背景:黄斑裂孔是黄斑中心视网膜组织的破裂,影响中央视力。标准治疗包括玻璃体切除术,膜剥离和气体填塞。然而,对于更大或慢性的洞,自体视网膜移植等替代技术已经出现。这项荟萃分析评估了视网膜移植治疗大黄斑裂孔的有效性和安全性。
方法:我们遵循PRISMA指南进行了系统评价和荟萃分析。该研究在PROSPERO(CRD42024504801)中进行了前瞻性注册。我们搜索了PubMed,WebofScience,科克伦,和Embase数据库,用于观察性研究,包括有或没有视网膜脱离的大黄斑裂孔和视网膜移植作为主要治疗的个体。我们使用随机效应模型以95%置信区间计算平均差,并使用R软件进行统计分析。
结果:我们对19项研究进行了综合分析,涉及322例诊断为各种类型的黄斑裂孔(MHs)的患者。这些包括难治性MH的队列,与MH相关的高度近视,主要MH,MH伴视网膜脱离(RD)。这些发现很有希望,总体闭合率为94%(95%CI88-98,I2=20%)。此外,所有亚组的术后视力均有显着改善,总体平均0.45(95%CI0.33-0.58;I2=72%;p<0.01)。然而,并发症发生率为15%(95%CI7~25;I2=59%).
结论:针对大型MH的ART显示出可喜的结果,包括视力显著改善,MH封堵率高,总体及亚组并发症风险低.
BACKGROUND: Macular holes are breaks in the retinal tissue at the center of the macula, affecting central vision. The standard treatment involves vitrectomy with membrane peeling and gas tamponade. However, for larger or chronic holes, alternative techniques like autologous retinal graft have emerged. This meta-analysis evaluates the efficacy and safety of retinal transplantation in managing large macular holes.
METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. The study was prospectively registered in PROSPERO (CRD42024504801). We searched PubMed, Web of Science, Cochrane, and Embase databases for observational studies including individuals with large macular holes with or without retinal detachments and retinal transplantation as the main therapy. We used a random-effects model to compute the mean difference with 95% confidence intervals and performed statistical analysis using R software.
RESULTS: We conducted a comprehensive analysis of 19 studies involving 322 patients diagnosed with various types of macular holes (MHs). These included cohorts with refractory MH, high myopia associated with MH, primary MH, and MH with retinal detachment (RD). The findings were promising, revealing an overall closure rate of 94% of cases (95% CI 88-98, I2 = 20%). Moreover, there was a significant improvement in postoperative visual acuity across all subgroups, averaging 0.45 (95% CI 0.33-0.58 ; I2 = 72%; p < 0.01) overall. However, complications occurred with an overall incidence rate of 15% (95% CI 7-25; I2 = 59%).
CONCLUSIONS: ART for large MH shows promising results, including significant improvements in visual acuity and a high rate of MH closure with low complication risks overall and for subgroups.