title: Meta-analysis of beta radiation augmentation for trabeculectomy - results in distinct ethnic groups.
abstract: OBJECTIVE
  To conduct a systematic review with meta-analysis on the efficacy of trabeculectomy (TREC) followed by beta irradiation (BRT/TREC) compared to TREC alone for glaucoma in terms of intraocular pressure (IOP) control and adverse effects of treatment in different ethnic groups.
  
  
  METHODS
  A meta-analysis of randomized controlled trials (RCT) was performed comparing adjunct BRT treatment for glaucoma with standard TREC after 12 months. The MEDLINE, EMBASE, LILACS, and Cochrane Library databases, Trial registers, bibliographic databases and recent studies of relevant journals were searched. Two reviewers independently reviewed relevant reports and the references from these reports were searched for additional trials, using guidelines set by QUOROM statement criteria.
  
  
  RESULTS
  Of a total of 1,350 citations, eight studies (five cohorts, three randomized) were identified and only 3 RCT were included in this meta-analysis. Higher IOP reductions were verified in the BRT arm compared to the control arm (mean difference=1.68 mmHg, 95% CI= 0.61-2.68, P=0.002). Uncontrolled postoperative IOP (>21 mmHg) was less frequent when BRT was used (BRT/ TREC arm) compared to the control arm (38/218=17.4% versus 9/239=3.8%; OR=6.7; 95% CI 3.2-14.3, P<0.0001). Although better IOP control was observed in all patients treated with adjuvant BRT, only Black patients displayed a significant difference (P=0.005). There were no significant differences between the BRT and control arms regarding loss of visual acuity, postoperative complications and necessity of cataract surgery.
  
  
  CONCLUSIONS
  Adjunct BRT increases the success rate of TREC, with better results in non Caucasian patients, and does not influence the occurrence of postoperative complications.
authors: Department of Ophthalmology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, SP, Brazil.
authors: Lígia Issa de
authors: LI
authors: Fendi
authors: Gustavo Viani
authors: GV
authors: Arruda
authors: Vital Paulino
authors: VP
authors: Costa
authors: Jayter Silva
authors: JS
authors: Paula
mesh_terms: D001610:Beta Particles / Q000627:therapeutic use*; D005901:Glaucoma / Q000208:ethnology / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D014130:Trabeculectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity