目的:比较单纯使用糖皮质激素(CTC)治疗视神经炎(ON)的疗效,CTC+血浆置换(PLP),CTC+静脉注射免疫球蛋白(IVIG)。
方法:在ON发作后,虽然视力恢复通常很好,一些患者可能有明显的视觉后遗症。虽然一线CTC的功效现在无可争议,对于二线治疗的性质没有共识。迄今为止,没有系统评价比较ON与CTC单独治疗的疗效,CTC+血浆置换(PLP),CTC+静脉注射免疫球蛋白(IVIG)。需要进行荟萃分析以比较PLP和IVIG在类固醇耐药性ON中的疗效。
方法:该系统综述包括所有研究,比较了三种治疗类固醇耐药ON的至少两种治疗方法(单独使用CTC,CTC+PLP,和CTC+IVIG)。从2000年1月至2022年6月在PubMed上发表的所有文章中,两名独立的眼科医生使用PRISMA方法选择了感兴趣的研究。方法论,患者特征,并确定了结果。然后进行网络荟萃分析以比较三种治疗的功效。
结果:包括六个比较研究,代表209名患者。单独使用CTC后视力显著恢复的百分比,CTC+PLP,CTC+IVIG在急性治疗类固醇耐药ON中的比例为30%,45%,77%,分别。CTC+IVIG与单独CTC的比较,CTC+PLP与仅CTCCTC+PLP与CTC+IVIG的比值比分别为12.81、2.47和0.19。
结论:用CTC+PLP或CTC+IVIG治疗类固醇耐药ON比单独用CTC治疗更有效。虽然没有研究直接比较这两种治疗方法,IVIG可能比PLP更有效。
OBJECTIVE: To compare the efficacy of treatment of optic neuritis (ON) with corticosteroids (CTC) alone, CTC+plasmapheresis (PLP), and CTC+intravenous immunoglobulin (IVIG).
METHODS: After an episode of ON, although visual recovery is usually good, some patients may have significant visual sequelae. While the efficacy of first-line CTC is now indisputable, there is no consensus on the nature of second-line treatment. To date, no systematic
review has compared the efficacy of treatment of ON with CTC alone, CTC+plasmapheresis (PLP), and CTC+intravenous immunoglobulin (IVIG). A meta-analysis is needed to compare the efficacy of PLP and IVIG in steroid-resistant ON.
METHODS: This systematic
review included all studies comparing at least two of the three treatments for steroid-resistant ON (CTC alone, CTC+PLP, and CTC+IVIG). From all articles published on PubMed between January 2000 and June 2022, two independent ophthalmologists selected studies of interest using the PRISMA method. Methodology, patient characteristics, and outcomes were identified. A network metaanalysis was then performed to compare the efficacy of the three treatments.
RESULTS: Six comparative studies were included, representing 209 patients. The percentage of significant visual recovery after CTC alone, CTC+PLP, and CTC+IVIG in the acute treatment of steroid-resistant ON was 30 %, 45 %, and 77 %, respectively. Comparison of CTC+IVIG vs CTC alone, CTC+PLP vs CTC only, and CTC+PLP vs CTC+IVIG yielded odds ratios of 12.81, 2.47, and 0.19 respectively.
CONCLUSIONS: Treatment of steroid-resistant ON with CTC+PLP or CTC+IVIG is more effective than treatment with CTC alone. Although no study has directly compared the two treatments, IVIG may be more effective than PLP.