飞秒激光辅助下白内障手术对角膜内皮细胞影响的Meta分析

Meta-analysis of the effects of femtosecond laser-assisted cataract surgery on corneal endothelial cells

目的:系统评价飞秒激光辅助下白内障手术(FLACS)与传统超声乳化白内障手术(CUCS)对角膜内皮细胞的影响。方法:从PubMed、Cochrane Library、Web of Science、Embase、CNKI、CBM、VIP和WanFang Data数据库中检索自建库至2021-11发表的关于飞秒激光辅助下白内障手术与传统超声乳化白内障手术对角膜内皮细胞影响相关的随机对照试验(RCT),语言限定为中文或英文。对纳入文献采用《Cochrane干预措施系统评价手册》和改良Jadad量表进行质量评价;采用Stata 15.0软件进行Meta分析和统计处理。结果:共纳入13篇RCT研究,其中纳入FLACS组1446眼,CUCS组1472眼,Meta分析结果显示,FLACS组术中累积耗散能量(CDE)明显低于CUCS组[WMD=-3.84,95%CI(-6.30,-1.38),P=0.002];FLACS组术中有效超声乳化时间(EPT)明显低于CUCS组[WMD=-3.03,95%CI(-4.00,-2.05),P<0.001];术后1、3mo FLACS组角膜内皮细胞密度(ECD)均明显多于CUCS组[WMD=121.76,95%CI(79.31,164.20),P<0.001;WMD=76.04,95%CI(19.25,132.82),P=0.009];术后1wk CUCS组中央角膜厚度(CCT)明显大于FLACS组[WMD=-9.89,95%CI(-18.60,-1.18),P=0.026];术后FLACS组角膜水肿发生率低于CUCS组[RR=0.46,95%CI(0.32,0.66),P<0.001];而两组六角形细胞百分比和角膜内皮细胞变异系数均无差异。结论:飞秒激光辅助下白内障手术相对于传统超声乳化白内障手术可以明显降低超声乳化能量并减少超声能量作用时间,术后早期角膜内皮细胞丢失明显减少,减少术后角膜水肿的发生。

·AIM:To systematically evaluate the effects of femtosecond laser-assisted cataract surgery and conventional ultrasound cataract surgery(CUCS)on corneal endothelial cells.·METHODS:Databases such as PubMed,Cochrane Library,Web of Science,Embase,CNKI,CBM,VIP and WanFang Data were searched for randomized controlled trials(RCT)from the establishment of the database to November 2021 on the effects of femtosecond laser cataract surgery and conventional ultrasound cataract surgery on corneal endothelial cells.Language is limited to Chinese or English.The literatures were evaluated by the Manual of Systematic Evaluation of Cochrane Interventions and the modified Jadad Scale.Stata 15.0 software was used for statistical analysis.·RESULTS:A total of 13 RCT were included,including 1446 eyes in the FLACS group and 1472 eyes in the CUCS group.The Meta-analysis results showed that the cumulative dissipated energy(CDE)in FLACS group was obviously lower than that in CUCS group[WMD=-3.84,95%CI(-6.30,-1.38),P=0.002].The effective phacoemulsification time(EPT)in the FLACS group was obviously lower than that in the CUCS group[WMD=-3.03,95%CI(-4.00,-2.05),P<0.001].The density of corneal endothelial cells in both the FLACS group after surgery at 1 and 3mo was higher than that in CUCS group[WMD=121.76,95%CI(79.31,164.20),P<0.001;WMD=76.04,95%CI(19.25,132.82),P=0.009];The thickness of the central cornea in the CUCS group was significantly thicker than that in the FLACS group at 1wk after the surgery[WMD=-9.89,95%CI(-18.60,-1.18),P=0.026];The incidence of postoperative corneal edema in the FLACS group was less than that in the CUCS group[RR=0.46,95%CI(0.32,0.66),P<0.001].There were no differences in the percentage of hexagonal cells and coefficient of variation of corneal endothelial cells between the two groups.·CONCLUSION:Compared with conventional ultrasound cataract surgery,femtosecond assisted cataract surgery can significantly reduce the phacoemulsification energy and the duration of the phacoemulsification energy,and significantly reduce the loss of corneal endothelial cells in the early postoperative period,while reducing the occurrence of postoperative corneal edema.