硅胶和聚甲基丙烯酸甲酯人工晶状体对晶状体后囊混浊影响的系统评价  

Effects of Intraocular Lenses of Silicone and Polymethylmethacrylate on Posterior Capsule Opacification: A Systematic Review

作　　者：李妮[1] 刘谊[1] 张军军[1] 周勇[1] 

机构地区：[1]四川大学华西医院眼科,成都610041

出　　处：《中国循证医学杂志》2005年第2期125-129,共5页Chinese Journal of Evidence-based Medicine

基　　金：美国中华医学基金资助项目 (编号 98680 )。~~

摘　　要：目的　评价白内障摘除联合人工晶状体术后植入硅胶 (silicone)与聚甲基丙烯酸甲酯 (polymethyl methacrylate ,PMMA)人工晶状体对晶状体后囊混浊 (posteriorcapsuleopacification ,PCO)影响的差异。方法　计算机检索MEDLINE(196 6～ 2 0 0 3)、EMBASE(1980～ 2 0 0 3)、Cochrane图书馆临床对照试验资料库 (2 0 0 3年第 1期 )和中国生物医学文献光盘数据库 (1979～ 2 0 0 3) ,收集有关比较PMMA和Silicone两种材料的人工晶状体植入对PCO形成影响的随机对照试验 (RCT) ,由两位研究者独立进行质量评价、资料提取 ,并进行交叉核对。采用RevMan 4 2进行Meta分析。结果　共纳入 9篇RCT ,6 72只眼。老年性白内障亚组的Meta分析结果显示 ,在PCO程度 [SMD合并=- 0. 92 ,95 %CI (- 1 .19,- 0 . 6 4 ) ]和Nd :YAG激光后囊切开率 [OR合并 =0 .35 ,95 %CI (0. 2 2 ,0. 5 7) ]方面 ,Silicone组明显低于PMMA组 ,其差异有统计学意义 ;在术后视力方面 ,其差异无统计学意义 [OR合并 =1. 2 2 ,95 %CI (0 . 4 3,3 .5 0 ) ]。葡萄膜炎并发白内障亚组的Meta分析结果显示 ,在术后视力方面 ,PMMA组较Silicone组为好 ,其差异有统计学意义 [OR合并 =0 .38,95 %CI(0. 15 ,0 .91) ];在PCO程度 [SMD =0 .2 3,95 %CI(- 0 .5Objective To evaluate the effects of intraocular lenses (IOL) of silicone and polymethylmethacrylate (PMMA) on posterior capsule opacification (PCO). Methods We searched MEDLINE (19662003), EMBASE (19802003), Cochrane Central Register of Controlled Trials (Issue 1, 2003) and CBMdisc (19792003). Only randomized controlled trials (RCTs) were identified. Two reviewers independently assessed the quality of the included trial and extracted data. The following outcomes were assessed: PCO index, percentage of neodymium: YAG (Nd: YAG) laser posterior capsulotomy and visual acuity after cataract surgery. RevMan 4.2 was used for meta analysis. Results Nine RCTs including 672 eyes were included. In patients with senile cataract, the results of meta analysis suggested that silicone lens were better than PMMA lens on PCO index (the pooled SMD=-0 92, 95%CI -1 19 to -0 64) and percentage of Nd: YAG (the pooled OR 0 35, 95%CI 0 22 to 0 57) with a statistically significant difference, but there was no significant difference on visual acuity (the pooled OR 1 22, 95%CI 0 43 to 3 50) after cataract surgery between silicone lens and PMMA lens. However, in patients with uveitic cataract, the results of meta analysis showed that PMMA lens were better than silicone lens in visual acuity (the pooled OR 0 38, 95%CI 0 15 to 0 91) after cataract surgery with a statistically significant difference, but there was no significant difference on PCO index (SMD 0 23, 95%CI -0 59 to 1 05) and percentage of Nd: YAG (the pooled OR 1 82, 95%CI 0 47 to 6 95) between silicone lens and PMMA lens. Conclusions Current evidence indicates that silicone lens are superior to PMMA lens in reducing PCO. Further trials with high quality on methodology are required.

关 键 词：人工晶状体 硅胶 聚甲基丙烯酸甲酯 后囊混浊 系统评价 

分 类 号：R779.66[医药卫生—眼科]