飞秒激光辅助撕囊的有效性和安全性Meta分析

Effectiveness and safety of femtosecond laser-assisted capsulotomy versus the manual technique in cataract surgery： a meta-analysis

目的比较飞秒激光辅助撕囊与传统手工连续环形撕囊在白内障手术中的有效性和安全性的分析。方法采用Cochrane系统评价方法统计研究。通过计算机和手工检索Embase、Pubmed、Co—chrane Library、Springerlink、万方数据库、中国知识资源总库及维普数据库。文献语种限制为中英文。检索文献发表时限2015年1月至2015年8月按照纳入和排除标准得到相关文献，再通过Jadad评分量表进行文献质量评估，提取资料，临床评价指标包括两种方法撕囊的圆度，偏心度和前囊撕裂率。采用DerSimonian—Laird的方法对各研究结果的效应值进行齐性检验，当P≥0．01（不存在异质性）时，采用固定效应模型进行Meta分析，否则采用随机效应模型进行Meta分析。结果按照纳入与排除标准，最终纳入9篇文献，其中7篇RCT文献，2篇队列研究文献，均为英文文献。4篇文献报到了两种方法撕囊的网度比较，Meta分析结果表明，传统手工撕囊与飞秒激光撕囊的圆度比较，差异有统计学意义（Z=2．90，P〈0．05）。5篇文献报到了撕囊偏心度的比较，结果显示差异有统计学意义（Z=6．79，P〈0．05），4篇文献报到了两种方法术中前囊撕裂率的发生率比较，结果显示差异有统计学意义（Z=5．37，P〈0．05）。结论与传统手工撕囊相比，飞秒激光撕囊具有更好的圆度，更小的偏心性，因此有效性更高，但术中前囊撕裂率的并发症增加，安全性下降。

Objective To compare the effectiveness and safety of cataract surgery using femtosecond laser-assisted anterior capsulotomy with conventional manual continuous curvilinear capsulorhexis （ccc）. Methods In accordance with evaluation guidelines of Cochrane collaboration, eligible studies published in Chinese and English till August, 2015 were identified through a systematic search of electric databases including EMbase, PubMed, Cochrane Library, Springerlink, Wan Fang, CNKI and VIE Qualities of the studies selected based on the inclusion and exclusion criteria were evaluated on the basis of the Jadad Score. Clinical evaluation index including the capsule opening circularity, decentration and complications of the anterior capsular tear rate by two methods were evaluated. The meta-analysis was performed using a fixed or random effects model, determined according the homogeneity test results of the selected studies. Results 7RCT studies and 2 cohort studies which were all English literature were included in this recta-analysis. The result of analysis showed that there was a significant difference between femtosecond laser-assisted anterior capsulotomy with conventional manual continuous curvilinear capsulorhexis in circularity （Z =2.90, P 〈0.05）, decentration （Z =6.79, P 〈0.05） and complication of the anterior capsular tear （Z =5.37, P 〈0.05）. Conclusions Compared with the manual capsulorhexis, femtosecond laser-assisted capsulotomy has better circularity, smaller decentration, more efficient, but the complication of the anterior capsular tear is increased and the safety is decreased.