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内界膜剥离与否:特发性黄斑皱褶手术系统回顾与荟萃分析 Internal limiting membrane peeling or not: a systematic review and meta-analysis of idiopathic macular pucker surgery

Fang, X.L., Tong, Y., Zhou, Y.L., Zhao, P.Q., Wang, Z.Y.

期刊名称:The British journal of ophthalmology



摘要:目的:旨在探讨内界膜剥离是否能改善特发性黄斑皱褶(IMP/视网膜外膜(ERM)手术的解剖学和功能性预后。方法:我们检索了PubMedMedline Web of ScienceCochraneOvid MEDLINEClinicalTrials.govCNKI数据库中2016915日前发表的研究。合格标准包括比较IMP手术中ILM剥离与不剥离的研究。结果:研究共包括13篇文章(10篇回顾性队列研究, 1项前瞻性队列研究和2项随机对照试验(RCT))。主要预后:12个月时最佳矫正视力(BCVA)或中央黄斑厚度(CMT)无差异;然而,最后随访中观察到有利于ILM剥离的较低的ERM复发率(OR0.13; 95CI 0.040.41; p = 0.0004)和再手术率(OR0.10; 95CI 0.020.49; p = 0.004 。次要预后:36个月,末次随访BCVA3,6个月,末次随访CMT无差异。RCT最终随访中显示CMT明显增加,这有利于ILM剥离,(p = 0.002)。结论:ILM剥离取得了更大的解剖学成功,但选择接受IMP手术的患者的功能预后没有改善。

PURPOSE:To determine whether internal limiting membrane (ILM) peeling improves anatomical and functional outcomes in idiopathic macular pucker (IMP)/epiretinal membrane (ERM) surgery in this systematic review and meta-analysis.METHODS:We searched the PubMed, Medline, Web of Science, Cochrane, Ovid MEDLINE, and CNKI databases for studies published before 15 September 2016. The eligibility criteria included studies comparing ILM peeling versus no-peeling for IMP surgery.RESULTS:Thirteen articles (10 retrospective cohort studies, 1 prospective cohort study and 2 randomised controlled trials (RCTs)) were included in the review. Primary outcomes: no differences were observed in the best-corrected visual acuity (BCVA) or central macular thickness (CMT) at 12months; however, lower ERM recurrence (OR, 0.13; 95% CI 0.04 to 0.41; p=0.0004) and reoperation rates (OR, 0.10; 95% CI 0.02 to 0.49; p=0.004) that favoured ILM peeling were observed at the final follow-up.SECONDARY OUTCOMES:no difference was observed in BCVA at 3, 6months, the final follow-up or in CMT at 3, 6months, the final follow-up. Significantly increased CMT, which favoured ILM peeling, was observed at the final follow-up (p=0.002) in the RCTs.CONCLUSIONS:ILM peeling yielded greater anatomical success, but no improvement in functional outcomes as the treatment of choice for patients undergoing IMP surgery.


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