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内界膜剥离联合特发性视网膜前膜剥离的效果:一个系统性文献回顾和meta分析

Azuma, K., Ueta, T., Eguchi, S., Aihara, M.

期刊名称:Retina

卷期:2017年第37卷第10期

摘要

摘要:目的:旨在评估内界膜(ILM)剥离联合特发性视网膜前膜(ERMs)剥离后的术后预后效果。方法:系统检索MEDLINECochrane对照试验中心登记(CENTRAL)和EMBASE,比较ILM剥离与无ILM剥离去除特发性ERM的研究。预后指标为最佳矫正视力,中心性黄斑厚度和ERM复发。选择比较ILM剥离与无ILM剥离治疗特发性ERM的研究。结果:选择了16项研究,共包括1,286只眼。所有研究都是回顾性或前瞻性比较研究;没有确定随机对照研究。ILM剥离和无ILM剥离组之间的基线术前最佳矫正视力和中心黄斑厚度相等。术后最佳矫正视力(最小矫正角度对数平均差异0.01 [相当于早期治疗糖尿病视网膜病变研究0.5个字母]; 95CI-0.050.07 [-3.52.5个早期治疗糖尿病视网膜病变研究字母]; P = 0.83)或中央黄斑厚度(平均差13.13μm; 95CI-10.6636.93; P = 0.28)差异无统计学意义。然而,ILM剥离复发率明显低于无ILM剥离(优势比0.25; 95CI 0.12-0.49; P <0.0001)。结论:文献中现有的证据表明,玻璃体切除术治疗特发性ERM中额外的ILM剥离可能会明显降低ERM复发率,但对术后最佳矫正视力和中心性黄斑厚度无明显影响。

PURPOSE:To evaluate the effects on postoperative prognosis of internal limiting membrane (ILM) peeling in conjunction with removal of idiopathic epiretinal membranes (ERMs).METHODS:MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were systematically searched for studies that compared ILM peeling with no ILM peeling in surgery to remove idiopathic ERM. Outcome measures were best-corrected visual acuity, central macular thickness, and ERM recurrence. Studies that compared ILM peeling with no ILM peeling for the treatment of idiopathic ERM were selected.RESULTS:Sixteen studies that included 1,286 eyes were selected. All the included studies were retrospective or prospective comparative studies; no randomized controlled study was identified. Baseline preoperative best-corrected visual acuity and central macular thickness were equal between ILM peeling and no ILM peeling groups. Postoperatively, there was no statistically significant difference in best-corrected visual acuity (mean difference 0.01 logarithm of the minimum angle of resolution [equivalent to 0.5 Early Treatment Diabetic Retinopathy Study letter]; 95% CI -0.05 to 0.07 [-3.5 to 2.5 Early Treatment Diabetic Retinopathy Study letters]; P = 0.83) or central macular thickness (mean difference 13.13 μm; 95% CI -10.66 to 36.93; P = 0.28). However, the recurrence rate of ERM was significantly lower with ILM peeling than with no ILM peeling (odds ratio 0.25; 95% CI 0.12-0.49; P < 0.0001).CONCLUSION:Currently available evidence in the literature indicates that additional ILM peeling in vitrectomy for idiopathic ERM could result in a significantly lower ERM recurrence rate, but it does not significantly influence postoperative best-corrected visual acuity and central macular thickness.


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