玻璃体切除联合ILM翻转对比ILM剥除治疗黄斑裂孔性视网膜脱离的meta分析

Vitrectomy with inverted internal limiting membrane flap versus inverted internal limiting membrane peeling for macular hole-induced retinal detachment:a meta-analysis

目的系统评价玻璃体切除联合内界膜(inner limiting membrane,ILM)翻转对比ILM剥除治疗黄斑裂孔性视网膜脱离(MHRD)的疗效差异。方法以黄斑裂孔性视网膜脱离、ILM剥除、ILM翻转,MHRD、ILM peeling、ILM flap等中英文检索词检索循证医学图书馆(cochrane library)、生物医学数据库(PubMed)、MEDLINE、EMBASE以及中国知网和万方数据资源系统。纳入病例对照研究,采用Newcastle-Ottawa Scale(NOS)文献质量评价量表评价纳入研究的质量,采用Revman5.3软件对玻璃体切除联合ILM翻转对比ILM剥除治疗MHRD的疗效差异进行统计学分析。结果共纳入6篇病例对照试验,共165眼,其中ILM翻转组79眼,ILM剥除组86眼。视网膜脱离复位率ILM翻转组与ILM剥除组相比差异无统计学意义(OR=2.55,95%CI:0.84～7.69,P>0.05)。黄斑裂孔闭合率ILM翻转组明显高于ILM剥除组,差异有统计学意义(OR=11.35,95%CI:4.82～26.72,P<0.01)。术后最佳矫正视力两组差异无统计学意义(WMD=-0.08,95%CI:-0.25～0.09,P>0.05)。结论 ILM翻转相较于ILM剥除治疗MHRD可明显提高黄斑裂孔闭合率,但术后视网膜脱离复位率及术后最佳矫正视力两者并无差异。

Objective To compare between the efficacy of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane(ILM)flap or ILM peeling in treatment of macular hole-induced retinal detachment(MHRD)through meta-analysis. Methods Relevant studies were searched from Cochrane Library,PubMed,MEDLINE,EMBASE,CNKI and Wanfang database.Literature screening and data extraction were performed,the quality of the controlled clinical trials(CCT)was evaluated according to the Newcastle-Ottawa Scale(NOS).The difference between the efficacy of PPV combined with ILM flap or ILM peeling in the treating macular hole retinal detachment was analyzed using the software Review manager 5.3. Results Six controlled clinical trials were included in the meta-analysis;and 165 MHRD eyes were involved,including 79 eyes receiving PPV with ILM flap(ILM flap group)and 86 eyes receiving PPV with ILM peeling(ILM peeling group):There were no statistical differences of in rate of retinal reattachment between the ILM flap group and ILM peeling group(OR=2.55,95%CI:0.84~7.69,P>0.05).The closure rate of macular hole in inverted ILM flap group was significantly higher,compared with ILM peeling group(OR=11.35,95%CI:4.82~26.72,P<0.01).There was no statistical difference in postoperative best corrected visual acuity(BCVA)between two groups(WMD=-0.08,95%CI:-0.25~0.09,P>0.05). Conclusion Compared with ILM peeling,PPV combined with inverted ILM flap can significantly improve the closure rate of macular hole in treating MHRD,while there are no significant differences in rates of retinal reattachment and postoperative BCVA between the two groups.