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白内障和复杂眼科手术后术后炎症的治疗:一项系统评价和Delphi调查

Aptel, F., Colin, C., Kaderli, S., et al.

期刊名称:The British journal of ophthalmology

卷期:2017年第101卷第11期

摘要

摘要:几项随机对照试验(RCTs)评估了皮质激素和非甾体抗炎药(NSAIDs)预防和治疗术后眼部炎症。然而,目前还没有对不同方案疗效和现有的指南达成共识。这导致了全世界存在不同的实践模式。一项系统文献回顾发现,三项RCTs显示奈帕芬胺对白内障后炎症有效,酮咯酸(1/1),溴芬酸(7/7),氯替泼诺(3/3),氯胺酮(3/3)和二氟泼尼酯(6/6)对白内障后炎症有效,但氟比洛芬无效(0/1)。一项单一研究发现,视网膜脱离(RD)术后,倍他米松产生不确定结果;酮咯酸在玻璃体切除术后有效(1/1),但曲安奈德在小梁切除术后无效(0/1)。Delphi的一项两轮调查要求28名国际专家评估不同眼科手术的验证可能性及其对不同治疗方案的一致性。他们认为小梁切除术,RD手术和联合玻璃体切除术的炎症比白内障手术更多。黄斑裂孔或视网膜前膜玻璃体切除术的炎症不比白内障手术多。对于小梁切除术,他们宁愿延长治疗而非白内障手术(NSAID +皮质类固醇每天3次,2个月:1个月)。对于单纯的玻璃体切除术,RD手术和联合玻璃体切除术,该小组更喜欢白内障手术(NSAID +皮质类固醇每天三次,1个月)相同的治疗。 RD和的专家对首选治疗和专家对RD眼部炎症状态的认知以及联合玻璃体视网膜手术之间的差异凸显了需要RCT来建立治疗指南。

Prevention and management of postoperative ocular inflammation with corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have been evaluated in several randomised controlled trials (RCTs). However, neither consensus regarding the efficacies of different regimens nor established guidelines are currently available. This has resulted in different practice patterns throughout the world. A systematic literature review found that for the management of postcataract inflammation nepafenac produced a positive outcome in three of three RCTs (3/3), as did ketorolac (1/1), bromfenac (7/7), loteprednol (3/3) and difluprednate (6/6), but not flurbiprofen (0/1). A single study found that betamethasone produced inconclusive results after retinal detachment (RD) surgery; ketorolac was effective (1/1) after vitrectomy, but triamcinolone was ineffective (0/1) after trabeculectomy. A two-round Delphi survey asked 28 international experts to rate both the inflammatory potential of different eye surgeries and their agreement with different treatment protocols. They rated trabeculectomy, RD surgery and combined phacovitrectomy as more inflammatory than cataract surgery. Vitrectomies for macular hole or epiretinal membrane were not deemed more inflammatory than cataract surgery. For trabeculectomy, they preferred to treat longer than for cataract surgery (NSAID + corticosteroid three times a day for 2 months vs 1 month). For vitrectomy alone, RD surgery and combined phacovitrectomy, the panel preferred the same treatment as for cataract surgery (NSAID + corticosteroid three times a day for 1 month). The discrepancy between preferred treatment and perception of the eye's inflammatory status by the experts for RD and combined vitreoretinal surgeries highlights the need for RCTs to establish treatment guidelines.


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