25 G与27 G玻璃体切割手术治疗孔源性视网膜脱离的meta分析

25 G and 27 G vitrectomy for treating rhegmatogenous retinal detachment:a meta-analysis

目的比较25 G与27 G玻璃体切割手术治疗孔源性视网膜脱离的有效性及安全性。方法检索英文数据库PubMed、Web of Science、The Cochrane Library和中文数据库万方、中国知网及维普,查找关于25 G与27 G玻璃体切割手术治疗孔源性视网膜脱离的临床研究,包括随机或非随机对照病例研究、回顾性病例对照研究。检索时限均为从建库到2021年8月。由两位研究者根据纳入与排除标准独立筛选文献、提取资料并评价质量后,使用RevMan5.4软件进行meta分析,用Cochrane协作工具评估每项研究中的偏倚风险。结果共纳入10项研究,共计715只眼,其中25 G有396只眼,27 G有319只眼。meta分析结果显示,25 G与27 G手术时间、视网膜复位率、末次随访BCVA、术后并发症发生率比较,差异无统计学意义(P>0.05)。与25 G比较,27 G术中并发症发生率(RR=2.31,95%CI:1.03~5.17,P=0.04)更高,术后低眼压发生率(RR=0.25,95%CI:0.10~0.63,P<0.01)和高眼压发生率(RR=0.54,95%CI:0.33~0.91,P=0.02)更低,差异有统计学意义(P<0.05)。结论25 G玻璃体切割手术术中并发症少,27 G术后眼压更稳定。

Objective To compare the effectiveness and safety between 25 G and 27 G vitrectomy for the treatment of rhegmatogenous retinal detachment.Methods The English databases of PubMed,Web of Science and Cochrane Data,and the chinese databases of Wanfang,China National Knowledge Infrastructure and China Science and Technology and VIP were retrieved for seeking the clinical studies on 25 G and 27 G vitrectomy for treating foraminal retinal detachment,including the randomized or non-randomized controlled case studies and retrospective case-control studies.The retrieval time was all from the database establishment to August 2021.The two researchers independently screened the literatures according to the inclusion and exclusion standards,extracted the data and evaluated the quality.Then the meta analysis was performed by the Review Manager 5.4 software.The risk of bias in each study was assessed by the Cochrane Collaboration Tool.Results Ten studies with a total of 715 eyes were included,including 396 eyes in 25 G and 319 eyes in 27 G.The meta analysis results showed that the operative time,retinal reattachment rate,last follow up BCVA and occurrence rate of postoperative complications had no statistical difference between 25 G and 27 G(P>0.05).Compared with the 25 G,the occurrence rate of intraoperative complications in the 27 G was higher(RR=2.31,95%CI:1.03-5.17,P=0.04);the occurrence rates of postoperative low intraocular pressure and postoperative high intraocular pressure were lower(RR=0.25,95%CI:0.10-0.63,P<0.01;RR=0.54,95%CI:0.33-0.91,P=0.02),and the differences were statistically significant(P<0.05).Conclusion 25 G vitrectomy has less intraoperative complications,while the ocular pressure after 27 G vitrectomy is more stable.