PDF(Pubmed)
Abstract：
Background: The purpose of the study is to compare the visual outcomes and complications of sutured scleral fixation (SSF), a traditional and conservative surgical approach, and the newer and faster Yamane technique for secondary intraocular lens placement. Methods: A literature search was performed on PubMed, Embase, and Scopus on studies published between 1 July 2017 to 29 September 2023. Outcomes analyzed included the final best corrected visual acuity (BCVA) between 3 and 12 months to assess the effectiveness of the procedure, post-operative month (POM) 1 BCVA to assess the speed of visual recovery, endothelial cell count (ECC), absolute refractive error, surgical duration, and complication rates. Additional subgroup analyses were performed based on surgeon experience with the technique. Single-surgeon studies had an average of 26 procedures performed, whereas multiple-surgeon studies averaged only 9 procedures performed; these were then used to delineate surgeon experience. A sample-size weighted mean difference (MD) meta-analysis was performed across all variables using RevMan 5.4.1; p < 0.05 was considered statistically significant. Results: Thirteen studies with 737 eyes were included: 406 eyes were included in the SSF group, and 331 eyes were included in the Yamane group. There was no significant difference in the final BCVA between groups in both the single-surgeon versus multiple-surgeon studies (MD = -0.01, 95% CI: [-0.06, 0.04], p = 0.73). In the single-surgeon studies, the BCVA at POM1 was significantly improved in the Yamane group compared to SSF (MD = -0.10, 95% CI: [-0.16, -0.04], p = 0.002). In the multiple-surgeon studies, there was no significant difference in BCVA at POM1 (MD = -0.06, 95% CI: [-0.16, 0.04], p = 0.23). The Yamane group had a shorter surgical duration than SSF in both single-surgeon and multiple-surgeon studies (MD = -24.68, 95% CI: [-35.90, -13.46], p < 0.0001). The ECC, refractive error, and complication rates did not significantly differ amongst all groups. Conclusions: The Yamane technique demonstrated similar long-term visual outcomes and complication rates to the traditional SSF. Visual recovery was significantly faster in the Yamane group in the single-surgeon studies. The operative times were shorter across all Yamane groups. Based on these findings, it is advisable to consider the Yamane technique as a viable, and perhaps preferable, option for patients requiring secondary IOL placement, alongside traditional SSF methods.
摘要：
背景：该研究的目的是比较缝合巩膜固定术（SSF）的视力结果和并发症，传统保守的手术方法,以及用于二次人工晶状体放置的更新和更快的Yamane技术。方法：在PubMed上进行文献检索，Embase,和Scopus在2017年7月1日至2023年9月29日之间发表的研究。分析的结果包括3至12个月之间的最终最佳矫正视力（BCVA），以评估手术的有效性。术后月（POM）1BCVA评估视力恢复的速度，内皮细胞计数（ECC），绝对屈光不正,手术时间,和并发症发生率。根据外科医生对该技术的经验进行了其他亚组分析。单外科医生研究平均进行了26次手术，而多外科医生研究平均只进行了9次手术;然后这些被用来描述外科医生的经验.使用RevMan5.4.1对所有变量进行样本量加权平均差异（MD）荟萃分析；p<0.05被认为具有统计学意义。结果：共纳入13项737只眼的研究：406只眼纳入SSF组，331只眼纳入Yamane组。在单外科医生和多外科医生研究中，两组之间的最终BCVA没有显着差异（MD=-0.01，95％CI：[-0.06，0.04]，p=0.73）。在单外科医生研究中，与SSF相比，Yamane组POM1的BCVA显着改善（MD=-0.10，95％CI：[-0.16，-0.04]，p=0.002)。在多外科医生研究中，POM1时的BCVA没有显着差异（MD=-0.06，95％CI：[-0.16，0.04]，p=0.23）。在单外科医生和多外科医生研究中，Yamane组的手术持续时间比SSF短（MD=-24.68，95％CI：[-35.90，-13.46]，p<0.0001)。ECC,屈光不正,所有组的并发症发生率无显著差异.结论：Yamane技术显示出与传统SSF相似的长期视觉结果和并发症发生率。在单外科医生研究中，Yamane组的视觉恢复明显更快。所有Yamane组的手术时间均较短。基于这些发现,建议将Yamane技术视为可行的，也许更可取，对于需要二次人工晶状体放置的患者，与传统的SSF方法一起。
