背景:目前许多治疗方法可用于弱视患者;尽管,这些疗法的疗效比较尚不清楚.我们进行了系统评价和网络荟萃分析(NMA),以确定这些治疗弱视的相对疗效。
方法:电子数据库(MEDLINE,EMBASE,CochraneLibrary)从开始到9月进行了系统搜索。2019.仅包括比较以下任何两种或三种治疗方法的随机临床试验:屈光矫正(单独使用眼镜),每天补片2小时(补片2小时),补丁6H,补丁12H,补丁2H+近活动(N),补丁2H+远程活动(D),阿托品(Atr)每日,Atr每周一次,每周+声眼上的平面透镜(钢琴),光学惩罚和双眼治疗。评审人员根据PRISMA指南独立提取数据;通过Cochrane偏倚风险工具评估随机试验的研究质量。主要结果指标是最佳矫正视力(BCVA)的变化,以logMAR线表示。进行直接比较和贝叶斯荟萃分析以综合数据。
结果:纳入了23项研究,共3279名患者。在网络荟萃分析中,光学惩罚是所有治疗方法中对视力变化效果最低的,眼镜(平均差异[MD],2.9记录MAR行;95%可信区间[CrI],1.8-4.0),补丁2H(MD,3.3;95%CrI,2.3-4.3),补丁6H(MD,3.6;95%CrI,2.6-4.6),补丁12H(MD,3.4;95%CrI,2.3-4.5),补丁2H+N(MD,3.7;95%CrI,2.5-5.0),补丁2H+D(MD,3.5;95%CrI,2.1-5.0),每天(MD,3.2;95%CrI,2.2-4.3),每周一次(MD,3.2;95%CrI,2.2-4.3),每周+普莱诺(医学博士,3.7;95%CrI,2.7-4.7),双眼疗法(MD,3.1;95%CrI,2.0-4.2)。贴片6H和贴片2H+N优于眼镜([MD,0.73;95%Crl,0.10-1.40];[MD,0.84;95%CrI,0.19-1.50])。
结论:NMA表明,大多数经检查的弱视治疗方式的疗效相当,没有显著差异。需要进一步高质量的随机对照试验来确定其疗效和可接受性。
■CRD42019119843。
BACKGROUND: Many treatments are currently available for amblyopic patients; although, the comparative efficacy of these therapies is unclear. We conducted a systematic
review and network meta-analysis (NMA) to establish the relative efficacy of these treatments for amblyopia.
METHODS: Electronic databases (MEDLINE, EMBASE, Cochrane Library) were systematically searched from inception to Sep. 2019. Only Randomized clinical trials comparing any two or three of the following treatments were included: refractive correction (spectacles alone), patching of 2 h per day (patch 2H), patch 6H, patch 12H, patch 2H + near activities (N), patch 2H + distant activities (D), atropine (Atr) daily, Atr weekly, Atr weekly + plano lens over the sound eye (Plano), optical penalization and binocular therapy. The reviewers independently extracted the data according to the PRISMA guidelines; assessed study quality by Cochrane risk-of-bias tool for randomized trials. The primary outcome measure was the change in best-corrected visual acuity (BCVA) expressed as log MAR lines. Direct comparisons and a Bayesian meta-analysis were performed to synthesize data.
RESULTS: Twenty-three studies with 3279 patients were included. In the network meta-analysis, optical penalization was the least effective of all the treatments for the change of visual acuity, spectacles (mean difference [MD], 2.9 Log MAR lines; 95% credibility interval [CrI], 1.8-4.0), patch 2H (MD, 3.3; 95% CrI, 2.3-4.3), patch 6H (MD, 3.6; 95% CrI, 2.6-4.6), patch 12H (MD, 3.4; 95% CrI, 2.3-4.5), patch 2H + N (MD, 3.7; 95% CrI, 2.5-5.0), patch 2H + D (MD, 3.5; 95% CrI, 2.1-5.0), Atr daily (MD, 3.2; 95% CrI, 2.2-4.3), Atr weekly (MD, 3.2; 95% CrI, 2.2-4.3), Atr weekly + Plano (MD, 3.7; 95% CrI, 2.7-4.7), binocular therapy (MD, 3.1; 95% CrI, 2.0-4.2). The patch 6H and patch 2H + N were better than spectacles ([MD, 0.73; 95% Crl, 0.10-1.40]; [MD, 0.84; 95% CrI, 0.19-1.50]).
CONCLUSIONS: The NMA indicated that the efficacy of the most of the examined treatment modalities for amblyopia were comparable, with no significant difference. Further high quality randomized controlled trials are required to determine their efficacy and acceptability.
UNASSIGNED: CRD42019119843.