PDF(Pubmed)
Abstract：
BACKGROUND: The epiretinal membrane (ERM) is a nonvascular fibrocellular tissue formed by cellular metaplasia and proliferation at the vitreoretinal surface and is generally treated by pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling. This network meta-analysis aimed to compare the efficacy of all available ERM removal interventions and assessed the use and efficacy of surgical dyes in managing idiopathic ERMs.
METHODS: MEDLINE, EMBASE, Cochrane CENTRAL, and the US National Library of Medicine were searched (June 28, 2023). Clinical studies that included patients with ERMs were included. Randomized controlled trials (RCTs) were also appraised using Cochrane risk of bias (ROB).
RESULTS: Ten RCTs and ten non-RCTs were included in this study. A pairwise meta-analysis between ERM removal and combined ERM and ILM removal showed no significant difference in visual outcome (change in BCVA) 1 year postintervention (MD = - 0.0034, SE = 0.16, p = 0.832). Similarly, there was no significant difference in the central macular thickness postoperatively between the two groups (MD = - 4.95, SE = 11.11, p = 0.656) (Q = 4.85, df = 3, p = 0.182, I2 = 41.21%). The difference in ERM recurrence between the groups was also not statistically significant (OR = 4.64, p = 0.062, I2 = 0). In a network meta-analysis, there was no significant difference in visual outcomes between ERM removal only and other treatment modalities: combined ILM and ERM removal (MD = 0.039, p = 0.837) or watchful waiting (MD = 0.020, p = 0.550). In a network meta-analysis, there was no significant difference in the visual outcomes between ERM removal alone and dye-stained combined ERM and ILM peeling (MD = 0.122, p = 0.742 for brilliant blue G; BBG and MD = 0.00, p = 1.00 for membrane blue-dual; MBD). The probability of being a better surgical dye for better visual outcomes was 0.539 for the MBD group and 0.396 for the BBG group. The recurrence of ERM was not significantly different when the ILM was stained with any of the dyes. No study was judged on ROB assessment as having low ROB in all seven domains.
CONCLUSIONS: The two types of surgical modalities provided comparable efficacy, with no significant differences between the outcomes. Among the dye-assisted ILM peeling methods, the membrane blue-dual dye was the most effective in providing better structural and functional outcomes.
METHODS: MEDLINE, EMBASE, Cochrane CENTRAL, and the US National Library of Medicine were searched (June 28, 2023). Clinical studies that included patients with ERMs were included. Randomized controlled trials (RCTs) were also appraised using Cochrane risk of bias (ROB).
RESULTS: Ten RCTs and ten non-RCTs were included in this study. A pairwise meta-analysis between ERM removal and combined ERM and ILM removal showed no significant difference in visual outcome (change in BCVA) 1 year postintervention (MD = - 0.0034, SE = 0.16, p = 0.832). Similarly, there was no significant difference in the central macular thickness postoperatively between the two groups (MD = - 4.95, SE = 11.11, p = 0.656) (Q = 4.85, df = 3, p = 0.182, I2 = 41.21%). The difference in ERM recurrence between the groups was also not statistically significant (OR = 4.64, p = 0.062, I2 = 0). In a network meta-analysis, there was no significant difference in visual outcomes between ERM removal only and other treatment modalities: combined ILM and ERM removal (MD = 0.039, p = 0.837) or watchful waiting (MD = 0.020, p = 0.550). In a network meta-analysis, there was no significant difference in the visual outcomes between ERM removal alone and dye-stained combined ERM and ILM peeling (MD = 0.122, p = 0.742 for brilliant blue G; BBG and MD = 0.00, p = 1.00 for membrane blue-dual; MBD). The probability of being a better surgical dye for better visual outcomes was 0.539 for the MBD group and 0.396 for the BBG group. The recurrence of ERM was not significantly different when the ILM was stained with any of the dyes. No study was judged on ROB assessment as having low ROB in all seven domains.
CONCLUSIONS: The two types of surgical modalities provided comparable efficacy, with no significant differences between the outcomes. Among the dye-assisted ILM peeling methods, the membrane blue-dual dye was the most effective in providing better structural and functional outcomes.
摘要：
背景：视网膜前膜（ERM）是由玻璃体视网膜表面的细胞化生和增殖形成的非血管纤维细胞组织，通常通过平坦部玻璃体切除术（PPV）进行治疗，有或没有内界膜（ILM）剥离。此网络荟萃分析旨在比较所有可用的ERM去除干预措施的疗效，并评估手术染料在治疗特发性ERM中的使用和疗效。
方法：MEDLINE，EMBASE,科克伦中部,并检索了美国国家医学图书馆（2023年6月28日）。纳入ERM患者的临床研究。还使用Cochrane偏倚风险（ROB）评估了随机对照试验（RCT）。
结果：本研究包括10个随机对照试验和10个非随机对照试验。ERM去除与ERM和ILM联合去除之间的成对荟萃分析显示，干预后1年的视觉结果（BCVA变化）没有显着差异（MD=-0.0034，SE=0.16，p=0.832）。同样，两组术后黄斑中心厚度差异无统计学意义(MD=-4.95,SE=11.11,p=0.656)(Q=4.85,df=3,p=0.182,I2=41.21%)。两组间ERM复发差异也无统计学意义(OR=4.64,p=0.062,I2=0)。在网络荟萃分析中，仅去除ERM与其他治疗方式的视觉结局无显著差异:联合去除ILM和ERM(MD=0.039,p=0.837)或观察等待(MD=0.020,p=0.550).在网络荟萃分析中，单独去除ERM与染料染色的ERM和ILM联合剥离之间的视觉结局没有显着差异(对于亮蓝G,MD=0.122,p=0.742;BBG和MD=0.00,对于膜蓝-双;MBD,p=1.00).MBD组是更好的手术染料以获得更好的视觉结果的概率为0.539，BBG组为0.396。当ILM用任何染料染色时,ERM的复发没有显著差异。在ROB评估中没有一项研究被判断为在所有七个域中具有低ROB。
结论：两种手术方式提供了相当的疗效，结果之间没有显著差异。在染料辅助的ILM剥离方法中，膜蓝-双重染料在提供更好的结构和功能结果方面最有效。
方法：MEDLINE，EMBASE,科克伦中部,并检索了美国国家医学图书馆（2023年6月28日）。纳入ERM患者的临床研究。还使用Cochrane偏倚风险（ROB）评估了随机对照试验（RCT）。
结果：本研究包括10个随机对照试验和10个非随机对照试验。ERM去除与ERM和ILM联合去除之间的成对荟萃分析显示，干预后1年的视觉结果（BCVA变化）没有显着差异（MD=-0.0034，SE=0.16，p=0.832）。同样，两组术后黄斑中心厚度差异无统计学意义(MD=-4.95,SE=11.11,p=0.656)(Q=4.85,df=3,p=0.182,I2=41.21%)。两组间ERM复发差异也无统计学意义(OR=4.64,p=0.062,I2=0)。在网络荟萃分析中，仅去除ERM与其他治疗方式的视觉结局无显著差异:联合去除ILM和ERM(MD=0.039,p=0.837)或观察等待(MD=0.020,p=0.550).在网络荟萃分析中，单独去除ERM与染料染色的ERM和ILM联合剥离之间的视觉结局没有显着差异(对于亮蓝G,MD=0.122,p=0.742;BBG和MD=0.00,对于膜蓝-双;MBD,p=1.00).MBD组是更好的手术染料以获得更好的视觉结果的概率为0.539，BBG组为0.396。当ILM用任何染料染色时,ERM的复发没有显著差异。在ROB评估中没有一项研究被判断为在所有七个域中具有低ROB。
结论：两种手术方式提供了相当的疗效，结果之间没有显著差异。在染料辅助的ILM剥离方法中，膜蓝-双重染料在提供更好的结构和功能结果方面最有效。
