PPV联合抗VEGF治疗增殖性糖尿病性视网膜病变远期疗效的Meta分析

Meta-analysis of long-term efficacy of vitrectomy combined with anti-VEGF in the treatment of proliferative diabetic retinopathy

目的:探究玻璃体切除(PPV)术联合或不联合抗VEGF药物治疗增殖性糖尿病性视网膜病变(PDR)的远期疗效。方法:计算机检索PUBMED、EMBASE、Cochrane Central Register of Controlled Trials(CENTRAL)、Web of Science等多个数据库,查找自建库至2020-07-02关于比较PPV术前是否行抗VEGF药物治疗PDR预后效果的临床随机对照试验(RCT),根据文献纳入与排除标准筛选文献,并进行数据提取和质量评价,主要评价指标包括术后视网膜脱离发生率、黄斑中心凹厚度和最佳矫正视力(BCVA)。结果:最终纳入11项(880眼)RCT研究。Meta分析结果显示,术前行抗VEGF治疗的PDR患者PPV术后视网膜脱离发生率明显低于未注射抗VEGF药物患者(RR=0.39,95%CI 0.22~0.71,P=0.002);亚裔和非亚裔患者中,单纯PPV与联合抗VEGF治疗患者PPV术后视网膜脱离发生率均具有显著差异(亚裔:RR=0.20,95%CI 0.05~0.87,P=0.03;非亚裔:RR=0.46,95%CI 0.24~0.89,P=0.02)。术前抗VEGF治疗的PDR患者PPV术后3、6mo黄斑中心凹厚度均低于PPV术前未行抗VEGF治疗的患者(MD=-78.49,95%CI-94.81~-62.17,P<0.00001;MD=-39.62,95%CI-48.44~-30.80,P<0.00001)。术前抗VEGF治疗的PDR患者PPV术后6mo BCVA优于未行抗VEGF治疗的患者(MD=-0.16,95%CI-0.21~-0.10,P<0.00001)。结论:PPV术前行抗VEGF治疗可有效降低PDR患者术后视网膜脱离发生率,缓解术后黄斑水肿,降低黄斑中心凹厚度,并改善视力预后。

AIM:To explore the long-term efficacy of vitrectomy combined with or without anti-VEGF in the treatment of proliferative diabetic retinopathy(PDR).METHODS:Randomized controlled trials(RCTs)comparing the efficacy of vitrectomy combined with or without anti-VEGF therapy for PDR were retrieved from databases including PUBMED,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL)and Web of Science.The retrieval time was from the establishment of the databases to July 2020.According to the inclusion and exclusion criteria,the literature was selected,then data extraction and quality evaluation was completed.Primary evaluation measures included postoperative incidence of retinal detachment,central retinal thickness(CRT),and best corrected visual acuity(BCVA).RESULTS:In this article,11 randomized controlled studies(880 eyes)were included.Meta-analysis results showed that the incidence of retinal detachment after vitrectomy was significantly lower in PDR patients who received anti-VEGF injection before vitrectomy than in patients who did not receive anti-VEGF injection[Risk ratio(RR)=0.39,95%Confidence interval(CI)0.22 to 0.71,P=0.002].There were significant differences in the incidence of retinal detachment after vitrectomy between the anti-VEGF group and the non-VEFG group in both Asian and non-Asian populations(Asian:RR=0.20,95%CI 0.05 to 0.87,P=0.03;Non-Asian:RR=0.46,95%CI 0.24 to 0.89,P=0.02).The central retinal thickness of PDR patients who received preoperative anti-VEGF therapy was significantly lower than that of patients who did not receive anti-VEGF therapy 3 and 6mo after PPV(MD=-78.49,95%CI-94.81 to-62.17,P<0.00001.MD=-39.62,95%CI-48.44 to-30.80,P<0.00001).The BCVA at 6mo after PPV in PDR patients with preoperative anti-VEGF treatment was better than that in patients without preoperative anti-VEGF treatment(MD=-0.16,95%CI-0.21 to-0.10,P<0.00001).CONCLUSION:Anti-VEGF injection before PPV can effectively reduce the incidence of retinal detachment,alleviate postoperative macular edema,reduce the central retinal thickness,and improve BCVA in PDR patients.