保留中央凹或标准内界膜剥除联合玻璃体切割术治疗近视牵引性黄斑病变的Meta分析

Vitrectomy with fovea-sparing versus complete internal limiting membrane peeling for myopic traction maculopathy: A Meta-analysis

摘要:

目的：评估玻璃体切割术中保留中央凹(FSIP)或标准内界膜剥除(CMIP)治疗近视牵引性黄斑病变(MTM)的疗效及安全性。方法：计算机检索中国知网、万方、维普、PubMed、Embase、Cochrane Library、Web of Science数据库，搜集2000-01-01/2022-07-01玻璃体切割术中FSIP或CMIP治疗MTM的对比研究。比较两组患者术后最佳矫正视力(BCVA)的变化值和改善率、术后全层黄斑裂孔(FTMH)发生率、视网膜中央凹厚度(CFT)变化值、术后中心凹完全解剖复位率。结果：共12篇文献484眼纳入研究，其中FSIP组203眼，CMIP组281眼。Meta分析结果显示：FSIP组患者术后BCVA的变化值(SMD=0.52，95%CI：0.20～0.85，P=0.002)、BCVA改善率(RR=1.50，95%CI：1.22～1.85，P=0.0002)及术后FTMH发生率(RR=0.23，95%CI：0.10～0.54，P=0.0008)优于CMIP组，两组患者CFT变化值(SMD=0.04， 95%CI： -0.19～0.26， P=0.75)及术后中心凹完全解剖复位率(RR=1.12，95%CI： 0.94～1.32， P=0.20)比较均无差异。结论：现有证据表明，两种术式解剖改善结果相似，但在改善视觉效果及降低术后全层黄斑裂孔发生率方面，FSIP明显优于CMIP。

Abstract:

AIM: To evaluate the efficacy and safety of foveal-sparing internal limiting membrane peeling(FSIP)or complete internal limiting membrane peeling(CMIP)for the treatment of myopic traction maculopathy(MTM)during vitrectomy.METHODS: CNKI, Wanfang, VIP, PubMed, Embase, Cochrane Library, and Web of Science were searched from January 1th 2000 to July 1th 2022, and studies that compared FSIP and CMIP for MTM were collected. The change and recovery rate of best corrected visual acuity(BCVA), incidence of full-thickness macular hole(FTMH), change of central foveal thickness(CFT)and the rate of complete reattachment.RESULTS: A total of 484 eyes from 12 literatures were included, with 203 eyes in the FSIP group and 281 eyes in the CMIP group. The results of Meta-analysis showed that FSIP group were superior to the CMIP group in the mean change of BCVA(SMD=0.52, 95%CI: 0.20～0.85, P=0.002), the improvement rate of BCVA(RR=1.50, 95%CI: 1.22～1.85, P=0.0002)and the incidence of postoperative FTMH(RR=0.23, 95%CI: 0.10～0.54, P=0.0008). There was no statistical difference between the two surgical methods in terms of mean change in CFT(SMD=0.04, 95%CI: -0.19～0.26, P=0.75)and the rate of complete reattachment(RR=1.12, 95%CI: 0.94～1.32, P=0.20).CONCLUSION: FSIP have similar anatomical outcomes compared to CMIP, but FSIP resulted in better visual acuity and lower incidence of postoperative FTMH.