Abstract：
A variety of different tamponade agents are used with vitrectomy combined with internal limiting membrane (ILM) peeling for the treatment of idiopathic macular holes. These agents include air, gas (sulfur hexafluoride [SF6], hexafluoroethane [C2F6], and perfluoropropane [C3F8]), and silicone oil. The optimal tamponade agent is uncertain, and we aimed to review the effect of tamponade choice on hole closure and visual outcomes.
Although most surgeons initially chose to use long-acting gas (C3F8), there has been a gradual change in practice to the increasing use of the medium- (C2F6) and short-acting gases (SF6) or even air. However, there is no consensus regarding their relative efficacies.
Systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective and retrospective comparative cohort studies comparing different tamponade agents in patients undergoing vitrectomy and ILM peeling for primary idiopathic macular holes. For RCTs, the risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs, whereas for nonrandomized studies, the Risk of Bias in Nonrandomized Studies of Interventions tool was used.
Thirteen publications, including 2 RCTs, were identified. Overall, there was no significant difference in the anatomic closure rates between studies using SF6 compared with either C3F8 or C2F6 (odds ratio [OR] = 0.74; 95% confidence interval [CI] = 0.51-1.08). A subgroup analysis showed a significantly higher closure rate using SF6 (OR = 0.49; 95% CI = 0.30-0.79) in patients without postoperative posturing but not in those who were advised to posture facedown. The visual outcomes and adverse events were not significantly different. The comparisons of anatomic closure rates of patients treated with gas tamponade vs. silicone oil and with air vs. SF6 showed no significant differences. The included studies had a number of methodological limitations and heterogeneities, making conclusions imprecise, with low or very low certainty by the Grades of Recommendation, Assessment, Development and Evaluation approach.
The current evidence base for tamponade selection with vitrectomy and ILM peeling for full-thickness macular hole has several major limitations. Further appropriately designed studies are needed to guide tamponade selection.
Although most surgeons initially chose to use long-acting gas (C3F8), there has been a gradual change in practice to the increasing use of the medium- (C2F6) and short-acting gases (SF6) or even air. However, there is no consensus regarding their relative efficacies.
Systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective and retrospective comparative cohort studies comparing different tamponade agents in patients undergoing vitrectomy and ILM peeling for primary idiopathic macular holes. For RCTs, the risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs, whereas for nonrandomized studies, the Risk of Bias in Nonrandomized Studies of Interventions tool was used.
Thirteen publications, including 2 RCTs, were identified. Overall, there was no significant difference in the anatomic closure rates between studies using SF6 compared with either C3F8 or C2F6 (odds ratio [OR] = 0.74; 95% confidence interval [CI] = 0.51-1.08). A subgroup analysis showed a significantly higher closure rate using SF6 (OR = 0.49; 95% CI = 0.30-0.79) in patients without postoperative posturing but not in those who were advised to posture facedown. The visual outcomes and adverse events were not significantly different. The comparisons of anatomic closure rates of patients treated with gas tamponade vs. silicone oil and with air vs. SF6 showed no significant differences. The included studies had a number of methodological limitations and heterogeneities, making conclusions imprecise, with low or very low certainty by the Grades of Recommendation, Assessment, Development and Evaluation approach.
The current evidence base for tamponade selection with vitrectomy and ILM peeling for full-thickness macular hole has several major limitations. Further appropriately designed studies are needed to guide tamponade selection.
摘要：
各种不同的填塞剂与玻璃体切除术结合内界膜(ILM)剥离用于治疗特发性黄斑裂孔。这些代理包括空气，气体(六氟化硫[SF6]，六氟乙烷[C2F6]，和全氟丙烷[C3F8])，和硅油。最佳填塞剂是不确定的,我们旨在回顾填塞剂的选择对孔闭合和视觉结果的影响。
尽管大多数外科医生最初选择使用长效气体（C3F8），在实践中逐渐改变了介质(C2F6)和短效气体(SF6)甚至空气的使用。然而,关于它们的相对效力没有共识。
系统评价和荟萃分析随机对照试验（RCT）和前瞻性和回顾性比较队列研究，比较不同填塞剂在接受玻璃体切除术和ILM剥离治疗原发性特发性黄斑裂孔患者中的应用。对于RCT，使用随机对照试验的Cochrane偏差风险工具评估偏差风险，而对于非随机研究，使用非随机干预研究中的偏倚风险工具。
13种出版物,包括2个RCT,已确定。总的来说,与C3F8或C2F6相比,使用SF6的研究之间的解剖闭合率没有显著差异(比值比[OR]=0.74;95%置信区间[CI]=0.51-1.08).亚组分析显示，在没有术后姿势的患者中，使用SF6的闭合率显着提高（OR=0.49；95％CI=0.30-0.79），而在建议采取姿势的患者中却没有。视觉结果和不良事件没有显着差异。用气体填塞与治疗的患者的解剖闭合率的比较硅油和空气vs.SF6无明显差别。纳入的研究有许多方法学上的局限性和异质性，使结论不精确，推荐等级的确定性较低或非常低，评估,开发和评估方法。
目前用于全厚度黄斑裂孔的玻璃体切除术和ILM剥离的填塞选择的证据基础有几个主要的局限性。需要进一步适当设计的研究来指导填塞剂的选择。
尽管大多数外科医生最初选择使用长效气体（C3F8），在实践中逐渐改变了介质(C2F6)和短效气体(SF6)甚至空气的使用。然而,关于它们的相对效力没有共识。
系统评价和荟萃分析随机对照试验（RCT）和前瞻性和回顾性比较队列研究，比较不同填塞剂在接受玻璃体切除术和ILM剥离治疗原发性特发性黄斑裂孔患者中的应用。对于RCT，使用随机对照试验的Cochrane偏差风险工具评估偏差风险，而对于非随机研究，使用非随机干预研究中的偏倚风险工具。
13种出版物,包括2个RCT,已确定。总的来说,与C3F8或C2F6相比,使用SF6的研究之间的解剖闭合率没有显著差异(比值比[OR]=0.74;95%置信区间[CI]=0.51-1.08).亚组分析显示，在没有术后姿势的患者中，使用SF6的闭合率显着提高（OR=0.49；95％CI=0.30-0.79），而在建议采取姿势的患者中却没有。视觉结果和不良事件没有显着差异。用气体填塞与治疗的患者的解剖闭合率的比较硅油和空气vs.SF6无明显差别。纳入的研究有许多方法学上的局限性和异质性，使结论不精确，推荐等级的确定性较低或非常低，评估,开发和评估方法。
目前用于全厚度黄斑裂孔的玻璃体切除术和ILM剥离的填塞选择的证据基础有几个主要的局限性。需要进一步适当设计的研究来指导填塞剂的选择。
