背景:白内障是常见的眼部疾病之一。目前,超声乳化术联合传统人工晶状体(IOL)植入术可获得满意的再生效果。然而,角膜散光的矫正是有限的,而ToricIOL植入可以提供良好的散光矫正治疗。
方法:我们检索了发表在PubMed,EBSCO,MEDLINE,EMBASE,科学直接,科克伦图书馆,中国国家知识基础设施(CNKI),万方,和Weipu数据库。手动搜索专业期刊以避免遗漏。研究主题搜索词包括白内障,散光,IOL,和人工晶状体。观察指标搜索词包括未矫正视力(UDVA),最佳矫正视力(BDVA),残余角膜散光,和白内障治愈率。
结果:共纳入12篇。使用最小角度分辨率对数(LogMAR)视敏度图对文章进行了UDVA的异质性测试,结果表明,卡方检验(Chi2)=75.21,自由度(df)=11,I2=85%>50%,因此采用随机效应模型(REM)进行分析。结果表明,Toric和非ToricIOL组之间的差异具有统计学意义,ToricIOL组疗效明显[Z=2.18,均差(MD)=-0.05,95%保密区间(CI):-0.09,-0.00,P=0.03]。采取固定效应模子(FEM)剖析LogMAR视敏图测定BDVA6篇。结果表明,ToricIOL与非ToricIOL组之间的差异无统计学意义(Z=0.29,MD=-0.00,95%CI:-0.02,0.01,P=0.77)。在残余角膜散光方面对三篇文章进行了异质性分析,结果表明,Chi2=75.55,df=3,I2=96%>50%,P<0.00001。REM分析结果显示两组间差异无统计学意义,ToricIOL组残余角膜散光较低(Z=1.35,MD=-0.34,95%CI:-0.83,0.15,P=0.18)。
结论:荟萃分析结果证实ToricIOL植入术在改善白内障患者UDVA和角膜残余散光方面具有明显优势。
BACKGROUND: Cataract is one of the common eye diseases. At present, Phacoemulsification combined with traditional intraocular lens (IOL) implantation can achieve satisfactory rejuvenation effects. However, the correction of corneal astigmatism is limited, while Toric IOL implantation can provide good astigmatism correction treatment.
METHODS: We retrieved randomized controlled trials (RCTs) on the treatment of cataracts published in the PubMed, EBSCO, MEDLINE, EMBASE, Science Direct, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases. Professional journals were searched manually to avoid omissions. The research subject search terms included cataract, astigmatism, IOL, and intraocular lens. The observation indicators search terms included uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), residual corneal astigmatism, and cataract cure rate.
RESULTS: A total of 12 articles were included. The articles were tested for heterogeneity of UDVA measured using the Logarithm of Mininal Angle Resolution (LogMAR) visual acuity chart, and the results showed that Chi-squared test (Chi2) =75.21, degree of freedom (df) =11, and I2=85%>50%, so the random effects model (REM) was adopted for analysis. The results indicated that the differences between the Toric and Non-Toric IOL groups statistically significant, and the Toric IOL group had a significant therapeutic effect [Z =2.18, mean difference (MD) =-0.05, 95% confidential interval (CI): -0.09, -0.00, P=0.03]. The fixed effects model (FEM) was adopted to analyze the determination of BDVA by LogMAR visual acuity chart in 6 articles. The results suggested that the difference between the Toric IOL and non-Toric IOL groups was not statistically significant (Z =0.29, MD =-0.00, 95% CI: -0.02, 0.01, P=0.77). Heterogeneity analysis was performed on three articles in terms of residual corneal astigmatism, which showed that Chi2=75.55, df =3, I2=96%>50%, and P<0.00001. The REM analysis results revealed that the difference between the two groups was not statistically significant, and the Toric IOL group had low residual corneal astigmatism (Z =1.35, MD =-0.34, 95% CI: -0.83, 0.15, P=0.18).
CONCLUSIONS: The meta-analysis results confirmed that Toric IOL implantation showed obvious advantages in improving UDVA and corneal residual astigmatism in cataract patients.