non-penetrating trabecular surgery; DS:deep sclerectomy; CP: canaloplasty; VCO: viscocanalostomy; SIA: surgically induced astigmatism; AstigmatismI: increase of astigmatism; Mesh: Medical subject headings; NOS: Newcastle-Ottawa Scale; SD\u003csub\u003eastigmatismI:\u0026nbsp;\u003c/sub\u003estandard deviation of the astigmatismI; SMD: standardized mean difference; RCT: randomized controlled trial; OAG: open-angle glaucoma; POAG: primary open angle glaucoma; XFG:exfoliative glaucoma; PXG:pseudoexfoliation glaucoma\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003eAll data needed to evaluate the conclusions in the paper are present in the paper or the Supplementary Materials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThis work was supported by the National Natural Science Foundation of China (Grant No. 81970801 to XD), Hunan Engineering Research Center for Glaucoma with Artificial Intelligence in Diagnosis and Application of New Materials(Grant No.2023TP2225 to XD), Natural Science Foundation of Hunan Province, China (Grant No. 2023JJ70014 to XD)，\u0026nbsp;Changsha Municipal Natural Science Foundation(No.kq2208495) and Science and Technology Foundation of Aier Eye Hospital Group, China (Grant No. AR2206D5 to XD and Aier Glaucoma Institute)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u0026nbsp;\u003c/strong\u003eConception of the work were performed by Xuanchu Duan. Article evaluation were performed by Xianfting Peng and Qiying Ling. Data analysis were performed by Xiangting Peng. Results interpretation were performed by Xiangting P and Qiying Ling. Drafting the article were performed byXiangting Peng. Critical revision of the manuscript were performed by Xiangting P and Qiying Ling. Final approval of the manuscript: all the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u0026nbsp;\u003c/strong\u003e\u003csup\u003e1\u003c/sup\u003eAier Eye Hospital, Jinan University, No. 191, huanshi Middle Road, Yuexiu District, Guangzhou, 510071, Guangdong PR China \u003csup\u003e2\u003c/sup\u003eAier Eye Hospital, Jinan University, Guangzhou, Guangdong Province, China. \u003csup\u003e3\u003c/sup\u003e Changsha Aier Eye Hospital, Changsha, Hunan Province, China \u003csup\u003e4\u0026nbsp;\u003c/sup\u003eAier Glaucoma Institute, Hunan Engineering Research Center for Glaucoma with Artificial Intelligence in Diagnosis and Application of New Materials, Changsha Aier Eye Hospital, No.188 South Furong Road，Changsha, Hunan，China，410015.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014 Nov;121(11):2081-90. doi: 10.1016/j.ophtha.2014.05.013. Epub 2014 Jun 26. PMID: 24974815.\u003c/li\u003e\n\u003cli\u003eMattox C. Glaucoma filtration surgery and antimetabolites. Ophthalmic Surg Lasers. 1995 Sep-Oct;26(5):473-80. PMID: 8963862.\u003c/li\u003e\n\u003cli\u003eDietlein TS. Perspektiven in der Glaukomchirurgie [Perspectives in glaucoma surgery]. Ophthalmologe. 2002 Feb;99(2):74-84. German. \u003c/li\u003e\n\u003cli\u003eMendrinos E, Mermoud A, Shaarawy T. Nonpenetrating glaucoma surgery. Surv Ophthalmol. 2008 Nov-Dec;53(6):592-630. doi: 10.1016/j.survophthal.2008.08.023. PMID: 19026321. \u003c/li\u003e\n\u003cli\u003eChan HHL, Kong YXG. Glaucoma surgery and induced astigmatism: a systematic review. Eye Vis (Lond). 2017 Nov 17;4:27. doi: 10.1186/s40662-017-0090-x. PMID: 29177182; PMCID: PMC5691392. \u003c/li\u003e\n\u003cli\u003eEgrilmez S, Ates H, Nalcaci S, Andac K, Yagci A. Surgically induced corneal refractive change following glaucoma surgery: nonpenetrating trabecular surgeries versus trabeculectomy. J Cataract Refract Surg. 2004 Jun;30(6):1232-9. doi: 10.1016/j.jcrs.2003.11.055. PMID: 15177597.\u003c/li\u003e\n\u003cli\u003eEl-Saied HM, Foad PH, Eldaly MA, Abdelhakim MA. Surgically induced astigmatism following glaucoma surgery in Egyptian patients. J Glaucoma. 2014 Mar;23(3):190-3. doi: 10.1097/IJG.0000000000000035. PMID: 24326967. \u003c/li\u003e\n\u003cli\u003eLee Y J, Hong S, Kim C Y, et al. Comparison of surgically induced corneal astigmatism following trabeculectomy and deep sclerectomy with collagen implant[J]. J Korean Ophthalmol Soc, 2012, 53: 94-102.\u003c/li\u003e\n\u003cli\u003eJankowska-Szmul J, Dobrowolski D, Wylegala E. CO2 laser-assisted sclerectomy surgery compared with trabeculectomy in primary open-angle glaucoma and exfoliative glaucoma. A 1-year follow-up. Acta Ophthalmol. 2018 Aug;96(5):e582-e591. doi: 10.1111/aos.13718. Epub 2018 Apr 14. PMID: 29655275.\u003c/li\u003e\n\u003cli\u003eTaruttis T, Chankiewitz E, Hammer T. Vergleich von Trabekulektomie und Kanaloplastik : Drucksenkender Effekt und postoperatives Komplikations- und Interventionsspektrum [Comparison of trabeculectomy and canaloplasty : Pressure reducing effect and postoperative interventions/complications]. Ophthalmologe. 2018 Feb;115(2):137-144. German. doi: 10.1007/s00347-017-0449-3. PMID: 28210791. \u003c/li\u003e\n\u003cli\u003eClaridge KG, Galbraith JK, Karmel V, Bates AK. The effect of trabeculectomy on refraction, keratometry and corneal topography. Eye (Lond). 1995;9 ( Pt 3):292-8. doi: 10.1038/eye.1995.57. PMID: 7556735. \u003c/li\u003e\n\u003cli\u003eDetry-Morel M, Pourjavan S, Detry MB. Comparative safety profile between \u0026quot;modern\u0026quot; trabeculectomy and non-penetrationg deep sclerectomy. Bull Soc Belge Ophtalmol. 2006;(300):43-54. PMID: 16903511.\u003c/li\u003e\n\u003cli\u003eHamard P, Lachkar Y. La chirurgie filtrante non perforante: \u0026eacute;volution du concept, r\u0026eacute;alisation, r\u0026eacute;sultats [Non penetrating filtering surgery, evolution and results]. J Fr Ophtalmol. 2002 May;25(5):527-36. French. PMID: 12048520.\u003c/li\u003e\n\u003cli\u003eAlpins NA. A new method of analyzing vectors for changes in astigmatism. J Cataract Refract Surg. 1993 Jul;19(4):524-33. doi: 10.1016/s0886-3350(13)80617-7. PMID: 8355160.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Trabeculectomy, Non-penetrating trabecular surgery, Astigmatism, glaucoma, Meta-Analysis","lastPublishedDoi":"10.21203/rs.3.rs-4617236/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4617236/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTrabeculectomy and non-penetrating trabecular surgery are common operations for glaucoma. This meta-analysis aims to compare the effect of trabeculectomy and non-penetrating trabecular surgery in postoperative astigmatism of patients with glaucoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe searched the PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure to identify studies that, compared between trabeculectomy and non-penetrating trabecular surgery in patients with glaucoma. The time frame for the search was from the time of construction to April 2024. There were no restrictions regarding study type or type of glaucoma. The primary endpoint was the surgically induced astigmatism assessed 6 months after operation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults Five\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eeligible studies were included in this meta-analysis and presented data for 359 eyes with various types of glaucoma at different stages. The results revealed an increase in astigmatism in patients with glaucoma after trabeculectomy and non-penetrating trabecular surgery. Trabeculectomy had a higher incidence of astigmatism than in the non-penetrating trabecular surgery group at or around 6 months postoperatively, and the difference was statistically significant. (SMD = 0.51, 95% CI = 0.19 to 0.83, P = 0.002).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur results demonstrated that both trabeculectomy and non-penetrating trabecular surgery could increase astigmatism until 6 months after operation. Moreover, non-penetrating trabecular surgery group seems to have less influence on astigmatism. Studies with longer follow-up durations and larger sample sizes are necessary in the future.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCRD42024517708\u003c/p\u003e","manuscriptTitle":"Non-penetrating filtration surgery versus trabeculectomy in postoperative astigmatism: a Meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 20:52:06","doi":"10.21203/rs.3.rs-4617236/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-24T13:23:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-24T09:09:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-24T09:08:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2024-06-21T11:51:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1fd87ff9-5e07-4f3e-a0da-7fb81e604725","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-02T16:05:14+00:00","versionOfRecord":{"articleIdentity":"rs-4617236","link":"https://doi.org/10.1186/s12886-024-03651-y","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2024-08-28 15:58:08","publishedOnDateReadable":"August 28th, 2024"},"versionCreatedAt":"2024-07-18 20:52:06","video":"","vorDoi":"10.1186/s12886-024-03651-y","vorDoiUrl":"https://doi.org/10.1186/s12886-024-03651-y","workflowStages":[]},"version":"v1","identity":"rs-4617236","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4617236","identity":"rs-4617236","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}