title: Anti-VEGF agents with or without antimetabolites in trabeculectomy for glaucoma: a meta-analysis.
abstract: OBJECTIVE
  We aimed to evaluate the intraoperative application of antimetabolites compared with anti-vascular endothelial growth factor (VEGF) agents with or without antimetabolites in trabeculectomy (Trab) for glaucoma.
  
  
  METHODS
  Relevant studies were selected through extensive search using PubMed, EMBASE, the Cochrane Library, and Web of Science databases in August 2013. The primary efficacy estimate was measured using weighted mean difference of the percentage of intraocular pressure reduction (IOPR%) from baseline to end-point, and the secondary efficacy estimates were odds ratio (OR) and 95% confidence interval (CI) for complete success rate and qualified success rate. ORs were also used to measure the tolerability estimate for adverse events. Meta-analyses of fixed or random effects models were conducted using RevMan software 5.2 to pool the results of the studies included. Heterogeneity was assessed using Chi(2) test and the I(2) measure.
  
  
  RESULTS
  Nine studies enrolling a total of 349 patients were included. The weighted mean difference of IOPR% from baseline was 7.23 (95% CI: 2.57-11.89) for antimetabolites vs. anti-VEGF agents and 3.96 (95% CI: -4.18-12.10) for antimetabolites vs. anti-VEGF agents plus antimetabolites. The pooled ORs comparing antimetabolites with anti-VEGF agents were 2.37 (95% CI: 0.78, 7.21) for the complete success rate and 1.93 (95% CI: 0.52, 7.16) for qualified success rate. The pooled ORs comparing antimetabolites with anti-VEGF agents plus antimetabolites were 1.43 (95% CI: 0.48, 4.29) for the complete success rate and 2.11 (95% CI: 0.12, 37.72) for qualified success rate. The rates of adverse events did not significantly differ between antimetabolites and anti-VEGF agents, with pooled ORs of 0.86 (0.28-2.69) for bleb leakage, 3.01 (0.45-20.10) for choroidal effusion, 0.96 (0.23-3.98) for flat anterior chamber, and 0.90 (0.12-6.60) for hypotony. Further, the rates of adverse events were similar between antimetabolites and anti-VEGF agents plus antimetabolites, with pooled ORs of 0.40 (0.08-2.00) and 8.00 (0.93-68.59) for bleb leakage and hypotony, respectively.
  
  
  CONCLUSIONS
  In comparison with anti-VEGF agents, antimetabolites were more effective in lowering IOP in Trab, while the intraoperative application of these two types of agents did not indicate statistically significant differences in the complete success rate, qualified success rate, or incidence of adverse events.
authors: Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China.
authors: Qi
authors: Q
authors: Xiong
authors: Department of Orthpedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
authors: Zhiliang
authors: Z
authors: Li
authors: Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China.
authors: Zhaohui
authors: Z
authors: Li
authors: Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China.
authors: Yi
authors: Y
authors: Zhu
authors: Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China.
authors: Sancar
authors: S
authors: Abdulhalim
authors: Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China.
authors: Ping
authors: P
authors: Wang
authors: Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China.
authors: Xiaojun
authors: X
authors: Cai
mesh_terms: D000368:Aged; D000963:Antimetabolites / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012984:Software; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D000963:Antimetabolites; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A