玻璃体切割术与巩膜扣带术治疗非复杂性孔源性视网膜脱离的系统评价

发布时间：2018-05-23 19:06

本文选题：]玻璃体切割术 + 巩膜扣带术　；参考：《广西医科大学》2011年硕士论文

【摘要】：目的系统地评价玻璃体切割术(PPV)与巩膜扣带术(SB)治疗非复杂性视网膜脱离的疗效及手术安全性。方法计算机检索Cochrane图书馆,Pubmed, Embase, CNKI和CBM,以及SCI数据库及手工检索,收集比较PPV与SB治疗非复杂性视网膜脱离的随机对照研究(RCT)。运用Cochrane协作网提供的质量评价标准评价纳入研究的方法学质量,提取有效数据,采用Revman 5.0软件根据晶状体情况分成两个亚组进行统计分析,比较PPV与SB治疗非复杂性视网膜脱离术后的最佳矫正视力(BCVA)的变化,初次手术及最终视网膜复位率及并发症的发生率。结果共纳入6篇RCTs (共1213人)。3个RCTs只纳入了人工晶体或无晶体眼的病人,2个RCTs纳入有晶体眼的病人,另一个研究则纳入了这两类的病人。Meta分析的结果显示: BCVA的提高上:有晶体眼组MD= 0.14, 95% CI (0.01,0.27);人工晶体眼/无晶体眼组MD= 0.07, 95% CI (0.01,0.13),这表明PPV比SB术后最佳矫正视力提高更显著。在视网膜复位率上,PPV与SB在初次手术视网膜复位率[有晶体眼组RR= 1.0, 95% CI (0.9,1.11),人工晶体眼/无晶体眼组RR= 1.12, 95% CI (0.97,1.3)]与最终视网膜复位率上[有晶体眼组RD= -0.00, 95% CI (-0.03,0.03),人工晶体眼/无晶体眼组RD= 0.03,95% CI (-0.00,0.06)]均无明显差异。结论无论有晶体眼还是人工晶体眼/无晶体眼,PPV在BCVA的提高上明显优于SB,而在视网膜的复位率上二者无显著性差异。两种手术的并发症情况不尽相同:与SB相比,PPV在增殖性玻璃体视网膜病变(PVR)发生率、脉络膜脱离发生率、再次手术率、屈光改变、眼轴的变化及手术时间上占有一定的优势;但是在医源性裂孔及并发性白内障的发生率上恰恰相反。由于纳入的各研究有限,所得结论需要进一步的研究证实。
[Abstract]:Objective to evaluate the efficacy and safety of vitrectomy and scleral buckling in the treatment of non-complicated retinal detachment. Methods Cochrane libraries were searched by computer for pubmeda, Embase, CNKI and CBM, SCI database and manual retrieval. The randomized controlled study of PPV and SB in the treatment of non-complex retinal detachment was collected and compared. The quality evaluation standard provided by Cochrane cooperation network was used to evaluate the methodological quality of the study, and the valid data were extracted. The software Revman 5.0 was used to divide the two subgroups according to the lens condition for statistical analysis. To compare the changes of best corrected visual acuity (BCVA), the rate of first and final retinal reattachment and the incidence of complications after PPV and SB in the treatment of non-complicated retinal detachment. Results A total of 6 RCTs articles were included (1213 patients). 3 RCTs patients only included intraocular lens or aphakic eyes, and 2 RCTs patients with lens eyes. The other study included two groups of patients. Meta-analysis showed that the increase of BCVA was: MD0.14,95% CI 0.01U 0.27 in the group with lens eye, MD0.07,95% CI 0.01C 0.13 in IOL / acrystalline eyes, which indicated that the improvement of PPV was more significant than that of the best corrected visual acuity after SB. At the rate of retinal reattachment, PPV and SB were found in the primary retinal reattachment rate (RR = 1.0, 95% CI 0.9 1.11, RR = 1.12, 95% CI 0.971.3) and the final retinal reattachment rate [RD = -0.00, 95% CI -0.03] and the final retinal reattachment rate (RD = -0.00, 95% CI = -0.030.03) in the intraocular eye group (RR = 1.0, 95% CI = 0.9%, RR = 1.12, 95% CI 0.971.3%) and the final retinal reattachment rate in the lens eye group. There was no significant difference in RD = 0.03 ~ 95% CI ~ (-0.000. 06)] between IOL eyes and Aphakic eyes. Conclusion both intraocular and intraocular lens eyes / Aphakic eyes can significantly improve BCVA, but there is no significant difference in the rate of retinal reattachment between the two groups. The complications of the two operations were different: compared with SB, PPV had some advantages in the incidence of proliferative vitreoretinopathy (PVR), choroidal detachment, reoperation rate, refractive change, axial change and operation time. However, the incidence of iatrogenic hiatus and cataract is quite the opposite. Due to the limited number of studies included, the conclusions need to be confirmed by further studies.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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