背景:弓形虫导致眼弓形虫病(OT),涉及炎症,疤痕,和视网膜并发症。OT并发症为视网膜脱离(RD),和视网膜破损(RB)。巩膜扣带术(SB)和玻璃体切除术等外科手术很常见。对OT继发RD/RB手术治疗的安全性和有效性了解有限。另一个并发症是弓形虫病相关性黄斑裂孔(tMH),关于手术结果的证据很少。这项荟萃分析旨在阐明临床特征,和手术结果,加强对RD的了解,RB,MH次要于OT。
方法:PubMed,科克伦,Embase和WebofScience数据库被查询为回顾性研究,提供RD信息的病例系列和病例报告,RB和MH与OT相关,并报告了以下结果:(1)RD/RB的视网膜复位和tMH闭合;(2)最佳矫正视力(BCVA)改善;(3)并发症。用I2统计量检查异质性。随机效应模型用于高度异质性的结果。使用软件R(4.2.3版,R统计计算基金会,维也纳,奥地利)。
结果:十四个最终研究,共分析了96名患者,81为RD或RB,15为tMH。总的来说,手术治疗与几个优点相关:RD/RB的视网膜复位率很高,为97%(95%置信区间[CI]92-100%;I2=0%),视网膜再附着的RD为96%(95%CI89-100%;I2=30%),tMH闭合为97%(95%CI87-100;I2=12%)。在RD/RB(MD0.60;95%CI0.35-0.65;I2=20%)和MH(MD0.67;95%CI0.50-0.84;I2=0%)的研究中,术后BCVA存在显着差异。经证实,与OT继发的RD/RB手术相关的总并发症发生率为25%。
结论:系统评价和荟萃分析显示,目前使用的治疗方法是有效的,RD/RB视网膜复位率显着,tMH闭合,和视力的实质性改善。更随机,对疾病和手术因素的长期研究可以为它们对解剖学和视觉结果的影响提供有价值的见解.
BACKGROUND: Toxoplasma gondii causes ocular toxoplasmosis (OT), involving inflammation, scarring, and retinal complications. The OT complications were retinal detachment (RD), and retinal breakage (RB). Surgical interventions like scleral buckling (SB) and vitrectomy are common. Limited understanding exists of the safety and efficacy of surgical management of RD/RB secondary to OT. Another complication is toxoplasmosis-related macular holes (tMH), with sparse evidence on surgical outcomes. This meta-analysis aims to clarify clinical characteristics, and surgical results, and enhance understanding of RD, RB, and MH secondary to OT.
METHODS: PubMed, Cochrane, Embase and Web of Science database were queried for retrospective studies, case series and case reports that provided information on RD, RB and MH associated with OT and reported the outcomes of: (1) Retinal reattachment of RD/RB and tMH closure; (2) Best-corrected visual acuity (BCVA) improvement; and (3) Complications. Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria).
RESULTS: Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/RB of 97% (95% Confidence Interval [CI] 92-100%; I2 = 0%), retinal reattachment of just RD of 96% (95% CI 89-100%; I2 = 30%) and tMH closure 97% (95% CI 87-100; I2 = 12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35-0.65; I2 = 20%) and MH (MD 0.67; 95% CI 0.50-0.84; I2 = 0%). The overall complication rate associated with surgical procedures in RD/RB secondary to OT was confirmed to be 25%.
CONCLUSIONS: The systematic review and meta-analysis showed that the treatment approaches currently in use are effective, with a remarkable rate of retinal reattachment of RD/RB, tMH closure, and substantial improvements in visual acuity. More randomized, long-term studies on disease and surgical factors can provide valuable insights into their impact on anatomical and visual outcomes.