中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2014年
2期
139-142
,共4页
吴静%崔裕波%王超%张瑾%秦晓艳%齐文娟
吳靜%崔裕波%王超%張瑾%秦曉豔%齊文娟
오정%최유파%왕초%장근%진효염%제문연
Meta分析%穿透性角膜移植%深板层角膜移植%圆锥角膜
Meta分析%穿透性角膜移植%深闆層角膜移植%圓錐角膜
Meta분석%천투성각막이식%심판층각막이식%원추각막
Meta-analysis%Penetrating keratoplasty%Deep anterior lamellar keratoplasty%Keratoconus
目的 系统评价圆锥角膜患者在进行深板层角膜移植术(DALK)或穿透性角膜移植术(PK)后,对患者有效性和屈光性改变的研究.方法 应用循证医学的方法.检索于2013年5月之前发表在Web of knowledge,Medline,Google Scholar,Cochrane图书馆,CNKI等数据库,纳入运用DALK和PK治疗圆锥角膜的随机对照试验和非随机对照试验,文献语种限为英文和中文的相关文章.由两名评价者进行独立的检索、评价和提取资料,争议性问题经过与第三评价人商讨解决,然后运用Co-chrane协作网上提供的RevMan5.0软件进行Meta分析.结果 随机对照试验5篇,病例对照试验和队列研究11篇,总共包含4 443只眼.Meta分析结果显示:DALK组患者的免疫排斥反应发生率明显低于PK组[OR=3.37,95％可信区间(CI)=(1.98,5.73),P＜0.01].DALK组患者的视力≥0.5和最佳矫正视力最小分辨角的对数(logMAR BSCVA)和PK组患者相比差异无统计学意义(P＞0.05),分别是[OR=1.38,95％CI=(0.86,2.23),P=0.19]和[OR=-0.01,95％CI=(-0.03,0.01),P=0.32].DALK组患者的屈光不正等效球镜(SE)和PK组相比,DALK更易有近视倾向,二者之间差异明显有统计学意义[MD=1.06,95％CI=(0.57,1.39),P＜0.01].结论 深板层角膜移植(DALK)在免疫排斥反应方面优于穿透性角膜移植(PK),在log MARBSCVA和视力≥0.5方面,则DALK和PK比较差异无统计学意义(P＞0.05),在屈光度等效球镜(SE)方面,DALK较PK更易具有近视倾向.
目的 繫統評價圓錐角膜患者在進行深闆層角膜移植術(DALK)或穿透性角膜移植術(PK)後,對患者有效性和屈光性改變的研究.方法 應用循證醫學的方法.檢索于2013年5月之前髮錶在Web of knowledge,Medline,Google Scholar,Cochrane圖書館,CNKI等數據庫,納入運用DALK和PK治療圓錐角膜的隨機對照試驗和非隨機對照試驗,文獻語種限為英文和中文的相關文章.由兩名評價者進行獨立的檢索、評價和提取資料,爭議性問題經過與第三評價人商討解決,然後運用Co-chrane協作網上提供的RevMan5.0軟件進行Meta分析.結果 隨機對照試驗5篇,病例對照試驗和隊列研究11篇,總共包含4 443隻眼.Meta分析結果顯示:DALK組患者的免疫排斥反應髮生率明顯低于PK組[OR=3.37,95％可信區間(CI)=(1.98,5.73),P＜0.01].DALK組患者的視力≥0.5和最佳矯正視力最小分辨角的對數(logMAR BSCVA)和PK組患者相比差異無統計學意義(P＞0.05),分彆是[OR=1.38,95％CI=(0.86,2.23),P=0.19]和[OR=-0.01,95％CI=(-0.03,0.01),P=0.32].DALK組患者的屈光不正等效毬鏡(SE)和PK組相比,DALK更易有近視傾嚮,二者之間差異明顯有統計學意義[MD=1.06,95％CI=(0.57,1.39),P＜0.01].結論 深闆層角膜移植(DALK)在免疫排斥反應方麵優于穿透性角膜移植(PK),在log MARBSCVA和視力≥0.5方麵,則DALK和PK比較差異無統計學意義(P＞0.05),在屈光度等效毬鏡(SE)方麵,DALK較PK更易具有近視傾嚮.
목적 계통평개원추각막환자재진행심판층각막이식술(DALK)혹천투성각막이식술(PK)후,대환자유효성화굴광성개변적연구.방법 응용순증의학적방법.검색우2013년5월지전발표재Web of knowledge,Medline,Google Scholar,Cochrane도서관,CNKI등수거고,납입운용DALK화PK치료원추각막적수궤대조시험화비수궤대조시험,문헌어충한위영문화중문적상관문장.유량명평개자진행독립적검색、평개화제취자료,쟁의성문제경과여제삼평개인상토해결,연후운용Co-chrane협작망상제공적RevMan5.0연건진행Meta분석.결과 수궤대조시험5편,병례대조시험화대렬연구11편,총공포함4 443지안.Meta분석결과현시:DALK조환자적면역배척반응발생솔명현저우PK조[OR=3.37,95％가신구간(CI)=(1.98,5.73),P＜0.01].DALK조환자적시력≥0.5화최가교정시력최소분변각적대수(logMAR BSCVA)화PK조환자상비차이무통계학의의(P＞0.05),분별시[OR=1.38,95％CI=(0.86,2.23),P=0.19]화[OR=-0.01,95％CI=(-0.03,0.01),P=0.32].DALK조환자적굴광불정등효구경(SE)화PK조상비,DALK경역유근시경향,이자지간차이명현유통계학의의[MD=1.06,95％CI=(0.57,1.39),P＜0.01].결론 심판층각막이식(DALK)재면역배척반응방면우우천투성각막이식(PK),재log MARBSCVA화시력≥0.5방면,칙DALK화PK비교차이무통계학의의(P＞0.05),재굴광도등효구경(SE)방면,DALK교PK경역구유근시경향.
Objective To compare the clinical efficacy and refractive changes of keratoconus following PK or DALK.Methods Databases,including Web of knowledge,Medline,Google Scholar,Cochrane library and CNKI were searched to select all relevant references of randomized control trials (RCTs) and retrospective trials about the treatment of keratoconus via PK or DALK according to the evidence-based medicine.Results Sixteen eligible papers reporting the outcomes in 3290 eyes entered the final analysis.With the fixed-effect meta-analysis,we found that the rejection was significantly lower after DALK than PK [odds ratio (OR)=3.37,95％ confidence index (CI)=(1.98,5.73),P ＜ 0.01].No significant difference in the visual acuity (0.5 or better) [OR=1.38,95％ CI=(0.86,2.23),P =0.18] and logarithm of the minimum angle of resolution of best corrected visual acuity (Log MAR BSCVA) [OR=-0.01,95％ CI=(-0.03,0.01),P =0.32] was detected.However,DALK was inclined to be myopic when compared with PK.[MD=1.06,95％ CI=(0.57,1.55),P ＜0.01].Conclusions According to this meta-analysis,it is revealed that DALK is superior to PK on the aspect of rejection.DALK shows the comparable results with PK of the VA and log MARBSCVA,while the DALK is inclined to be myopic compared with PK.
