白内障手术后单纯性孔源性视网膜脱离手术治疗的meta分析

A meta-analysis of uncomplicated retinal detachment surgery after cataract surgery

目的比较玻璃体切割手术（PPV）与巩膜扣带手术（SB）治疗白内障手术后单纯性孔源性视网膜脱离（RRD）的疗效及安全性。方法计算机检索循证医学图书馆、美国国立医学图书馆医学在线数据库、荷兰医学文摘、中国期刊全文数据库、中国生物医学文献数据库以及通过手工检索相关文献，收集比较PPV与SB治疗白内障手术后单纯性RRD的随机对照试验（RcT）。比较PPV与SB后最佳矫正视力（BCVA），初次手术及最终视网膜复位率及并发症的发生率。结果共有4篇RCT纳人研究，共有690例690只眼。其中，PPV组331只眼，SB组359只眼。2组间初次视网膜复位率比较，差异无统计学意义[优势比（OR）=1．68，95％可信区间（CI）0．81～3．49，P=0．16]；2组间最终视网膜复位率比较，差异有统计学意义，PPV组存在明显优势（OR=1．97，95％CI1．04～3．73，P=0．04）；手术后6个月，2组间BCVA比较，差异无统计学意义（加权均数差=0．06，95％CI=0．01～0．14，P=0．11）。并发症方面，2组间仅复视和（或）眼外肌运动功能障碍发生率比较，差异有统计学意义（OR=6．59，95％CI1．16～37．27，P=0．03）；2组间增生性玻璃体视网膜病变、黄斑前膜、黄斑囊样水肿、脉络膜脱离发生率比较，差异均无统计学意义（P〉0．05）。结论对于白内障手术后单纯性RRD患者，PPV治疗最终能够获得较SB治疗更高的视网膜复位率，且具有较低的复视和（或）眼外肌运动功能障碍发生率。

Objective To compare the efficacy and safety of pars plana vitrectomy （PPV） versus scleral buckling （SB） on rhegmatogenous retinal detachment （RRD） after cataract surgery. Methods A computerized search was conducted in the Cochrane Library, Medline, Embase, China National Knowledge Infrastructure （CNKI）, Chinese Biological Medicine Database （CBM） combined with manually searching of related literatures. Randomized controlled trials （RCT） comparing PPV with SB for RRD after cataract surgeries were collected. Best corrected visual acuity （BVCA）, reattachment rate after primary surgery, final reattachment rate and complications between the two operations were compared. Results A total of four RCTs were included in this meta analysis, including 690 eyes of 690 patients （331 eyes in the PPV group, 359 eyes in the SB group）. There was no difference in reattachment rates after primary surgery between two groups [odds ratio （OR） ： 1.68; 95% confidence interval （CI）, 0.81-3.49; P=0.16）. Final reattachment rate were in favor of PPV （OR= 1.97; 95% CI, 1.04 - 3.73; P=0.04）. There was no significant difference in the proportion of BCVA at six months （weighted mean difference= 0.06; 95 % CI=0.01 - 0. 14; P：0.11）. PPV was associated with a significantly lower frequency of diplopia/extrocular muscle dysfunction than SB （OR： 6.59; 95 % CI 1.16 - 37.27; P = 0.03）, whereas other complications, such as proliferative vitreoretinopathy, macular pucker, cystoid maeular edema, and ehoroidal detachment did not differ statistically （P〉0.05）. Conclusion Compared with SB, PPV is more likely to achieve a favorable final reattachment rate for RRD after cataract surgery, and with a lower rate of diplopia/extrocular muscle dysfunction.