【摘要】 目的探讨内界膜撕除术(ILMP)治疗特发性黄斑裂孔(IMH)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,研究者分别以"黄斑裂孔"、"内界膜撕除"及"内界膜"为关键词,在Pub Med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及中国知网等数据库中,通过计算机检索方式,检索1991年1月至2012年3月IMH玻璃体切割术(PPV)相关的文章,对眼科学杂志和有关学术会议论文汇编进行检索,对相关综述性文章的参考文献进行查阅,通过与作者联系等方式追踪查询还未发表的文章。应用Jadad量表对纳入研究的文献进行质量评价,对术后裂孔闭合率、视力及并发症等3个方面内容进行Meta分析。结果最终有23篇PPV中应用ILMP治疗IMH的文献纳入本研究,其中5篇为临床随机对照研究,18篇为非随机临床对照研究。通过Meta分析,3组结果分别为:(1)对术后裂孔闭合率合并分析:与非ILMP组相比,ILMP组有较高的术后裂孔闭合率,差异有统计学意义[OR=4.78,95%CI(2.94,7.75)];对IMH的2、3、4期裂孔进行分层分析,与非ILMP组相比,2期[OR=6.21,95%CI(2.59,14.90)]、3期[OR=3.89,95%CI(2.50,6.05)]及4期[OR=2.77,95%CI(1.77,4.34)]裂孔ILMP组有较高的术后裂孔闭合率,差异均有统计学意义。(2)对术后视力合并分析结果。与非ILMP组相比,ILMP组有较高的术后视力提高率[OR=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=1.64,95%CI(0.85,3.18)],差异无统计学意义;与非ILMP组相比,ILMP组有较高的术后矫正视力(BCVA),差异有统计学意义[SMD=-0.51,95%CI(-0.73,-0.29)]。(3)对术后并发症合并分析结果。ILMP组裂孔复发率低于非ILMP组[OR=0.05,95%CI(0.02,0.16)]。两组视网膜脱离发生率[OR=0.88,95%CI(0.50,1.56)]、术后高眼压发生率[OR=0.92,95%CI(0.50,1.70)]及视网膜裂孔发生率[OR=2.07,95%CI(0.85,5.02)],差异均无统计学意义。结论与非ILMP组相比,ILMP组有较高的术后裂孔闭合率、术后视力及术后最佳矫正视力(BCVA)提高率高,且术后裂孔复发率低;而在闭合裂孔视力提高率、术后视网膜脱离、术后高眼压及术后视网膜裂孔的发生率等方面比较,两组差异无统计学意义。此外,各研究间的异质性、低质量研究和潜在发表偏倚的存在,均提示还需要开展一系列高质量的研究,才能对其安全性和有效性进行更为系统全面的评价。更多还原

【Abstract】 Objective To perform a comprehensive evaluation and comparison of the safety and clinical efficacy of inner limiting membrane peeling( ILMP) in idiopathic macular hole surgery.Methods A comprehensive literature search of Pub Med,Ovid-Medline,Cochrane library,Wanfang,VIP database for Chinese Technical Periodicals,Chinese National Knowledge Infrastructure( CNKI) databases was conducted for randomized controlled trials of the necessity of ILMP in macular hole surgery. All relevant studies regardless of language or publication status( published,unpublished,in press,and in progress) were calculated and reported as odds ratios( ORs) and 95% confidence intervals( CIs). Quality assessments were performed with Jadad rating scales. Results Finally,23 pieces of paper about internal limiting membrane peeling in vitrectomy among idiopathic macular hole were included,5 pieces were randomized controlled trials,while the other 18 cases were non-randomized controlled trials. First,performed this meta-analysis to compare the hole closure rate after vitrectomy,postoperative vision and complications between ILMP and NOILMP groups. Combined results of postoperative closed rate: ILMP could improve the postoperative closed rate in IMH[OR = 4. 78,95 % CI( 2. 94-7. 75) ],the resultswas statistically significant. Stratified analysis was performed for three stage of IMH,ILMP can improve postoperative closed rate in stage 2 IMH [OR =6. 21,95% CI( 2. 59-14. 90) ],stage 3 IMH [OR = 3. 89,95% CI( 2. 50-6. 05) ] and stage 4 IMH [OR =2. 77,95% CI( 1. 77-4. 34) ],the results were statistically significant. Second,combined results of postoperative visual outcome: visual acuity improved rate in ILMP group was higher than that in NO-ILMP group[OR = 3. 37,95% CI( 1. 74- 6. 51) ]. Visual acuity improved rate in closed hole had the same rate between the two groups [OR = 1. 64,95% CI( 0. 85-3. 18) ],and the result was not statistically significant.The combined result of postoperative BCVA in ILMP [SMD =-0. 51,95% CI(-0. 73-- 0. 29) ] was higher than that in the NO-ILMP group,and the result was not statistically significant. Third,postoperative complications findings of this study: combined results suggested that the reopening rate of ILMP group was lower than that in the NO-ILMP group [OR = 0. 05,95% CI( 0. 02-0. 16) ]. Retinal detachment incidence[OR = 0. 88,95% CI( 0. 50-1. 56) ],increased IOP incidence [OR = 0. 92,95% CI( 0. 50-1. 70) ] and retinal tear incidenceare [OR = 2. 0 7,9 5 % CI( 0. 8 5-5. 0 2) ] were not statistically significant.Conclusions Compareing with NO-ILMP,ILMP was associated with significantly higher postoperative anatomical closed rate,visual acuity improved rate and BCVA in IMH and lower reopening rate. While ILMP does not significantly improve visual acuity among anatomical successful holes compareing with NO-ILMP.The occurrence of the postoperative retinal detachment,retinal tear and increased IOP were not statistically significant between ILMP and NO-ILMP. Due to heterogeneity between studies,low-quality research and the presence of potential publication bias,it is required to carry out a series of high-quality research on its safety and efficacy of a more comprehensive evaluation.更多还原