Department of Preventive Medicine and Health Care Policy & Management, Health Sciences Center, Stony Brook University, Stony Brook, New York.
Department of Ophthalmology, Mayo Clinic College of Medicine, Jacksonville, Florida.
Am J Ophthalmol. 2011 Sep;152(3):345-357.e3. doi: 10.1016/j.ajo.2011.02.010. Epub 2011 Jun 17.
To evaluate the effect of vitrectomy timing on outcomes for patients with crystalline retained lens fragments receiving vitrectomy 3+ days after cataract surgery.
Systematic review and meta-analysis of retrospective interventional cases series.
Searches of MEDLINE (English, 1/1/85 through 7/30/2010) and article reference lists. Articles were screened for patients with crystalline retained lens fragments after surgery for age-related cataracts, discussion of vitrectomy timing, and, for the meta-analysis, patient totals for at least 1 outcome and multiple time periods, 10+ patients, and mean follow-up ≥3 months. Outcomes included visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation, cystoid macular edema, and corneal edema. Data extraction was performed twice and quality assessed. Logistic regression estimated study-level odds ratios for each additional 1-week vitrectomy delay. Meta-analysis estimated summary odds ratios using random-effects models.
Of 257 articles identified, there were 43 unique studies (53 articles) for the systematic review, including 27 (31 articles) for the meta-analysis. Early vitrectomies were statistically significantly associated with better outcomes for not good visual acuity (odds ratio: 1.13; 95% CI: 1.04-1.22, P = .005); bad visual acuity (odds ratio: 1.05; 95% CI: 1.01-1.09, P = .009); previtrectomy retinal detachment (odds ratio: 1.29; 95% CI: 1.01-1.65, P = .038); postvitrectomy retinal detachment (odds ratio: 1.13; 95% CI: 1.02-1.26, P = .024); increased intraocular pressure (odds ratio: 1.23; 95% CI: 1.07-1.41, P = .003); and intraocular infection/inflammation (odds ratio: 1.20; 95% CI: 1.01-1.42, P = .041). Results were robust to sensitivity analyses.
This systematic review and meta-analysis found significantly better outcomes (visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation) with earlier vitrectomy for retained lens fragments. Reduced vitrectomy delays may yield better patient outcomes.
评估白内障术后 3 天以上行玻璃体切除术患者的玻璃体切除术时机对治疗结果的影响。
系统回顾和回顾性干预性病例系列的荟萃分析。
检索 MEDLINE（英文，1985 年 1 月 1 日至 2010 年 7 月 30 日）和文章参考文献列表。筛选了术后因年龄相关性白内障而残留晶状体碎片的患者的文章，讨论了玻璃体切除术时机，并且对于荟萃分析，至少有 1 个结果和多个时间段、10 例以上患者以及平均随访时间≥3 个月的患者总例数。结果包括视力、视网膜脱离、眼内压升高、眼内感染/炎症、囊样黄斑水肿和角膜水肿。对数据进行了两次提取和质量评估。逻辑回归估计每延迟 1 周玻璃体切除术的研究水平比值比。使用随机效应模型估计汇总比值比。
在确定的 257 篇文章中，有 43 项为系统综述的单独研究（31 篇文章），包括 27 项为荟萃分析的研究（31 篇文章）。早期玻璃体切除术与视力不佳（比值比：1.13；95%置信区间：1.04-1.22，P =.005）、视力差（比值比：1.05；95%置信区间：1.01-1.09，P =.009）、术前视网膜脱离（比值比：1.29；95%置信区间：1.01-1.65，P =.038）、术后视网膜脱离（比值比：1.13；95%置信区间：1.02-1.26，P =.024）、眼内压升高（比值比：1.23；95%置信区间：1.07-1.41，P =.003）和眼内感染/炎症（比值比：1.20；95%置信区间：1.01-1.42，P =.041）显著相关。敏感性分析结果稳健。
本系统评价和荟萃分析发现，对于残留晶状体碎片，早期玻璃体切除术的治疗结果（视力、视网膜脱离、眼内压升高、眼内感染/炎症）明显更好。减少玻璃体切除术的延迟可能会带来更好的患者结果。
