CAJ | 학술논문

目的比较玻璃体切割手术(PPV)与巩膜扣带手术(SB)治疗白内障手术后单纯性孔源性视网膜脱离(RRD)的疗效及安全性.方法计算机检索循证医学图书馆、美国国立医学图书馆医学在线数据库、荷兰医学文摘、中国期刊全文数据库、中国生物医学文献数据库以及通过手工检索相关文献,收集比较PPV与SB治疗白内障手术后单纯性RRD的随机对照试验(RCT).比较PPV与SB后最佳矫正视力(BCVA),初次手术及最终视网膜复位率及并发症的发生率.结果共有4篇RCT纳入研究,共有690例690只眼.其中,PPV组331只眼,SB组359只眼.2组间初次视网膜复位率比较,差异无统计学意义[优势比(OR)=1.68,95％可信区间(CI)0.81～3.49,P=0.16];2组间最终视网膜复位率比较,差异有统计学意义,PPV组存在明显优势(OR=1.97,95％ CI1.04～3.73,P=0.04);手术后6个月,2组间BCVA比较,差异无统计学意义(加权均数差=0.06,95％ CI-0.01～0.14,P=0.11).并发症方面,2组间仅复视和(或)眼外肌运动功能障碍发生率比较,差异有统计学意义(OR=6.59,95％ CI 1.16～37.27,P=0.03);2组间增生性玻璃体视网膜病变、黄斑前膜、黄斑囊样水肿、脉络膜脱离发生率比较,差异均无统计学意义(P＞0.05).结论对于白内障手术后单纯性RRD患者,PPV治疗最终能够获得较SB治疗更高的视网膜复位率,且具有较低的复视和(或)眼外肌运动功能障碍发生率.
목적 비교파리체절할수술(PPV)여공막구대수술(SB)치료백내장수술후단순성공원성시망막탈리(RRD)적료효급안전성.방법 계산궤검색순증의학도서관、미국국립의학도서관의학재선수거고、하란의학문적、중국기간전문수거고、중국생물의학문헌수거고이급통과수공검색상관문헌,수집비교PPV여SB치료백내장수술후단순성RRD적수궤대조시험(RCT).비교PPV여SB후최가교정시력(BCVA),초차수술급최종시망막복위솔급병발증적발생솔.결과 공유4편RCT납입연구,공유690례690지안.기중,PPV조331지안,SB조359지안.2조간초차시망막복위솔비교,차이무통계학의의[우세비(OR)=1.68,95％가신구간(CI)0.81～3.49,P=0.16];2조간최종시망막복위솔비교,차이유통계학의의,PPV조존재명현우세(OR=1.97,95％ CI1.04～3.73,P=0.04);수술후6개월,2조간BCVA비교,차이무통계학의의(가권균수차=0.06,95％ CI-0.01～0.14,P=0.11).병발증방면,2조간부복시화(혹)안외기운동공능장애발생솔비교,차이유통계학의의(OR=6.59,95％ CI 1.16～37.27,P=0.03);2조간증생성파리체시망막병변、황반전막、황반낭양수종、맥락막탈리발생솔비교,차이균무통계학의의(P＞0.05).결론 대우백내장수술후단순성RRD환자,PPV치료최종능구획득교SB치료경고적시망막복위솔,차구유교저적복시화(혹)안외기운동공능장애발생솔.
Objective To compare the efficacy and safety of pars plana vitrectomy (PPV) versus scleral buckling (SB) on rhegmatogenous retinal detachment (RRD) after cataract surgery.Methods A computerized search was conducted in the Cochrane Library,Medline,Embase,China National Knowledge Infrastructure (CNKI),Chinese Biological Medicine Database (CBM) combined with manually searching of related literatures.Randomized controlled trials (RCT) comparing PPV with SB for RRD after cataract surgeries were collected.Best corrected visual acuity (BVCA),reattachment rate after primary surgery,final reattachment rate and complications between the two operations were compared.Results A total of four RCTs were included in this meta analysis,including 690 eyes of 690 patients (331 eyes in the PPV group,359 eyes in the SB group).There was no difference in reattachment rates after primary surgery between two groups [odds ratio (OR) =1.68; 95％ confidence interval (CI),0.81-3.49; P=0.16).Final reattachment rate were in favor of PPV (OR =1.97; 95％ CI,1.04-3.73; P =0.04).There was no significant difference in the proportion of BCVA at six months (weighted mean difference =0.06 ; 95 ％ CI,-0.01-0.14; P=0.11).PPV was associated with a significantly lower frequency of diplopia/extrocular muscle dysfunction than SB (OR=6.59; 95％ CI 1.16-37.27; P=0.03),whereas other complications,such as proliferative vitreoretinopathy,macular pucker,cystoid macular edema,and choroidal detachment did not differ statistically (P＞0.05).Conclusion Compared with SB,PPV is more likely to achieve a favorable final reattachment rate for RRD after cataract surgery,and with a lower rate of diplopia/extrocular muscle dysfunction.