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Beta radiation for glaucoma surgeryKirwan JF, Rennie C, Evans JR
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SummaryBeta radiation in glaucoma surgeryThe aim of glaucoma surgery is to lower the pressure in the eye. The outcome of glaucoma surgery can be affected by the rate at which the surgical wound heals. Beta radiation has been proposed as a rapid and simple treatment to slow down the healing response. It is applied during the operation using a radioactive applicator which emits beta rays which have only a very local penetration to a depth of less than one millimetre. The intensity of the emission from the applicator (usually Strontium-90) determines the duration it is applied to the surgical site in order to deliver the required dose of radiation which effectively prevents scar tissue formation. We found four trials that randomised 551 people to trabeculectomy with beta irradiation versus trabeculectomy alone. People who had trabeculectomy with beta irradiation were less likely to have a high pressure that was too high one year after surgery compared to people who had trabeculectomy alone. However, people who had beta irradiation had an increased risk of cataract after surgery.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 2, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 15. 2009 AbstractBackgroundThe outcome of glaucoma surgery can be affected by the rate at which the surgical wound heals. Beta radiation has been proposed as a rapid and simple treatment to slow down the healing response. ObjectivesTo assess the effectiveness of beta radiation during glaucoma surgery (trabeculectomy). Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (which includes the Cochrane Eyes and Vision Group Trials Register) (Issue 4 2008), MEDLINE (January 1966 to October 2008) and EMBASE (January 1980 to October 2008). The databases were last searched on 24 October 2008. Selection criteriaWe included randomised controlled trials comparing trabeculectomy with beta radiation to trabeculectomy without beta radiation. Data collection and analysisWe collected data on surgical failure (intraocular pressure > 21 mmHg), intraocular pressure and adverse effects of glaucoma surgery. We pooled data using a fixed-effect model. Main resultsWe found four trials that randomised 551 people to trabeculectomy with beta irradiation versus trabeculectomy alone. Two trials were in Caucasian people (126 people), one trial in black African people (320 people) and one trial in Chinese people (105 people). People who had trabeculectomy with beta irradiation had a lower risk of surgical failure compared to people who had trabeculectomy alone (pooled risk ratio (RR) 0.23 (95% CI 0.14 to 0.40). Beta irradiation was associated with an increased risk of cataract (RR 2.89, 95% CI 1.39 to 6.0). Authors' conclusionsTrabeculectomy with beta irradiation has a lower risk of surgical failure compared to trabeculectomy alone. A trial of beta irradiation versus anti-metabolite is warranted. |