目的:比较联合和序贯玻璃体切割和超声乳化术治疗黄斑裂孔(MH)和视网膜前膜(ERM)的疗效和安全性。
结论:MH和ERM的护理标准是玻璃体切除术,这增加了患白内障的风险。联合晶状体切除术消除了第二次手术的需要。
方法:OvidMEDLINE,EMBASE,和CochraneCENTRAL于2022年5月检索了所有文章,比较了MH和/或ERM的联合和序贯超声玻璃体切除术.主要结果是12个月随访时的平均最佳矫正视力(BCVA)。采用随机效应模型进行Meta分析。使用CochraneRoB2工具进行随机对照试验(RCTs)和ROBINS-I工具进行观察性研究,评估偏倚风险。(PROSPERO,注册号,CRD42021257452)结果:在6470项研究中发现,确定了2项RCT和8项非随机回顾性比较研究。合并组和顺序组的总眼睛分别为435和420。Meta分析提示12个月BCVA的联合手术和序贯手术之间没有显着差异(合并=0.38logMAR,序贯=0.36logMAR;平均差(MD)=0.02logMAR;95%CI=-0.04至0.08;p=0.51,I2=0%,n=4项研究,398名参与者),以及绝对屈光不正(p=0.76,I2=97%,n=4项研究,289名与会者),近视风险(p=0.15,I2=66%,n=2项研究,148名参与者),MH非闭合(p=0.57,I2=48%,n=4项研究,321名参与者),黄斑囊样水肿(p=0.15,I2=0%,n=6项研究,526名参与者),高眼压(p=0.09,I2=0%,n=2项研究,161名参与者),后囊混浊(p=0.46,I2=0%,n=2项研究,161名参与者),后囊破裂(p=0.41,I2=0%,n=5项研究,455名参与者)和视网膜脱离(p=0.67,I2=0%,n=6项研究,545名参与者)。
结论:联合手术和序贯手术在视觉结局方面没有发现显著差异,屈光结果,或并发症。鉴于大多数研究是回顾性的,并且存在较高的偏倚风险,未来高质量的RCT是有保证的。
Comparing the efficacy and safety between combined and sequential pars plana vitrectomy and phacoemulsification for macular hole (MH) and epiretinal membrane (ERM).
The standard of care for MH and ERM is vitrectomy, which increases the risk of developing cataract. Combined
phacovitrectomy eliminates the need for a second surgery.
Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were searched in May 2022 for all articles comparing combined versus sequential
phacovitrectomy for MH and ERM. The primary outcome was mean best-corrected visual acuity (BCVA) at 12 months follow-up. Meta-analysis was conducted using a random effects model. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool for randomized controlled trials (RCTs) and Risk of Bias in Nonrandomized Studies of Interventions tool for observational studies (PROSPERO, registration number, CRD42021257452).
Of the 6470 studies found, 2 RCTs and 8 nonrandomized retrospective comparative studies were identified. Total eyes for combined and sequential groups were 435 and 420, respectively. Meta-analysis suggested no significant difference between combined and sequential surgery for 12-month BCVA (combined = 0.38 logarithm of the minimum angle of resolution [logMAR]; sequential = 0.36 logMAR; mean difference = + 0.02 logMAR; 95% confidence interval = -0.04 to 0.08; P = 0.51; I2 = 0%; n = 4 studies, 398 participants), as well as absolute refractive error (P = 0.76; I2 = 97%; n = 4 studies, 289 participants), risk of myopia (P = 0.15; I2 = 66%; n = 2 studies, 148 participants), MH nonclosure (P = 0.57; I2 = 48%; n = 4 studies, 321 participants), cystoid macular edema (P = 0.15; I2 = 0%; n = 6 studies, 526 participants), high-intraocular pressure (P = 0.09; I2 = 0%; n = 2 studies, 161 participants), posterior capsule opacification (P = 0.46; I2 = 0%; n = 2 studies, 161 participants), posterior capsule rupture (P = 0.41; I2 = 0%; n = 5 studies, 455 participants), and retinal detachment (P = 0.67; I2 = 0%; n = 6 studies, 545 participants).
No significant difference was detected between combined and sequential surgeries for visual outcomes, refractive outcomes, or complications. Given that most studies were retrospective and contained a high RoB, future high-quality RCTs are warranted.
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