目的:难治性黄斑裂孔的治疗存在争议,人类羊膜移植物最近成为一个有吸引力的选择。我们在本文中进行了荟萃分析和系统评价,以评估人羊膜(hAM)治疗难治性黄斑裂孔(MH)的结果。
方法:我们搜索了Cochrane系统评价数据库,WebofScience,PubMed,Embase,中国国家知识基础设施数据库,VIP数据库,万方数据知识服务平台,Sinomed,中国临床试验注册中心,和临床试验。包括报告hAM治疗难治性MH的研究。结果是MH闭合率,视力(VA)改善率,和移植物脱位/挛缩率。
结果:共纳入8项103眼的研究,所有这些都经历了失败的玻璃体切除术和内界膜(ILM)剥离.在所有研究中,VA改善率为66%(95CI:45%至84%),MH闭合率为94%(95CI:84至100%),hAM移植物脱位/挛缩率为6%(95CI:0至15%)。在使用冷冻保存的hAM移植物的研究中,MH闭合率为99%(95CI:94至100%),hAM移植物脱位/挛缩率为3%(0%,10%)。视网膜脱离亚组VA改善率为94%(95CI:79~100%),病理性近视亚组的37%(95CI:20至56%),特发性MH亚组为62%(95CI:14-100%)。
结论:人羊膜治疗难治性MH可改善视力。它具有较高的黄斑裂孔闭合率和较低的脱位/挛缩率。冷冻保存的hAM移植物可能比脱水移植物具有更好的结果。
OBJECTIVE: The treatment of refractory macular holes is controversial, with human amniotic membrane grafts emerging recently as an attractive option. We performed a meta-analysis and systematic
review in this paper to assess the results of human amniotic membrane (hAM) in the treatment of refractory macular hole (MH).
METHODS: We searched the Cochrane Database of Systematic Reviews, Web of Science, PubMed, Embase, China National Knowledge Infrastructure databases, VIP database, Wanfang Data Knowledge Service Platform, Sinomed, Chinese Clinical Trial Registry, and Clinical Trials.gov. Studies reporting hAM for the treatment of refractory MH were included. The outcomes are MH closure rate, visual acuity (VA) improvement rate, and graft dislocation/contracture rate.
RESULTS: A total of 8 studies on 103 eyes were included, all of which had undergone failed vitrectomy and internal limiting membrane (ILM) peeling. In all studies, the VA improvement rate was 66% (95%CI: 45 to 84%), the MH closure rate was 94% (95%CI: 84 to 100%) and the hAM graft dislocation/contracture rate was 6% (95%CI: 0 to 15%). In the studies using cryopreserved hAM grafts, the MH closure rate was 99% (95%CI: 94 to 100%) and the hAM graft dislocation/contracture rate was 3% (0%, 10%). The VA improvement rates were 94% (95%CI: 79 to 100%) in the retinal detachment subgroup, 37% (95%CI: 20 to 56%) in the pathologic myopia subgroup, and 62% (95%CI: 14 to 100%) in the idiopathic MH subgroup.
CONCLUSIONS: Human amniotic membrane in the treatment of refractory MH results in visual improvement. It has a high macular hole closure rate and low dislocation/contracture rate. Cryopreserved hAM grafts might have better outcomes than dehydrated grafts.