背景:在某些情况下,提出了气动视网膜固定术(PnR)作为平坦部玻璃体切除术(PPV)的替代方法。PnR是一种门诊手术,更具成本效益。然而,应根据成功率和不良事件来判断其益处。在这里,我们比较了PnR和PPV修复孔源性视网膜脱离(RRD)的疗效和安全性。
方法:我们搜索了PubMed,Scopus,EMBASE,WebofScience,科克伦,和谷歌学者数据库。纳入比较PnR和PPV疗效和安全性的观察性和介入性研究。结果是治疗的成功率,改善视力,和不良事件发生率。根据晶状体和黄斑状态进行亚组分析。11篇文章有资格进入我们的研究;这些包括11,346名平均年龄为74.1的患者。
结果:PnR在视网膜位移方面优于PPV,感光体完整性,视觉功能,和垂直变形得分。在荟萃分析中,PPV的再附着率高于PnR(OR=3.39,95%CI2.25-5.11)。亚组分析显示,PPV优于PnR的优势在有晶状体眼数量较少的研究中更为明显,更多黄斑上的患者,以及主要PnR故障的情况。虽然PnR患者的术前(SMD=-0.58,95%CI=-1.16至0.00)和术后(SMD=-0.45,95%CI=-0.60至-0.30)LogMAR更好,PPV患者术后视力改善较高(SMD=0.49,95%CI=-0.15~1.13).
结论:与以前的研究相比,在2015年之后发表的研究中,PnR的成功率更高(82%vs.59%)。白内障形成和手术在PPV臂中明显较高,而新的视网膜撕裂的发生在PnR组中更为频繁。在某些情况下,PnR可以用作RRD修复的主要程序。然而,我们建议对PIVOT标准进行一些修改,例如,排除具有不良结局的几个危险因素的病例。
BACKGROUND: Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair.
METHODS: We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1.
RESULTS: PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2.25-5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = - 0.58, 95% CI = - 1.16 to 0.00) and post-op (SMD = - 0.45, 95% CI = - 0.60 to - 0.30) LogMAR, the improvement in visual acuity after surgery was higher in PPV patients (SMD = 0.49, 95% CI = - 0.15 to 1.13).
CONCLUSIONS: The success rate of PnR was higher in studies published after 2015 compared to previous studies (82% vs. 59%). Cataract formation and surgery were significantly higher in the PPV arm, while the occurrence of new retinal tears was more frequent in the PnR group. PnR can be used as the primary procedure for RRD repair in selected cases. However, we propose some modifications to the PIVOT criteria, e.g., the exclusion of cases presenting with several risk factors of poor outcomes.