结膜下注射曲安奈德治疗非感染性葡萄膜炎继发黄斑水肿的Meta分析

Meta-analysis of the subconjunctival injection of triamcinolone acetonide in the treatment of macular edema secondary to non-infectious uveitis

目的:系统评价结膜下与玻璃体腔注射曲安奈德(TA)治疗非感染性葡萄膜炎继发黄斑水肿的有效性和安全性。方法:检索数据库包括万方数据库、中国知网(CNKI)、维普数据库、中国生物医学文献服务系统(CBM)、美国国立医学图书馆(PubMed)、荷兰医学文摘(Embase)、Cochrane图书馆、Web of Science,检索时间为建库至2022-05。纳入以TA治疗非感染性葡萄膜炎继发黄斑水肿的临床随机对照试验(RCT),试验组采用结膜下注射TA,对照组采用玻璃体腔注射曲安奈德(IVTA)。采用Review Manager 5.4和Stata15软件对治疗后的最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)、总有效率、不良反应进行Meta分析,应用比值比(OR)、加权平均数(MD)及95%可信区间(CI)进行评价。结果:最终纳入8项RCT研究进行统计分析。Meta分析结果显示:结膜下注射TA在提高BCVA(MD=0.81,95%CI:0.60~1.01,P<0.0001)、降低CMT(MD=-48.35,95%CI:-58.82~-37.88,P<0.0001)、总体有效率(OR=3.88,95%CI:2.32~6.52,P<0.0001)优于IVTA组;不良反应发生情况低于IVTA组(OR=0.45,95%CI:0.32~0.62,P<0.0001)。结论:对于非感染性葡萄膜膜炎,结膜下注射TA在提高视力、降低CMT、总体有效率等方面优于IVTA,且不良反应发生率更低。

AIM:To systematically evaluate the effectiveness and safety of subconjunctival and intravitreal injection of triamcinolone acetonide(TA)in the treatment of macular edema secondary to non-infectious uveitis.METHODS:Databases,including Wanfang database,CNKI,VIP database,CBM,PubMed,Embase,Cochrane Library and Web of Science,were searched from the establishment to May 2022.A clinical randomized controlled trial(RCT)of TA for the treatment of non-infectious uveitis secondary to macular edema was included,with subconjunctival injection of TA in the trial group and intravitreal injection of triamcinolone acetonide(IVTA)in the control group.Review Manager 5.4 and Stata15 were used for Meta-analysis of the postoperative best corrected visual acuity(BCVA),central macular thickness(CMT),overall efficiency and adverse effects.Odds ratio(OR),weighted mean(MD)and 95%confidence interval(CI)were applied to evaluate.RESULTS:A total of 8 studies were included.The Meta-analysis showed that subconjunctival injection of TA was better than the IVTA group in improving BCVA(MD=0.81,95%CI:0.60~1.01,P<0.0001),reducing CMT(MD=-48.35,95%CI:-58.82~-37.88,P<0.0001)and in the overall efficiency(OR=3.88,95%CI:2.32~6.52,P<0.0001);The incidence of adverse events was lower than that of the IVTA group(OR=0.45,95%CI:0.32~0.62,P<0.0001).CONCLUSION:As for the treatment of non-infectious uveitis,subconjunctival injection of TA was superior to IVTA in terms of its improved visual acuity,reduced CMT,overall efficiency and lower incidence of adverse events.