内界膜剥除术对比不剥除术治疗特发性黄斑前膜的疗效的Meta分析

A meta-analysis of the clinical effectiveness of idiopathic macular epiretinal membrane surgery with or without internal limiting membrane peeling

目的：系统评价单纯黄斑前膜剥除术与黄斑前膜剥除联合黄斑区内界膜剥除术治疗特发性黄斑前膜的疗效。方法循证医学研究。计算机检索美国国立医学图书馆、荷兰医学文摘、循证医学数据库、中国期刊全文数据库等数据库。按照纳入标准及排除标准对检索文献进行筛选，对纳入文献进行Downs ＆ Black评分。连续变量以加权均数差（WMD）作为效应尺度，分类变量以比值比（OR）作为效应尺度，提取各组相应资料后运用Revman 5.0软件进行异质性分析并进行合并分析。用倒漏斗图对发表偏倚进行检测。结果共纳入8项对照研究，共417眼，其中黄斑前膜联合黄斑区内界膜剥除术200眼（联合组），单纯黄斑前膜剥除术217眼（单纯组）。Meta分析结果显示：①最佳矫正视力（BCVA， logMAR）：治疗后3个月，单纯组术后BCVA优于联合组，差异有统计学意义[WMD=0.16，95%CI（0.02，0.29），P〈0.05]；治疗后半年以上[WMD=-0.06，95%CI（-0.15，0.03），P〉0.05]和1年以上[WMD=0.04，95%CI （-0.02，0.09），P〉0.05]，2组BCVA差异无统计学意义。2组治疗半年以上视力无下降比例比较，差异无统计学意义[WMD=1.37，95%CI（0.40，4.76），P〉0.05]。②黄斑中心凹视网膜厚度：治疗后3个月[WMD=20.42，95%CI（-1.50，42.35），P〉0.05]和1年以上[WMD=12.37，95%CI（-11.29，36.04），P〉0.05]2组黄斑中心凹视网膜厚度比较差异无统计学意义；但治疗半年以上时，联合组的黄斑中心凹视网膜厚度大于单纯组，差异有统计学意义[WMD=26.43，95%CI（8.12，44.75），P〈0.05]。③黄斑前膜复发率：单纯组高于联合组，差异有统计学意义[WMD=0.20，95%CI（0.07，0.61），P〈0.05]。结论与单纯黄斑前膜剥除术相比，黄斑前膜联合黄斑区内界膜剥除术用于治疗特发性黄斑前膜在改善术后视力及黄斑中心凹厚度方面并无优势，但可以显著降低黄斑前膜的复发率。

Objective To evaluate the clinical effectiveness of idiopathic macular epiretinal membrane surgery with or without internal limiting membrane peeling. Methods Meta-analysis study. Searches were conducted in Pubmed, EMbase, Cochrane Library, CNKI, etc. Studies that met the inclusion criteria were selected for further analysis. The Downs ＆ Black score was used for quality and comparability assessment, and the meta-analysis was performed using Revman 5.0 software. Results Eight studies in the literature were selected for meta-analysis, including a total of 417 eyes：one group had undergone epiretinal membrane （ERM） removal with internal limiting membrane （ILM） peeling （200 eyes） and the other group had undergone ERM removal alone （217 eyes）. The results of the meta-analysis showed the following： ①Best corrected visual acuity （BCVA）： The group that underwent ERM removal alone had better BCVA at the postsurgical follow-up after 3 months compared with the group that underwent ERM removal with ILM peeling [WMD=0.16, 95%CI （0.02, 0.29）, P〈0.05]. There were no significant differences in BCVA between the two groups at the postsurgical follow-up after at least 6 months [WMD=-0.06, 95%CI（-0.15, 0.03）, P〉0.05] and BCVA at the postsurgical follow-up after at least one year [WMD=0.04, 95%CI（-0.02, 0.09）, P〉0.05]. There were also no significant differences between the two groups in the incidence of people who did not have decreased vision at the postsurgical follow-up after at least 6 months [WMD=1.37, 95%CI（0.40, 4.76）, P〉0.05]. ②Central macular thickness： The central macula was thicker in the group that underwent ERM removal with ILM peeling when compared with the group that underwent ERM removal alone at the postsurgical follow-up after at least 6 months [WMD=26.43, 95%CI（8.12, 44.75）, P〈0.05]. There were no significant differences in central macular thickness between the two groups at the postsurgical follow-up after 3 months [WMD=20.42, 95%CI（-1.50, 42.35）, P〉0.05] and after at least one year [WMD=12.37, 95%CI（-11.29, 36.04）, P〉0.05]. ③The recurrence rate of the macular ERM： The group that underwent ERM removal alone showed a higher recurrence rate than the group that underwent ERM removal with ILM peeling [WMD=0.20, 95%CI（0.07, 0.61）, P〈0.05]. Conclusion Compared with the group that underwent ERM removal alone, the group that underwent ERM removal with ILM peeling has no advantages in the improvement of BCVA and the reduction in central macular thickness, but ILM peeling significantly reduces the recurrence rate of idiopathic macular epiretinal membrane.