糖尿病性视网膜病变患者常规全视网膜光凝后黄斑中心凹下脉络膜厚度变化的荟萃分析

A meta-analysis of changes in the subfoveal choroidal thickness in diabetic retinopathy patients after conventional panretinal photocoagulation

目的通过荟萃分析系统评价糖尿病性视网膜病变(DR)患者在常规全视网膜光凝(PRP)后黄斑中心凹下脉络膜厚度(SFCT)的变化。方法检索PubMed、EMBASE、Web of Science及Cochrane Library英文数据库和万方数据知识服务平台、维普中文期刊服务平台及中国知网中文数据库,搜集行PRP术后不同时间段DR患者SFCT的相关文献,由两位评价者独立进行文献检索、筛选、质量评价及数据提取,采用合并的加权平均差(WMD)和95%置信区间(CI)作为统计量,各文献研究间的异质性采用Q和I^(2)检验,如P<0.05或I^(2)>50%则认为异质性较大,采用敏感性分析剔除发表偏倚差异较大的研究或存在高偏倚风险的研究,而后检测合并结果的稳定性,如剔除后异质性仍不显著降低,则采用随机效应模型进行分析。结果初步检索各数据库最初获得文献141篇,根据纳入与排除标准,最终将11篇文献共计401眼纳入研究。考虑到纳入文献样本量较少,无论I^(2)如何,均首选随机效应模型。经随机效应模型分析,PRP术后1周,合并的WMD显示SFCT较基线时显著增加(WMD=-18.012,95%CI为31.905~4.118,P=0.011);PRP术后1个月,合并的WMD显示SFCT与基线无显著差异(WMD=10.818,95%CI为-0.993~22.630,P=0.073),PRP术后3个月和6个月,合并的WMD均显示SFCT较基线时显著下降(WMD=15.973,95%CI为5.610~26.336,P=0.003;WMD=18.249,95%CI为0.560~35.939,P=0.043)。结论DR患者行PRP术后,SFCT在早期会增高,并会随着时间推移降低,到术后3个月时会显著降低至基线水平。

Objective To evaluate the changes in the subfoveal choroidal thickness(SFCT)in diabetic retinopathy(DR)patients after conventional panretinal photocoagulation(PRP)using a meta-analysis system.Methods By searching PubMed,EMBASE,Web of Science and Cochrane Library English databases,Wanfang Data Knowledge Service Platform,VIP Chinese Journal Service Platform,and CNKI Chinese Database,two researchers collected literature studying the SFCT of DR patients at different times post PRP.The two researchers independently performed paper search,screening,quality evaluation,and data extraction,and used pooled weighted mean differences(WMD)and 95%confidence interval(CI)as statistical data.Q and I^(2) tests were used to evaluate the heterogeneity among different studies,with P<0.05 or I^(2)>50%indicating large heterogeneity.Sensitivity analysis was used to exclude studies with large bias or with a high risk of bias,and then the stability of the combined results was checked.If the exclusion did not significantly reduce heterogeneity,the random effects model was used for analysis.Results A preliminary search in the above databases initially obtained 141 relevant studies.After screening based on inclusion and exclusion criteria,11 studies that investigated a total of 401 eyes were eventually included in the meta-analysis.Considering that the sample size of the included studies was relatively small,the random effects model was preferred regardless of I^(2) value.As shown by the random effects model analysis,one week after PRP,the combined WMD showed a significant increase in SFCT(WMD=-18.012;95%CI31.905,4.118;P=0.011).One month after PRP,the combined WMD showed that the SFCT was not significantly different from the baseline(WMD=10.818;95%CI-0.993,22.630,P=0.073).Three and six months after PRP,the combined WMD showed a significant decrease in SFCT(three monthsWMD=15.973;95%CI5.610,26.336,P=0.003.Six monthsWMD=18.249;95%CI0.560,35.939,P=0.043).Conclusion After PRP,DR patients will have increased SFCT first,which then gradually decreases over time and becomes significantly lower than the baseline after three months.