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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

卷期:2017年第101卷第11期

摘要

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, ClinicalTrials.gov 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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