背景:几种类型的手术已用于治疗先天性上睑下垂,但是这种治疗的最佳方法和材料是未知的。
目的:该研究旨在评估各种手术方法和材料治疗先天性上睑下垂的比较有效性和安全性。
方法:我们对五个数据库进行了全面搜索,从开始到2022年1月的两个临床试验注册中心和一个灰色文献数据库,用于纳入本研究的相关试验.进行Meta分析以评估手术方法和材料对主要结局的影响:边缘反射距离1(MR1),睑裂高度(PFH),和眩眼程度;和次要结果:矫正不足,阑尾,角膜上皮缺损,伤口裂开,复发,感染,和美容结果。
结果:共有14项试验评估了657例患者的909只眼。与提肌折叠相比,额叶吊带显着增加了MR1(MD=-1.21;95%CI[-1.69,-0.73]),并且提上肌切除术显着增加了PFH(MD=1.30;95%CI[0.27,2.33])。对于额肌吊带手术模式,狐狸五边形明显优于双三角形(MD=0.70;95%CI[0.32,1.08]),而开放模式提供了统计上更好的美容效果比封闭的额叶吊带。对手术材料的分析表明,与用于提上肌折叠术的不可吸收缝合线相比,可吸收缝合线显着增加了MRD1(MD=1.16;95%CI[0.60,1.72]);与使用Gore-Tex,条带相比,使用硅棒进行的额叶吊带手术显着增加了PFH(MD=0.88;95%CI[0.29,1.47])而自体筋膜lata为眼睑高度对称性和轮廓提供了统计上更好的美学结果。
结论:不同的手术方法和材料似乎会影响先天性上睑下垂治疗结果的不同方面。
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Several types of surgeries have been used in the treatment of congenital ptosis, but the optimal methods and materials for this treatment are unknown.
The study aims to evaluate the comparative effectiveness and safety of various surgical methods and materials for treatment of congenital ptosis.
We performed comprehensive searches of five databases, two clinical trial registries and one gray literature database from inception to January 2022 for related trials to include in this study. Meta-analysis was performed to evaluate the effect of surgical methods and materials on the primary outcomes: margin reflex distance 1 (MRD1), palpebral fissure height (PFH), and degree of
lagophthalmos; and secondary outcomes: undercorrection, entropion, corneal epithelial defects, wound dehiscence, recurrence, infection, and cosmetic outcomes.
A total of 14 trials evaluating 909 eyes of 657 patients were included in our study. Compared with the levator plication, the frontalis sling significantly increased the MRD1 (MD = - 1.21; 95% CI [- 1.69, - 0.73]), and the levator resection significantly increased the PFH (MD = 1.30; 95% CI [0.27, 2.33]). For the frontalis sling surgical patterns, the fox pentagon was significantly better than the double triangle at improving the degree of
lagophthalmos (MD = 0.70; 95% CI [0.32, 1.08]), while the opened pattern provided statistically better cosmetic outcome than the closed frontalis sling. Analysis of surgical material showed that absorbable sutures significantly increased the MRD1 (MD = 1.16; 95% CI [0.60, 1.72]) compared to non-absorbable sutures when used in levator plication; frontalis sling surgeries performed with silicon rods significantly increased the PFH (MD = 0.88; 95% CI [0.29, 1.47]) compared to those performed with Gore-Tex strips, while autogenous fascia lata provided statistically better aesthetic outcome for lid height symmetry and contour.
Different surgical methods and materials appear to affect different aspects of the congenital ptosis treatment outcome.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .