■糖尿病显著增加白内障手术后黄斑水肿(PME)的风险,导致潜在的最坏的术后结果。这项研究旨在比较不同的预防性干预措施在改善白内障手术的糖尿病患者术后解剖和视力方面的效果。
■我们搜索了MEDLINE,Embase,WebofScience数据库从成立到2月2日,2022年,用于研究,包括报告PME事件和/或最佳矫正视力(BCVA)结果的研究。进行随机效应贝叶斯网络荟萃分析,以比较玻璃体内注射抗血管内皮生长因子(抗VEGF)的有效性,非甾体抗炎药(NSAIDs)和局部类固醇滴眼液在1周,1个月,3个月,白内障术后6个月。
■来自17项随机对照试验的2566名参与者被纳入网络荟萃分析,具有中等偏倚风险,没有发表偏倚的证据。与单独的安慰剂/类固醇眼药水相比,接受额外局部NSAIDs或玻璃体内注射抗VEGF的患者在1个月时发生PME的风险较低(NSAIDs:OR=0.221,95%置信区间[CI],0·044-0·755,I2=0·0%,5项研究;抗VEGF:OR=0·151,95CI,0·037-0·413,I2=0·0%,5项研究)和3个月(NSAIDs:OR=0·370,95CI,0·140-0·875,I2=0·0%,8项研究;抗VEGF:OR=0·203,95CI,0·101-0·353,I2=0·0%,4项研究)白内障手术后。Further,额外的抗VEGF在1个月时表现出更好的BCVA结果(LogMAR的平均差:-0·083,95CI,-0·17至-0·014,I2=62·0%,5项研究),和3个月(LogMAR的平均差:-0·061,95CI,-0·11至-0·011,I2=0·0%,5项研究)白内障手术后。这些额外的益处在手术后6个月没有达到统计学意义。
■我们的数据表明,与单独的安慰剂/类固醇滴眼液相比,可考虑额外预防性抗VEGF干预,以预防糖尿病患者白内障手术后PME的发生.
■研究开发专项(2020-1-2052);北京市科学技术委员会科技项目(Z201100005520045,Z1811000018003).
UNASSIGNED: Diabetes significantly increases the risk of postoperative macular edema (PME) after cataract surgery, leading to potential worst post-operative outcomes. This study aims to compare the effect of different prophylactic interventions in improving postoperative anatomic and visual acuity outcomes of diabetes patients who underwent cataract surgery.
UNASSIGNED: We searched MEDLINE, Embase, Web of Science databases from inception until February 2nd, 2022, for studies including studies reporting PME events and/or best-corrected visual acuity (BCVA) outcomes. Random-effects Bayesian network meta-analysis was performed to compare the efficiency of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF), nonsteroidal anti-inflammatory drugs (NSAIDs) and topical steroids eye drop at 1 week, 1 month, 3 months, 6 months after cataract surgery.
UNASSIGNED: The total of 2566 participants from 17 randomized controlled trials were included in the network meta-analysis, with moderate risk of bias and no evidence of publication of bias. Compared to placebo/steroid eye drop alone, patients received additional topical NSAIDs or intravitreal anti-VEGF injections had lower risk of PME at 1 month (NSAIDs: OR=0·221, 95% Confidence interval [CI], 0·044-0·755, I2 =0·0%, 5 studies; anti-VEGF: OR=0·151, 95%CI, 0·037-0·413, I2 =0·0%, 5 studies) and 3 month (NSAIDs: OR=0·370, 95%CI, 0·140-0·875, I2 =0·0%, 8 studies; anti-VEGF: OR=0·203, 95%CI, 0·101-0·353, I2 =0·0%, 4 studies) after cataract surgery. Further, additional anti-VEGF exhibited better BCVA outcome at 1 month (mean difference of LogMAR: -0·083, 95%CI, -0·17 to -0·014, I2 =62·0%, 5 studies), and 3 months (mean difference of LogMAR: -0·061, 95%CI, -0·11 to -0·011, I2 =0·0%, 5 studies) after cataract surgery. Such additional benefits did not reach statistic significant at 6 months after surgery.
UNASSIGNED: Our data suggests that compared to placebo/steroid eye drop alone, additional prophylactic anti-VEGF intervention could be considered for preventing the occurrence of PME after cataract surgery in patients with diabetes.
UNASSIGNED: Research and Development of Special (2020-1-2052); Science & Technology Project of Beijing Municipal Science & Technology Commission (Z201100005520045, Z181100001818003).