目的对自发玻璃体黄斑牵引(VMT)释放的预测因素进行综述。
对OvidMEDLINE进行了系统的文献检索,Embase,科克伦图书馆包括将自发释放的VMT与持久性VMT进行比较的研究。使用随机效应模型进行荟萃分析,和加权平均差,风险比(RR),并酌情报告95%置信区间(95%CI)。
搜索了258项研究,包括12项研究,934只眼中的272只(29%)进行了自发释放。平均年龄为70.0岁,37.2%的患者为男性,平均随访22.0个月。自发释放的重要预测因素是较小的VMT直径(n=177;加权平均差=-212.48µm,95%CI=[-417.36,-7.60],P=0.04),视网膜前膜缺失(n=162;RR=2.17,95%CI=[1.18,3.97],P=0.01),和右眼受累(n=76;RR=2.10,95%CI=[1.14,3.88],P=0.02)。非重要因素是年龄,初始最佳矫正视力,性别,眼部合并症,对眼玻璃体后脱离,以前的玻璃体内注射,和VMT分类,焦点定义为≤400µm。平均释放时间为15.3个月(n=212)。平均最佳矫正视力从0.34±0.21(Snellen20/44)提高到0.20±0.58logMAR(Snellen20/32)(n=121)。
较小的VMT直径,视网膜前膜缺失,和右眼受累可能支持自发性VMT释放。如果患者有可以忍受的症状,临床医生可以考虑对有这些预测因素的患者进行观察.
To
review predictive factors of spontaneous vitreomacular traction (VMT) release.
A systematic literature search was performed on Ovid MEDLINE, Embase, and Cochrane Library. Studies comparing spontaneously released VMT to persistent VMT were included. A meta-analysis was performed using a random effects model, and weighted mean difference, risk ratio (RR), and 95% confidence intervals (95% CI) were reported as appropriate.
Of a search of 258 studies, 12 studies were included, from which 272 of 934 eyes (29%) underwent spontaneous release. Mean age was 70.0 years, 37.2% of patients were men, and mean follow-up was 22.0 months. Significant predictive factors for spontaneous release were smaller VMT diameter (n = 177; weighted mean difference = -212.48 µm, 95% CI = [-417.36, -7.60], P = 0.04), epiretinal membrane absence (n = 162; RR = 2.17, 95% CI = [1.18, 3.97], P = 0.01), and right eye involvement (n = 76; RR = 2.10, 95% CI = [1.14, 3.88], P = 0.02). Nonsignificant factors were age, initial best-corrected visual acuity, sex, ocular comorbidity, fellow-eye posterior vitreous detachment, previous intravitreal injection, and VMT classification with focal defined as ≤400 µm. Mean release time was 15.3 months (n = 212). Mean best-corrected visual acuity improved from 0.34 ± 0.21 (Snellen 20/44) to 0.20 ± 0.58 logMAR (Snellen 20/32) postrelease (n = 121).
Smaller VMT diameter, epiretinal membrane absence, and right eye involvement may support spontaneous VMT release. If patients have tolerable symptoms, clinicians may consider observation in patients with these predictive factors.