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玻璃体内注射贝伐单抗治疗增生性玻璃体视网膜病变视网膜脱离患者的疗效:前瞻性研究的 Meta 分析。

EFFICACY OF INTRAVITREAL INJECTION OF BEVACIZUMAB IN VITRECTOMY FOR PATIENTS WITH PROLIFERATIVE VITREORETINOPATHY RETINAL DETACHMENT: A Meta-analysis of Prospective Studies.

机构信息

Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

出版信息

Retina. 2018 Mar;38(3):462-470. doi: 10.1097/IAE.0000000000001584.

Abstract

PURPOSE

To evaluate the effect of intravitreal injection of bevacizumab in vitrectomy for patients with proliferative vitreoretinopathy (PVR)-related retinal detachment.

METHODS

The PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from their earliest entries through October, 2016, to identify the studies that had evaluated the effects of intravitreal injection of bevacizumab in vitrectomy for eyes with PVR-related retinal detachment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The relevant data were analyzed using Stata 12.0 software. The weighted mean difference, relative risk, and their 95% confidence intervals were used to assess the strength of the association.

RESULTS

The authors' search yielded 133 records from which 3 studies that have examined the effects of intravitreal injection of bevacizumab (120 eyes with PVR-related retinal detachment) were included for review and analysis. Their meta-analyses showed that neither the best-corrected visual acuity nor retinal redetachment rate showed any clinically or statistically important difference between the nonbevacizumab and bevacizumab groups (P > 0.05). In addition, bevacizumab did not influence the interval between vitrectomy and retinal redetachment (P > 0.05).

CONCLUSION

Based on the available evidence, intravitreal injection of bevacizumab in vitrectomy for patients with PVR-related retinal detachment did not decrease retinal redetachment rate or improve visual acuity. Better-designed studies with larger simple sizes and longer follow-up periods are required to reach valid conclusions regarding benefits and harms. Moreover, evaluation of anti-vascular endothelial growth factor therapy on surgical outcomes in eyes with milder subtypes of PVR or no PVR, but deemed at high risk of PVR, may be worthy of future consideration.

摘要

目的

评估玻璃体内注射贝伐单抗联合玻璃体切除术治疗增生性玻璃体视网膜病变(PVR)相关视网膜脱离的效果。

方法

检索PubMed、Embase 和 Cochrane 中心对照试验注册库,检索时间截至 2016 年 10 月,旨在评估玻璃体内注射贝伐单抗联合玻璃体切除术治疗 PVR 相关视网膜脱离的效果。研究遵循《系统评价和荟萃分析的首选报告项目》(PRISMA)指南。使用 Stata 12.0 软件对相关数据进行分析。采用加权均数差、相对危险度及其 95%置信区间来评估关联强度。

结果

作者检索到 133 条记录,其中 3 项研究(共 120 只眼 PVR 相关视网膜脱离)纳入审查和分析。荟萃分析结果显示,玻璃体内注射贝伐单抗组和非贝伐单抗组的最佳矫正视力或视网膜再脱离率均无明显临床或统计学差异(P>0.05)。此外,玻璃体内注射贝伐单抗并不影响玻璃体切割术和视网膜再脱离之间的间隔(P>0.05)。

结论

根据现有证据,玻璃体内注射贝伐单抗联合玻璃体切除术治疗 PVR 相关视网膜脱离不能降低视网膜再脱离率或提高视力。需要设计更好、样本量更大且随访时间更长的研究,以对其疗效和安全性得出更可靠的结论。此外,评估抗血管内皮生长因子治疗对轻度 PVR 或无 PVR 但被认为 PVR 风险较高的眼手术结局的影响,可能值得进一步研究。

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