人工晶状体嵌顿术治疗儿童白内障临床疗效的Meta分析

Meta-analysis of clinical efficacy of intraocular lens incarceration in the treatment of pediatric cataract

目的:系统对比分析人工晶状体(IOL)嵌顿术与非嵌顿术治疗儿童白内障的临床疗效。方法:利用计算机检索PubMed、Embase、Cochrane Library、万方、中国知网等数据库,并查阅相关杂志纸质版,检索文献发表时间从2000-01/2021-01。由2名研究人员分别对检索到的文献进行筛选、评价和数据提取,按照Cochrane评价手册和NOS量表进行质量评价后,使用Rev Man 5.4软件完成Meta分析。结果:最终纳入7篇文献,包括受试眼328眼,Meta分析结果显示,两组患者在术后最佳矫正视力(BCVA)>0.5眼数(RR=2.00,95%CI:1.18~3.37,P=0.01)、IOL偏移(RR=0.28,95%CI:0.17~0.46,P<0.00001)和轻度及以上中央视轴混浊(RR=0.35,95%CI:0.19~0.65,P=0.0007)的发生情况上存在明显差异,但在术后虹膜后黏连(RR=0.67,95%CI:0.10~4.33,P=0.67)和极轻度的中央视轴区混浊(RR=1.05,95%CI:0.64~1.73,P=0.84)的发生情况上无差异。结论:IOL嵌顿术治疗儿童白内障能显著提高术后BCVA、减少IOL偏移并可减轻轻度及以上中央视轴区混浊程度,在总体临床疗效上更具优势。然而上述结论尚需进一步开展严格设计的随机双盲对照试验加以验证。

AIM:To systematically compare and evaluate the clinical efficacy of intraocular lens(IOL)incarceration and non-incarceration in pediatric cataract.METHODS:Literatures were searched from domestic and foreign databases such as PubMed,Embase,Cochrane Library,Wanfang,and CNKI,and the paper editions of relevant journals were consulted as well.The retrieval period of literature was from January 2000 to January 2021.The screened literatures were evaluated and extracted by two experienced researchers.After performing the evaluation guidelines of Cochrane collaboration and the Newcastle-Ottawa Scale(NOS),the Rev Man 5.4 software was applicated to complete the Meta-analysis.RESULTS:Seven references(328 eyes)were involved in this analysis.The results of the Meta-analysis showed that the two groups had statistically significant differences in best corrected visual acuity(BCVA)>0.5 eyes(RR=2.00,95%CI:1.18-3.37,P=0.01),IOL shift(RR=0.28,95%CI:0.17-0.46,P<0.00001)and mild or above opacification of the visual axis(RR=0.35,95%CI:0.19-0.65,P=0.0007)after surgery.However,there was no significant difference in the occurrence of posterior synechia(RR=0.67,95%CI:0.10-4.33,P=0.67)and very mild opacification of the visual axis(RR=1.05,95%CI:0.64-1.73,P=0.84).CONCLUSION:IOL incarceration in the treatment of pediatric cataract can significantly improve postoperative BCVA,reduce occurrence of IOL shift and prevent mild or above opacification of the visual axis,which has more advantages in overall clinical efficacy.But more high quality prospective studies should be still required for further analysis.