玻璃体内注射曲安奈德联合激光光凝治疗糖尿病黄斑水肿的疗效和安全性的Meta分析

Efficacy and safety of intravitreal triamcinolone acetonide combined with laser photocoagulation versus intravitreal triamcinolone acetonide alone for diabetic macular edema: a Meta-analysis

目的 系统评价黄斑光凝（Laser）联合曲安奈德玻璃体内注射（IVTA）和单纯应用IVTA治疗糖尿病黄斑水肿的疗效和差异。方法 通过PubMed，Web of science，Google scholar， CNKI全文数据库检索有关IVTA联合Laser和单用IVTA两种不同的方法 治疗糖尿病黄斑水肿的临床对照研究文献资料。采用Cochrane系统评价的方法 ，文献质量采用Jadad量表评分，使用RevMan 5.2软件进行Meta分析。结果 经检索筛选后最终可纳入5篇（253眼）相关文献且结果 显示，在减轻中央黄斑厚度（CMT）方面，IVTA＋Laser组和单纯IVTA组比较，随访3个月后降低幅度差异为：-0.3μm（95%CI：-8.68～8.09）；6个月后为：-65.96μm（95%CI：-161.58，29.66），两组差异无统计学意义；在提高最佳矫正视力（BCVA）方面，随访3、6个月后提高幅度的差异分别为-0.04（95%CI：-0.24～0.17），-0.11（95%CI：-0.29～0.07），P＝0.22，两者差异仍无统计学意义。两组并发白内障及眼压升高的概率无差别。结论 两组方案治疗糖尿病黄斑水肿疗效和安全性相仿，但尚需更多前瞻性多中心大样本的临床随机对照试验数据对其验证。

Objective To quantify the effect of the intravitreal injection of triamcinolone acetonide （IVTA） combined with laser photocoagulation （Laser） versus IVTA alone in patients with diabetic macular edema（DME）.Methods RevMan 5.2 was used to conduct a Meta analysis and searched for reports about IVTA combined with Laser versus IVTA alone for the treatment of DME. Using PubMed, Web of science, Google scholar and CNKI according to Cochrane evaluation guidelines. Methodological quality of the literatures was valuated according to the Jadad Score.Results Five studies （253 eyes） were ultimately included in this meta-analysis. The results of our analysis showed IVTA combined with laser had no statistically significant improvement in vision over the IVTA at 3 months（P=0.72） and 6 months （P=0.22）, and the same of reduce in central macular thickness （CMT） （at 3 monthsP=0.95, at 6 months P=0.18）. The incidence of adverse events（mainly elevation of intraocular pressure and progression of cataracts） had no significant.Conclusion Current evidence shows that the equal reduced CMT, improved BCVA and adverse event rates is observed in IVTA combined with Laser group versus IVTA group for treatment of DME.