Abstract：
OBJECTIVE: To evaluate the effect of vitreomacular interface (VMI) configuration on treatment outcomes after intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME) using optical coherence tomography (OCT).
METHODS: A systematic literature search was performed on PubMed, Embase, web of science and clinicaltrials.gov. The primary outcome parameters were central macular thickness (CMT), best-corrected visual acuity (BCVA) and mean injection numbers. We performed this meta-analysis by Review Manager (RevMan) 5.4.1.
RESULTS: The impact of epiretinal membrane (ERM), vitreomacular traction (VMT) and vitreomacular adhesion (VMA) on the treatment outcomes were analyzed separately. 9 clinical studies involving 699 eyes were eligible for the meta-analysis for evaluating the effect of ERM/VMT on efficacy. And 7 studies with 610 eyes were included to access whether VMA affected the response to anti-VEGF therapy in patients with DME. The ERM/VMT group had poorer CMT reductions than the control group at 1 month ([MD] 52.91 mm, P<0.00001), while no significant difference at 3 months ([MD] 43.95 mm, P = 0.22) and over 12 months ([MD] 30.51 mm, P = 0.45). No statistically significant difference in the mean BCVA change at 1 month ([MD] -0.03 Log MAR, P = 0.79), whereas ERM/VMT group had poor visual acuity gains at 3 months ([MD] 0.08 Log MAR, P = 0.003), and a tendency of poor vision improvement over 12 months follow-up ([MD] 0.07 Log MAR, P = 0.11). There was no significant difference in the visual and anatomical results over 3 months in DME patients with or without VMA ([MD] -21.92 mm, P = 0.09; [MD] 1.79 letters, P = 0.22). Besides, VMI configuration was not found to affect mean injection numbers.
CONCLUSIONS: The limited evidence suggested that ERM/VMT was associated with worse CMT reduction at 1 month, poor BCVA gain at 3 months and a tendency of limited vision improvement over 12 months follow-up in DME patients treated with anti-VEGF agents. And VMA may not adversely affect the anatomic and functional outcomes. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among study designs.
METHODS: A systematic literature search was performed on PubMed, Embase, web of science and clinicaltrials.gov. The primary outcome parameters were central macular thickness (CMT), best-corrected visual acuity (BCVA) and mean injection numbers. We performed this meta-analysis by Review Manager (RevMan) 5.4.1.
RESULTS: The impact of epiretinal membrane (ERM), vitreomacular traction (VMT) and vitreomacular adhesion (VMA) on the treatment outcomes were analyzed separately. 9 clinical studies involving 699 eyes were eligible for the meta-analysis for evaluating the effect of ERM/VMT on efficacy. And 7 studies with 610 eyes were included to access whether VMA affected the response to anti-VEGF therapy in patients with DME. The ERM/VMT group had poorer CMT reductions than the control group at 1 month ([MD] 52.91 mm, P<0.00001), while no significant difference at 3 months ([MD] 43.95 mm, P = 0.22) and over 12 months ([MD] 30.51 mm, P = 0.45). No statistically significant difference in the mean BCVA change at 1 month ([MD] -0.03 Log MAR, P = 0.79), whereas ERM/VMT group had poor visual acuity gains at 3 months ([MD] 0.08 Log MAR, P = 0.003), and a tendency of poor vision improvement over 12 months follow-up ([MD] 0.07 Log MAR, P = 0.11). There was no significant difference in the visual and anatomical results over 3 months in DME patients with or without VMA ([MD] -21.92 mm, P = 0.09; [MD] 1.79 letters, P = 0.22). Besides, VMI configuration was not found to affect mean injection numbers.
CONCLUSIONS: The limited evidence suggested that ERM/VMT was associated with worse CMT reduction at 1 month, poor BCVA gain at 3 months and a tendency of limited vision improvement over 12 months follow-up in DME patients treated with anti-VEGF agents. And VMA may not adversely affect the anatomic and functional outcomes. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among study designs.
摘要：
目的：使用光学相干断层扫描（OCT）评估玻璃角膜界面（VMI）结构对玻璃体腔抗血管内皮生长因子（抗VEGF）治疗糖尿病性黄斑水肿（DME）后治疗结果的影响。
方法：在PubMed上进行了系统的文献检索，Embase,科学与临床试验网主要结果参数为中央黄斑厚度（CMT），最佳矫正视力（BCVA）和平均注射次数。我们由ReviewManager(RevMan)5.4.1进行了这项荟萃分析。
结果：视网膜前膜（ERM）的影响，分别分析玻璃体黄斑牵引(VMT)和玻璃体黄斑粘连(VMA)对治疗结果的影响。涉及699只眼的9项临床研究符合评估ERM/VMT对疗效影响的荟萃分析的条件。纳入了7项610只眼的研究，以了解VMA是否影响DME患者对抗VEGF治疗的反应。ERM/VMT组在1个月时的CMT降低程度低于对照组（[MD]52.91mm，P<0.00001),而在3个月时无显著差异([MD]43.95mm，P=0.22）和超过12个月（[MD]30.51mm，P=0.45)。1个月时平均BCVA变化无统计学意义（[MD]-0.03LogMAR，P=0.79),而ERM/VMT组在3个月时视力增强较差（[MD]0.08LogMAR，P=0.003),以及12个月随访期间视力改善不良的趋势([MD]0.07LogMAR，P=0.11）。有或没有VMA的DME患者在3个月内的视觉和解剖结果没有显着差异（[MD]-21.92mm，P=0.09；[MD]1.79字母，P=0.22）。此外,未发现VMI配置影响平均进样次数。
结论：有限的证据表明ERM/VMT在1个月时与CMT降低更差相关，在接受抗VEGF药物治疗的DME患者中,3个月时的BCVA增益较差,且在12个月随访期间视力改善有限.VMA可能不会对解剖和功能结果产生不利影响。然而,本荟萃分析的结果应谨慎解释,因为研究设计之间存在异质性.
方法：在PubMed上进行了系统的文献检索，Embase,科学与临床试验网主要结果参数为中央黄斑厚度（CMT），最佳矫正视力（BCVA）和平均注射次数。我们由ReviewManager(RevMan)5.4.1进行了这项荟萃分析。
结果：视网膜前膜（ERM）的影响，分别分析玻璃体黄斑牵引(VMT)和玻璃体黄斑粘连(VMA)对治疗结果的影响。涉及699只眼的9项临床研究符合评估ERM/VMT对疗效影响的荟萃分析的条件。纳入了7项610只眼的研究，以了解VMA是否影响DME患者对抗VEGF治疗的反应。ERM/VMT组在1个月时的CMT降低程度低于对照组（[MD]52.91mm，P<0.00001),而在3个月时无显著差异([MD]43.95mm，P=0.22）和超过12个月（[MD]30.51mm，P=0.45)。1个月时平均BCVA变化无统计学意义（[MD]-0.03LogMAR，P=0.79),而ERM/VMT组在3个月时视力增强较差（[MD]0.08LogMAR，P=0.003),以及12个月随访期间视力改善不良的趋势([MD]0.07LogMAR，P=0.11）。有或没有VMA的DME患者在3个月内的视觉和解剖结果没有显着差异（[MD]-21.92mm，P=0.09；[MD]1.79字母，P=0.22）。此外,未发现VMI配置影响平均进样次数。
结论：有限的证据表明ERM/VMT在1个月时与CMT降低更差相关，在接受抗VEGF药物治疗的DME患者中,3个月时的BCVA增益较差,且在12个月随访期间视力改善有限.VMA可能不会对解剖和功能结果产生不利影响。然而,本荟萃分析的结果应谨慎解释,因为研究设计之间存在异质性.
