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Abstract：
BACKGROUND: We conducted a systematic review to compare the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options.
METHODS: Databases, including PubMed, ClinicalTrials.gov ( www.
RESULTS: gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies.
RESULTS: Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared with PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively. Adverse events and postoperative complications occurring after treatment have also been documented in these studies.
CONCLUSIONS: PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.
METHODS: Databases, including PubMed, ClinicalTrials.gov ( www.
RESULTS: gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies.
RESULTS: Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared with PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively. Adverse events and postoperative complications occurring after treatment have also been documented in these studies.
CONCLUSIONS: PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.
摘要：
背景：我们进行了系统综述，以比较气动玻璃体溶解（PV）的效果，酶促玻璃溶解（EVL）与ocrilasmin，和平坦部玻璃体切除术（PPV）对玻璃体黄斑牵引（VMT）综合征和黄斑裂孔（MHs）的疗效评估。
方法：数据库，包括PubMed,ClinicalTrials.gov(www.
结果：gov)，Cochrane中央受控试验登记册（CENTRAL）-包括Cochrane眼睛和视觉小组试验登记册（Cochrane图书馆2013，第2期）-，OvidMEDLINE,和EMBASE（2000年1月-2022年10月），进行搜索以确定比较PV和PPV结果的研究，PPV与奥氏酶和奥氏酶与PV。RevMan5.1用于研究的荟萃分析。
结果：在89项研究中，79人被认为有资格进行定性分析，10项定量研究进行了荟萃分析。PPV术后视力改善优于ocriplasmin（标准化平均偏差（SMD）=0.38，95％CI0.03-0.73，p=0.0003）。与PPV相比，PV在视觉改善方面没有显着差异（SMD=-0.15，95％CI-0.47至0.16，p=0.35）。在VMT释放率（风险比=0.48，95％CI0.38-0.62，p=0.00001）和MH闭合率（风险比=0.49，95％CI0.30-0.81，p=0.006）方面，PPV显着更有效。在VMT释放率方面，PV比ocriplasmin更有效（风险比=0.49，95％CI0.35-0.70，p=0.0001）。定性分析显示MH闭合率为46%，47.8%,95%，VMT释放率为46%，68%和100%后的ocriplasmin，PV,和PPV治疗，分别。这些研究也记录了治疗后发生的不良事件和术后并发症。
结论：PPV似乎是MH封闭和VMT发布的最有希望的选择，严重并发症少于EVL或PV。然而,鉴于比较这些治疗方法的研究数量有限，需要进一步的研究来确定PPV优于其他选择。
方法：数据库，包括PubMed,ClinicalTrials.gov(www.
结果：gov)，Cochrane中央受控试验登记册（CENTRAL）-包括Cochrane眼睛和视觉小组试验登记册（Cochrane图书馆2013，第2期）-，OvidMEDLINE,和EMBASE（2000年1月-2022年10月），进行搜索以确定比较PV和PPV结果的研究，PPV与奥氏酶和奥氏酶与PV。RevMan5.1用于研究的荟萃分析。
结果：在89项研究中，79人被认为有资格进行定性分析，10项定量研究进行了荟萃分析。PPV术后视力改善优于ocriplasmin（标准化平均偏差（SMD）=0.38，95％CI0.03-0.73，p=0.0003）。与PPV相比，PV在视觉改善方面没有显着差异（SMD=-0.15，95％CI-0.47至0.16，p=0.35）。在VMT释放率（风险比=0.48，95％CI0.38-0.62，p=0.00001）和MH闭合率（风险比=0.49，95％CI0.30-0.81，p=0.006）方面，PPV显着更有效。在VMT释放率方面，PV比ocriplasmin更有效（风险比=0.49，95％CI0.35-0.70，p=0.0001）。定性分析显示MH闭合率为46%，47.8%,95%，VMT释放率为46%，68%和100%后的ocriplasmin，PV,和PPV治疗，分别。这些研究也记录了治疗后发生的不良事件和术后并发症。
结论：PPV似乎是MH封闭和VMT发布的最有希望的选择，严重并发症少于EVL或PV。然而,鉴于比较这些治疗方法的研究数量有限，需要进一步的研究来确定PPV优于其他选择。
