特发性黄斑裂孔术中内界膜撕除与否的Meta分析

发布时间：2018-04-13 18:16

本文选题：Meta分析 + 特发性黄斑裂孔　；参考：《吉林大学》2012年硕士论文

【摘要】：目的：评价内界膜撕除术对特发性黄斑裂孔的安全性及有效性。方法：不受盲法、发表状态以及语言的限制，两名研究者分别以“黄斑裂孔”、“内界膜撕除”、“内界膜”为关键词，在Pubmed数据库、Ovid-Medline数据库、Cochrane图书馆、万方数据库、维普中文期刊全文数据库和中国知网中，通过计算机检索方式，检索特发性黄斑裂孔玻璃体切割术中采用与不采用内界膜撕除的相关文章，，对眼科学杂志和有关学术会议论文汇编进行手工检索，对相关的综述性文章的参考文献进行查阅，通过与著者联系等方式追踪查询还未发表的文章。应用Jadad量表对纳入文献进行质量评价。对术后裂孔闭合率、术后视力及术后并发症三方面进行Meta分析。结果：最终有23篇玻璃体切割术中应用内界膜撕除术治疗特发性黄斑裂孔的文献纳入本研究。其中5篇为临床随机对照研究，18篇为非随机的临床对照研究。首先对符合研究指标的纳入文献进行异质性分析，若存在异质性，采用RevMan5.0软件中的随机效应模型；若各研究间具有同质性，则采用固定效应模型。（1）对术后裂孔闭合率合并分析结果：与NO-ILMP组相比，ILMP组有较高的术后裂孔闭合率（OR合并=4.78，95%CI[2.94,7.75]），结果有统计学意义。对IMH的2、3、4期裂孔进行分层分析，与NO-ILMP组相比，2期（OR合并=6.21，95%CI[2.59,14.90]）、3期（OR合并=3.89，95%CI[2.50,6.05]）及4期（OR合并=2.77，95%CI[1.77,4.34]）裂孔ILMP组有较高的术后裂孔闭合率，结果均有统计学意义。（2）对术后视力合并分析结果：与NO-ILMP组相比，ILMP组有较高的术后视力提高率（OR合并=3.37，95%CI[1.74,6.51]）；对闭合裂孔术后视力提高率进行合并统计量，结果提示两组闭合裂孔视力提高率相同（OR合并=1.64，95%CI[0.85,3.18]），结果无统计学意义；与NO-ILMP组相比，ILMP组有较高的术后LogMAR BCVA（SMD合并=-0.51，95%CI[-0.73,-0.29]），结果有统计学意义。（3）对术后并发症合并分析结果：ILMP组裂孔复发率低于NO-ILMP组（OR合并=0.05，95%CI[0.02,0.16]）。两组视网膜脱离发生率（OR合并=0.88，95%CI[0.50,1.56]）、术后高眼压发生率（OR合并=0.92，95%CI[0.50,1.70]）及视网膜裂孔发生率（OR合并=2.07，95%CI[0.85,5.02]）结果均无统计学意义。结论：与NO-ILMP组相比，ILMP组有较高的术后裂孔闭合率、术后视力提高率及术后BCVA，且术后裂孔复发率低；但对于闭合裂孔视力提高率，ILMP组与NO-ILMP组无统计学差异；ILMP组与NO-ILMP组术后视网膜脱离、术后高眼压及术后视网膜裂孔的发生率无统计学差异；由于各研究间的异质性、低质量研究和潜在发表偏倚的存在，这就需要开展一系列高质量的研究对其安全性和有效性进行更为系统全面的评价。
[Abstract]:Objective: to evaluate the safety and efficacy of internal membrane avulsion for idiopathic macular hole.Methods: without blind method, publication status and language restriction, the two researchers used "macular hole", "internal membrane tear" and "inner boundary membrane" as the keywords, respectively, in the Pubmed database Ovid-Medline database, Cochrane library, Wanfang database.In the full text database of Chinese Journal of Weipu and the Chinese Web of knowledge, the relevant articles on vitrectomy of idiopathic macular hole were searched by computer search, which were used or not used in vitrectomy of idiopathic macular hole, and the internal boundary membrane was not used in vitrectomy.This paper carries on the manual retrieval to the ophthalmology journal and the related academic conference paper compilation, carries on the consult to the related summary article's reference document, through the way of contact with the author and so on, tracks the unpublished article.Jadad scale was used to evaluate the quality of the included literature.Meta analysis was performed on the closure rate, visual acuity and postoperative complications.Results: finally, 23 articles on the treatment of idiopathic macular hole were included in this study.Among them, 5 were clinical randomized controlled trials and 18 were non-randomized clinical controlled studies.First of all, the heterogeneity analysis is carried out on the inclusion literature that accords with the research index. If there is heterogeneity, the random effect model in RevMan5.0 software is used.The results showed that compared with NO-ILMP group, NO-ILMP group had a higher closure rate (OR + 4.78% 95 CI [2.944 卤7.75]), and the results were statistically significant.The results showed that compared with NO-ILMP group, the postoperative visual acuity improvement rate was higher and OR was 3.37 卤95CI [1.74 卤6.51], and the postoperative visual acuity improvement rate of NO-ILMP group was statistically higher than that of NO-ILMP group.The results showed that the improved visual acuity rate of the two groups was the same as OR combined with CI (0.85V 3.18), and there was no significant difference between the two groups.Compared with NO-ILMP group, the postoperative LogMAR BCVA(SMD with CI (-0.73 卤-0.29) was higher in LogMAR BCVA(SMD group than that in NO-ILMP group [-0.73U -0.29]. The results showed that the recurrence rate of hiatus in NO-ILMP group was lower than that in NO-ILMP group (0.020.16).There was no significant difference between the two groups in the incidence of retinal detachment (OR) and the incidence of retinal detachment (OR) combined with 0.8895 CI (0.501.56), the incidence of high intraocular pressure (OR) combined with 0.92% 95 CI (0.501.70) and the incidence of retinal rupture (OR + 2.0795 CI [0.855.02]).Conclusion: compared with NO-ILMP group, NO-ILMP group has a higher rate of closure of postoperative hole, improved postoperative visual acuity and lower recurrence rate of postoperative hiatus.However, there was no significant difference between the two groups in improving the visual acuity of closed hole. There was no significant difference in the incidence of postoperative high intraocular pressure (IOP) and retinal hiatus between the two groups, due to the heterogeneity between the two groups, but there was no significant difference in the incidence of postoperative retinal detachment between the ILMP group and the NO-ILMP group.The existence of low-quality research and potential publication bias requires a series of high-quality studies to evaluate their safety and effectiveness more systematically and comprehensively.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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