内界膜翻转填塞与内界膜剥除治疗高度近视黄斑裂孔视网膜脱离的Meta分析

A Meta-analysis of the efficacy of internal limiting membrane reversal tamponade and internal limiting membrane stripping for macular hole retinal detachment in the highly myopia eyes

摘要:

目的：评价玻璃体切除(PPV)联合内界膜(ILM)翻转填塞或ILM剥除在治疗高度近视黄斑裂孔视网膜脱离(MHRD)中解剖学及视力恢复疗效。

方法：从中国知网(CNKI)、维普(VIP)、万方数据库(Wan Fang Database)、PubMed、EMbase、The Cochrane Library、Europe PMC、Nature数据库中检索文献，检索时间均为建库至2018-09。以术后6mo为随访时间节点，观察黄斑裂孔闭合、原发性视网膜复位及BCVA情况。采用Review 5.3及Stata 15.1软件进行Meta分析。

结果：本研究包括8项研究266眼。ILM翻转填塞在黄斑裂孔闭合率方面优于ILM剥除(RR=2.05，95%CI 1.69～2.49，P<0.00001)，在原发性视网膜复位率方面无差异(RR=1.04，95%CI 0.98～1.12，P=0.21)，在术后6mo两组BCVA均较术前明显提高(分别为：RR=0.44，95%CI 0.33～0.55，P<0.00001； RR=0.29，95%CI 0.10～0.48，P=0.003)，两组间BCVA改善程度的差异结果存在异质性，其结论可能不稳定，尚需更多可靠数据证明。

结论：PPV联合ILM翻转填塞在治疗高度近视MHRD患者中更有效。

Abstract:

AIM: To evaluate the anatomical and visual recovery effects of vitrectomy(PPV)combined with inner limiting membrane(ILM)reversal tamponade or ILM stripping in the treatment of high myopia macular hole retinal detachment(MHRD).

METHODS:The literature was retrieved from China Knowledge Network(CNKI), VIP, Wanfang Database, PubMed, EMbase, Cochrane Library, European PMC, and Natural database. The search time was built until September 2018. The 6-month follow-up time was used to observe the macular hole closure, primary retinal detachment and BCVA. Meta-analysis was performed using Review 5.3 and Stata 15.1 software.

RESULTS: In this study, a comparative analysis of 266 eyes in 8 studies was included. Statistically, the effect of ILM reversal tamponade in the macular hole closure rate is better than ILM stripping, the difference was statistically significant(RR=2.05, 95% CI 1.69 to 2.49, P<0.00001), there was no statistically significant difference in the efficacy of primary retinal detachment rate(RR=1.04, 95% CI 0.98 to 1.12, P=0.21), the BCVA of the two groups was significantly higher than that before surgery at 6mo after surgery, the difference was statistically significant(RR=0.44, 95% CI 0.33 to 0.55, P<0.00001; RR=0.29, 95% CI 0.10 to 0.48, P=0.003). The results of the extent of BCVA improvement between the two groups are heterogeneous, and the conclusions may be unstable, and more reliable data are needed.

CONCLUSION: PPV+ ILM flap insertion is more effective in treating patients with high myopia macular hole retinal detachment.