手术前糖皮质激素辅助治疗脉络膜脱离型视网膜脱离的网状荟萃分析

Preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment:a network meta-analysis

目的系统评价手术前应用糖皮质激素辅助治疗脉络膜脱离型视网膜脱离(RRDCD)的疗效。方法循证医学研究。计算机检索美国国立医学图书馆医学数据库PubMed、Web of Science、中国知网、万方数据库相关文献。选取以RRDCD患者作为研究对象,干预方式为手术前使用糖皮质激素辅助治疗的临床对照研究。检索时间为2000年1月至2022年1月。排除重复、信息不完整或不相关文献。采用传统荟萃分析方法评估手术前使用糖皮质激素的疗效;网状荟萃分析方法直接或间接比较手术前口服糖皮质激素或静脉注射地塞米松、球周注射糖皮质激素、泼尼松龙滴眼液、玻璃体腔注射曲安奈德(TA)、后Tennon囊下注射TA等不同给药途径的疗效。漏斗图对发表偏倚进行评价。结果根据检索策略初步检索出43篇文献,最终纳入13篇文献的929只眼进行分析。其中,传统荟萃分析、网状荟萃分析分别纳入6、10篇文献。传统荟萃分析6篇文献中,回顾性、随机对照研究分别为5、1篇,共计575只眼。分析结果显示,糖皮质激素组、对照组患眼手术后视网膜复位率差异无统计学意义[比值比(OR)=1.53,95%可信区间(CI)0.67~3.53,P=0.314]。网状荟萃分析10篇文献中,回顾性、随机对照、前瞻性研究分别为7、2、1篇,共计606只眼。分析结果显示,玻璃体腔注射TA组与对照组视网膜复位率比较,差异有统计学意义(OR=4.09,95%CI 1.06~15.79)。与口服糖皮质激素或静脉注射地塞米松者比较,后Tennon囊下注射TA者手术后高眼压发生率更高,差异有统计学意义(OR=4.47,95%CI 1.42~14.13)。结论手术前玻璃体腔注射TA可以提高RRDCD患者1期手术视网膜复位率;后Tennon囊下注射TA应该警惕高眼压的发生。

Objective To systematically review the efficacy of preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment(RRDCD).Methods A evidence-based medicine study.The National Library of Medicine's PubMed,Web of Science,CNKI,and WanFang database were searched.Clinical controlled studies were selected the study object was RRDCD patients and the interventions were preoperative corticosteroids used as an adjunctive treatment.The search was conducted from January 2000 to January 2022.Duplicated,incomplete,or irrelevant articles were excluded.The conventional meta-analysis was used to evaluate the efficacy of corticosteroids used before surgery.The network meta-analysis was used to directly or indirectly compare the efficacy of oral corticosteroids or intravenous dexamethasone,peribulbar injection of glucocorticoids,prednisolone acetate eye-drops,intravitreal injection of triamcinolone acetonide(TA)and posterior sub-tenon injection of triamcinolone acetonide.Publication bias was evaluated by funnel plot.Results According to the search strategy,43 articles were initially retrieved,and 929 eyes of 13 articles were finally included for analysis;6 and 10 articles were included in the traditional meta-analysis and the network meta-analysis.Among the 6 studies included in the conventional meta-analysis,5 studies were retrospective and 1 study was a randomized controlled trial,involving a total of 575 eyes.The analysis results showed that there was no significant difference in the primary retinal reattachment rate between the corticosteroids group and the control group[odds ratio(OR)=1.53,95%confidence interval(CI)0.67-3.53,P=0.314].Among the 10 studies included in the network meta-analysis,7 studies were retrospective trials,2 studies were randomized controlled trials,and 1 study was prospective trial,involving a total of 575 eyes.The analysis results showed that there were significant differences in the primary retinal reattachment rate between the triamcinolone acetonide intravitreal injection group and the no corticosteroid treatment group(OR=4.09,95%CI 1.06-15.79).Sub-tenon injection triamcinolone acetonide had a higher incidence rate of ocular hypertension than oral glucocorticoid or intravenous dexamethasone(OR=4.47,95%CI 1.42-14.13).Conclusions Triamcinolone acetonide intravitreal injection before surgery can improve the primary retinal reattachment rate in RRDCD patients.Patients with the posterior sub-tenon injection of triamcinolone acetonide should be alert to elevated intraocular pressure.