Vanner Elizabeth A, Stewart Michael W
Department of Preventive Medicine, Pathology and Bioinformatics, Stony Brook University, Stony Brook, NY, USA.
Department of Ophthalmology, Mayo Clinic College of Medicine, Jacksonville, FL, USA.
Clin Ophthalmol. 2014 Nov 18;8:2261-76. doi: 10.2147/OPTH.S71494. eCollection 2014.
PURPOSE/DESIGN: We aimed to perform a systematic review and meta-analysis comparing the risk difference of clinical outcomes for same-day (SD) vs delayed (DEL) pars plana vitrectomy (PPV).
We searched MEDLINE (English; January 1, 1985 to July 16, 2013) and article reference lists, for patients with crystalline retained lens fragments and discussion of SD-PPV vs DEL-PPV. For the meta-analysis, articles needed the number of patients receiving SD-PPV and DEL-PPV, and the number, in each group, who experienced one or more of the outcomes: not good visual acuity (VA) (<20/40), bad VA (≤20/200), retinal detachment, increased intraocular pressure/glaucoma, intraocular infection/inflammation, cystoid macular edema, and corneal edema.
Of 304 articles identified, 23 provided data for the meta-analysis. Results were mixed, indicating 1) neither vitrectomy time produced better outcomes in all studies (not good VA risk difference =10.3% [positive numbers favored SD-PPV; negative numbers favored DEL-PPV], 95% confidence interval [CI] = [-0.4% to 21.0%], P=0.059; and bad VA risk difference =-0.3%, 95% CI = [-10.7% to 10.1%], P=0.953); 2) better outcomes with immediate SD-PPV compared with all DEL-PPV (not good VA risk difference =16.2%, 95% CI = [0.8% to 31.5%], P=0.039; and bad VA risk difference =8.5%; 95% CI = [0.8% to 16.2%], P=0.030); and 3) immediate SD-PPV and prompt DEL-PPV (3 to 14 days after cataract surgery) had no significant differences and so may produce similar outcomes (not good VA risk differences range = [-19.9% to 6.5%], 95% CI = [-59.9% to 36.4%]; and bad VA risk differences range = [-6.9% to 7.4%], 95% CI = [-33.1% to 31.8%]).
Perhaps SD-PPV should be limited to facilities at which a vitreoretinal surgeon is immediately available. Otherwise, these results support referring a patient with retained lens fragments promptly to a vitreoretinal surgeon but do not support interfacility transport for SD-PPV.
目的/设计：我们旨在进行一项系统评价和荟萃分析，比较同期（SD）与延迟（DEL）玻璃体切割术（PPV）临床结局的风险差异。
我们检索了MEDLINE（英文；1985年1月1日至2013年7月16日）及文章参考文献列表，纳入有晶状体残留碎片患者以及关于SD-PPV与DEL-PPV的讨论。对于荟萃分析，文章需提供接受SD-PPV和DEL-PPV的患者数量，以及每组中经历以下一种或多种结局的患者数量：视力不佳（VA）（<20/40）、视力差（≤20/200）、视网膜脱离、眼压升高/青光眼、眼内感染/炎症、黄斑囊样水肿和角膜水肿。
在检索到的304篇文章中，23篇提供了荟萃分析的数据。结果不一，表明：1）在所有研究中，两种玻璃体切割时间均未产生更好的结局（视力不佳的风险差异=10.3%[正数有利于SD-PPV；负数有利于DEL-PPV]，95%置信区间[CI]=[-0.4%至21.0%]，P=0.059；视力差的风险差异=-0.3%，95%CI=[-10.7%至10.1%]，P=0.953）；2）与所有DEL-PPV相比，立即进行SD-PPV有更好的结局（视力不佳的风险差异=16.2%，95%CI=[0.8%至31.5%]，P=0.039；视力差的风险差异=8.5%；95%CI=[0.8%至16.2%]，P=0.030）；3）立即进行SD-PPV和及时进行DEL-PPV（白内障手术后3至14天）无显著差异，因此可能产生相似的结局（视力不佳的风险差异范围=[-19.9%至6.5%]，95%CI=[-59.9%至36.4%]；视力差的风险差异范围=[-6.9%至7.4%]，95%CI=[-33.1%至31.8%]）。
或许SD-PPV应限于有玻璃体视网膜外科医生随时可用的机构。否则，这些结果支持将有晶状体残留碎片的患者迅速转诊给玻璃体视网膜外科医生，但不支持为进行SD-PPV进行机构间转运。
