目的:评价亚阈值微脉冲激光(SML)治疗慢性中心性浆液性脉络膜视网膜病变(CSC)的疗效。
方法:PubMed,科克伦图书馆,和Embase进行了全面搜索,以查找截至2021年4月19日发表的研究。随机对照试验(RCT),我们选择了回顾性和前瞻性队列研究,比较了SML与任何其他慢性CSC干预措施.主要结果是最佳矫正视力(BCVA)和中央黄斑厚度(CMT)。使用ReviewManager5.3进行Meta分析。随机效应模型用于汇总分析。
结果:共纳入11项研究,包括834只眼,428只眼睛接受SML治疗,406只眼睛接受其他干预。汇总结果显示,在BCVA方面,SML和对照之间没有显着差异,CMT,或视网膜下液的完全消退,而SML治疗在中央凹下脉络膜厚度(SFCT)降低方面不如对照组[加权平均差(WMD)=44.75,95%Cl,14.31-75.20,P<0.05,I2=72%]。然而,相对于SFCT,SML并不优于光动力疗法(WMD=61.29,95%Cl,29.50-93.08,P<0.05,I2=56%),视网膜敏感度(WMD=-1.85,95%Cl,-3.05--0.65,P<0.01,I2=0)或NEI-VFQ25评分(WMD=-2.44,95%Cl,-4.72--0.16,P<0.05,I2=0)。没有观察到SML治疗的严重副作用。
结论:现有证据表明,SML治疗慢性CSC的临床疗效与其他治疗方式相似。然而,因为没有严重的副作用,SML可能是慢性CSC最有前途的替代疗法。研究方案在PROSPERO(CRD42021258837)上注册。
OBJECTIVE: To evaluate the efficacy of subthreshold micropulse laser (SML) treatment for chronic central serous chorioretinopathy (CSC).
METHODS: PubMed, Cochrane Library, and Embase were comprehensively searched for studies published up to April 19, 2021. Randomized controlled trials (RCTs), retrospective and prospective cohort studies that compared SML with any other intervention for chronic CSC were selected. The primary outcomes were best corrected visual acuity (BCVA) and central macular thickness (CMT). Meta-analysis was performed using Review Manager 5.3. Random-effect model was used for pooled analysis.
RESULTS: Eleven studies including 834 eyes were included, with 428 eyes undergoing SML treatment and 406 eyes receiving other interventions. Pooled results showed no significant differences between SML and control with respect to BCVA, CMT, or complete resolution of subretinal fluid, while SML treatment was inferior to control in terms of subfoveal choroidal thickness (SFCT) reduction [weighted mean difference (WMD)=44.75, 95% Cl, 14.31-75.20, P<0.05, I2=72%]. However, SML was not superior to photodynamic therapy with respect to SFCT (WMD=61.29, 95% Cl, 29.50-93.08, P<0.05, I2=56%), retinal sensitivity (WMD=-1.85, 95% Cl, -3.05--0.65, P<0.01, I2=0) or NEI-VFQ25 score (WMD=-2.44, 95% Cl, -4.72--0.16, P<0.05, I2=0). No serious side effects of SML treatment were observed.
CONCLUSIONS: Available evidence suggests that the clinical efficacy of SML therapy is similar to other treatment modalities for chronic CSC. However, because of the lack of serious side effects, SML may be the most promising alternative therapy for chronic CSC. The study protocol was registered on PROSPERO (CRD42021 258837).