玻璃体切割手术联合完全内界膜剥除与保留中心凹内界膜剥除治疗高度近视黄斑劈裂疗效比较的系统评价  

The effect of vitrectomy combined total versus fovea-sparing peeling of internal limiting membrane for myopic foveoschisis

作　　者：何海龙 方雨新 刘振宇 周春媛 佘海澄 万修华 金子兵 He Hailong;Fang Yuxin;Liu Zhenyu;Zhou Chunyuan;She Haicheng;Wan Xiuhua;Jin Zibing(Beijing Institute of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100005,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing 100005,China;Liangxiang Hospital of Beijing Fangshan District,Beijing 102401,China)

机构地区：[1]首都医科大学附属北京同仁医院,北京同仁眼科中心,北京市眼科研究所,北京市眼科学与视觉科学重点实验室,北京100005 [2]首都医科大学附属北京同仁医院,北京同仁眼科中心,北京100005 [3]北京市房山区良乡医院眼科,北京102401

出　　处：《中华眼底病杂志》2022年第10期823-828,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的系统评价玻璃体切割手术(PPV)联合完全内界膜(ILM)剥除与联合保留中心凹ILM剥除治疗高度近视黄斑劈裂的疗效。方法循证医学研究。以高度近视黄斑劈裂、玻璃体切除术、内界膜剥除为检索词,在中国知网、万方、维普中文期刊全文数据库、美国国立医学图书馆PubMed、在线数据库Medline、荷兰医学文摘Embase、Cochrane图书馆检索相关文献。选取以高度近视黄斑劈裂作为研究对象,干预方式为PPV联合完全ILM剥除与联合保留中心凹ILM剥除手术的临床对照研究。检索时间为2010年1月1日至2021年6月31日。排除重复、信息不完整或不相关文献和综述性文献。使用纽卡斯尔-渥太华量表评价纳入文献质量。采用RevMan5.3软件对文献进行meta分析。选择均数差(MD)和95%可信区间(CI)作为效应量的估计值,应用固定效应模型进行分析。评价指标为最佳矫正视力(BCVA)、黄斑中心凹厚度(CFT)、手术后黄斑裂孔(MH)发生率。结果根据检索策略初步检索出232篇文献,最终纳入10篇文献的417只眼进行分析,其中PPV联合完全ILM剥除、保留中心凹ILM剥除分别为245、172只眼。Meta分析结果显示,PPV联合完全ILM剥除者与联合保留中心凹ILM剥除者治疗后BCVA、CFT比较,差异无统计学意义(BCVA:MD=0.05,95%CI-0.00~0.11,P>0.05;CFT:MD=-4.79,95%CI-18.69~9.11,P>0.05);MH发生率比较,差异有统计学意义(比值比=5.70,95%CI 2.22~14.61,P<0.05)。结论PPV联合完全ILM剥除与保留中心凹ILM剥除手术均可有效治疗高度近视黄斑劈裂,患眼BCVA、CFT均得到改善;与完全ILM剥除比较,保留中心凹ILM剥除手术后MH发生率更低。Objective To systematically evaluate the effect of pars plana vitrectomy(PPV)combined total peeling of internal limiting membrane(ILM)versus fovea-sparing peeling of ILM for myopic foveoschisis.Methods A evidence-based medicine study.Chinese and English as search terms for myopic foveoschisis,vitrectomy,and peeling of internal limiting membrane were used to search literature in China National Knowledge Infrastructure,Wanfang database,VIP database,PubMed of National Library of Medicine,Medline,Embase,and Cochrane Library.The high myopic macular schisis was selected as the research object,the intervention method was PPV combined with complete ILM peeling and combined with foveal preservation ILM peeling surgery clinical control study between Jan 1,2010,and Jun 31,2021.Incomplete or irrelevant literature and review literature were excluded.The method of Newcastle-Ottawa Scale system was used to evaluate the included literature.The literature was meta-analyzed by RevMan5.3 software.The mean difference(MD)and a confidence interval(CI)of 95%were used to describe the effect sizes of continuous data,fixed effects model was performed.The data including the best corrected visual acuity(BCVA),central fovea thickness(CFT),and postoperative macular hole(MH)were analyzed.Results In those databases,232 articles based search stratery were totally retrieved,and 10 articles(417 eyes)were finally included for meta-analysis with 245 eyes for PPV combined total peeling of ILM and 172 eyes for PPV combined fovea-sparing peeling of ILM.Meta-analysis results showed there was no significant difference in BCVA and CFT between the two groups(BCVA:MD=0.05,95%CI 0.00-0.11;P>0.05;CFT:MD=-4.79,95%CI-18.69-9.11,P>0.05).It was compared with the incidence of MH,the difference was statistically significant(odds ratio=5.70,95%CI 2.22-14.61,P<0.05).Conclusion BCVA and CFT could be improved by PPV combined total and fovea-sparing peeling of ILM for myopic foveoschisis;compared with complete ILM peeling,the incidence of MH was lower after foveal-spari

关 键 词：近视 退行性 黄斑劈裂 玻璃体切除术 内界膜剥除 Meta分析 

分 类 号：R779.6[医药卫生—眼科]