单侧截除-后徙术与折叠-后徙术治疗外斜视的Meta分析

Meta-analysis of unilateral resection-recession versus plication-recession for exotropia

目的:比较单侧内直肌截除联合外直肌后徙术(RR)与单侧内直肌折叠联合外直肌后徙术(RP)治疗外斜视的有效性。方法:循证医学研究。系统检索Medline、Embase、Web of Science、the Cochrane Register of Controlled Trials等数据库,检索日期2011-08/2021-08。纳入符合入选标准的研究。主要结局指标为成功率和术后斜视度。优势比(OR)和均数差(MD)及95%置信区间(CI)作为计量资料及连续变量统计量进行统计分析。结果:共纳入2篇随机对照研究和5篇回顾性队列研究,Meta分析结果显示:RP组与RR组相比,手术成功率相似(OR=0.65,95%CI:0.39~1.07,P=0.09);两组之间不良预后发生率(欠矫率和过矫率)无差异(OR=1.59,95%CI:0.92~2.74,P=0.10;OR=4.43,95%CI:0.69~28.18,P=0.12);RP组与RR组比较,术后斜视度与外斜漂移量亦无差异(MD=0.75,95%CI:-0.27~1.76,P=0.15;MD=-0.34,95%CI:-1.30~0.63,P=0.50)。结论:RP与RR手术成功率与术后不良预后发生率接近,且两种手术术后斜视度与外斜漂移量无显著差异,RP手术是一个有效的治疗外斜视的手术方式。

AIM: To compare the effectiveness of unilateral lateral rectus recession-medial rectus resection(RR))and lateral rectus recession-medial rectus plication(RP) in the treatment of exotropia. METHODS: Evidence-based medicine research. A systematic database search was conducted Medline, Embase, Web of Science, the Cochrane Register of Controlled Trials and so on from August 2011 to August 2021. Related studies meeting the inclusion criteria were included in our study. The main outcome measures were as follows: success rate and postoperative deviation. Mean difference(MD) and odds ratio(OR) with 95% confidence interval(CI) were statistical analyzed as measurement data and continuous variables statistics. RESULTS: A total of two randomized controlled studies and five retrospective studies were included. The Meta-analysis results showed that the success rate of surgery was similar for RP group compared with RR group(OR=0.65, 95%CI:0.39-1.07, P=0.09). There was no difference in the incidence of poor postoperative prognosis of the two groups(the undercorrection and overcorrection rates)(OR=1.59;95%CI: 0.92-2.74, P=0.10;OR=4.43;95%CI: 0.69-28.18, P=0.12). There were no significant differences in postoperative deviation and the amount of external oblique drift(MD=0.75, 95%CI:-0.27-1.76, P=0.15;MD=-0.34, 95%CI:-1.30-0.63, P=0.50). CONCLUSION: The success rate of RP and RR surgery is close to the incidence of poor postoperative prognosis, moreover, there was no significant difference between the deviation and the amount of external oblique drift after the two surgeries, RP is an effective surgical procedure for the treatment of exotropia.