目的:比较巩膜扣(SB)的结局,平坦部玻璃体切除术(PPV),并联合PPV-SB治疗下视网膜破裂的孔源性视网膜脱离(IRB-RRD)。
结论:IRB-RRD并不少见;它们的管理具有挑战性,失败的风险更高。对他们的治疗没有共识,特别是SB,应执行PPV或PPV-SB。
方法:系统评价和荟萃分析。随机对照试验(RCT),病例控制,和前瞻性/回顾性系列(如果n>50)的英语是合格的。Medline,截至2023年1月23日,Embase和Cochrane数据库已被搜索。遵循标准的系统审查方法。评估了3(±1)和12(±3)个月时的以下结果:一次和一次以上手术后视网膜重新附着的眼睛数量;最佳矫正视力(BCVA)从术前到术后水平的变化以及术后>10和>15个ETDRS字母改善的眼睛数量。符合条件的研究的作者被要求提供个体参与者数据(IPD)和IPD荟萃分析。使用NIH研究质量评估工具评估偏倚风险。本研究在PROSPERO(CRD42019145626)中进行了前瞻性注册。
结果:共确认542项研究,其中15项研究符合条件,60%是回顾性的。IPD来自8项研究(1017只眼)。鉴于只有26名患者单独接受了SB,分析中未考虑这些数据.没有证据表明治疗组之间(PPV与PPV-SB)在术后3或12个月时视网膜平坦的可能性存在差异(分别为p=0.067,比值比[OR]0.47;p=0.408,OR2.55)或一次以上(分别为OR0.54,p=0.21;p=0.926,OR0.89)。PPV-SB显示术后3个月视力改善较少(估计0.18;95%CI0.01,0.35;p=0.044),但在12个月时不再观察到这种差异(估计-0.07;95%CI-0.27,0.13;p=0.479)。
结论:现有证据表明在PPV中加入SB治疗IRB-RRD缺乏益处。证据,然而,主要来自回顾性系列,因此,尽管有大量的眼睛,应该谨慎解释。需要进一步的研究。
OBJECTIVE: To compare outcomes of scleral buckle (SB), pars plana vitrectomy (PPV), and combined PPV-SB to treat rhegmatogenous retinal detachments (RRDs) with inferior retinal breaks (IRBs).
CONCLUSIONS: Rhegmatogenous retinal detachments with IRBs are not uncommon; their management is challenging with higher risk of failure. There is no consensus about their treatment, specifically whether SB, PPV, or PPV-SB should be performed.
METHODS: Systematic
review and meta-analysis. Randomized controlled trials, case-control, and prospective/retrospective series (if n > 50) in English were eligible. Medline, Embase, and Cochrane databases were searched up to January 23, 2023. Standard systematic
review methods were followed. The following outcomes at 3 (± 1) and 12 (± 3) months were evaluated: number of eyes with retinal reattachment after ≥ 1 surgeries, change in best-corrected visual acuity from preoperative to postoperative levels, and number of eyes with improvement of > 10 and > 15 ETDRS letters after surgery. Authors of eligible studies were asked for individual participant data (IPD) and IPD meta-analysis was undertaken. Risk of bias was assessed using National Institutes of Health study quality assessment tools. This study was registered prospectively in PROSPERO (CRD42019145626).
RESULTS: A total of 542 studies were identified: 15 were eligible and included and 60% were retrospective. Individual participant data was obtained from 8 studies (1017 eyes). Given that only 26 patients had received SB alone, these data were not considered in the analysis. There was no evidence for differences between treatment groups (PPV versus PPV-SB) in the probability of having a flat retina at 3 or 12 months postoperatively after 1 (P = 0.067; odds ratio [OR], 0.47; P = 0.408; OR 2.55; respectively) or > 1 (OR, 0.54; P = 0.21; OR, 0.89; P = 0.926; respectively) surgery. Pars plana vitrectomy-SB showed less improvement in vision postoperatively at 3 months (estimate, 0.18; 95% confidence interval, 0.01-0.35; P = 0.044), but this difference was no longer observed at 12 months (estimate, -0.07; 95% confidence interval, -0.27, 0.13; P = 0.479).
CONCLUSIONS: Available evidence suggests a lack of benefit of adding SB to PPV to treat RRDs with IRBs. Evidence, however, comes mainly from retrospective series and, thus, despite the large number of eyes included, should be interpreted with caution. Further research is needed.
BACKGROUND: The author(s) have no proprietary or commercial interest in any materials discussed in this article.