Kokavec Jan, Wu Zhichao, Sherwin Justin C, Ang Alan Js, Ang Ghee Soon
South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Level 8, East Wing, North Terrace, Adelaide, SA, Australia, 5000.
Cochrane Database Syst Rev. 2017 Jun 1;6(6):CD011676. doi: 10.1002/14651858.CD011676.pub2.
The vitreous is the clear jelly of the eye and contains fine strands of proteins. Throughout life the composition of this vitreous changes, which causes the protein strands in it to bundle together and scatter light before it reaches the retina. Individuals perceive the shadows cast by these protein bundles as 'floaters'. Some people are so bothered by floaters that treatment is required to control their symptoms. Two major interventions for floaters include Nd:YAG laser vitreolysis and vitrectomy. Nd:YAG laser vitreolysis involves using laser energy to fragment the vitreous opacities via a non-invasive approach. Vitrectomy involves the surgical replacement of the patient's vitreous (including the symptomatic vitreous floaters) with an inert and translucent balanced salt solution, through small openings in the pars plana.
To compare the effectiveness and safety of Nd:YAG laser vitreolysis to pars plana vitrectomy for symptomatic vitreous floaters.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 17 January 2017), Embase Ovid (1947 to 17 January 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 17 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 17 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 17 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 17 January 2017. We did not use any date or language restrictions in the electronic searches for trials. We also searched conference proceedings to identify additional studies.
We included only randomised controlled trials (RCTs) that compared Nd:YAG laser vitreolysis to pars plana vitrectomy for treatment of symptomatic floaters.
We planned to use methods recommended by Cochrane. The primary outcome we planned to measure was change in vision-related quality of life from baseline to 12 months, as determined by a vision-related quality of life questionnaire. The secondary outcomes we planned to measure were best corrected logMAR or Snellen visual acuity at 12 months for the treated eye(s) and costs. Adverse outcomes we planned to record were the occurrence of sight-threatening complications by 12 months (asymptomatic retinal tears, symptomatic retinal tears, retinal detachment, cataract formation, and endophthalmitis).
No studies met the inclusion criteria of this review.
AUTHORS' CONCLUSIONS: There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision-related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.
玻璃体是眼内透明的胶状物质，含有纤细的蛋白质丝。在人的一生中，玻璃体的成分会发生变化，这会导致其中的蛋白质丝束在一起，并在光线到达视网膜之前使其散射。人们将这些蛋白质束投射的阴影视为“飞蚊”。有些人受飞蚊困扰严重，需要治疗来控制症状。飞蚊的两种主要治疗方法包括钕：钇铝石榴石（Nd：YAG）激光玻璃体溶解术和玻璃体切除术。Nd：YAG激光玻璃体溶解术是通过非侵入性方法利用激光能量使玻璃体混浊物破碎。玻璃体切除术是通过睫状体扁平部的小切口，用惰性且半透明的平衡盐溶液手术替代患者的玻璃体（包括有症状的玻璃体飞蚊）。
比较Nd：YAG激光玻璃体溶解术与睫状体扁平部玻璃体切除术治疗有症状玻璃体飞蚊的有效性和安全性。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（其中包含Cochrane眼与视觉试验注册库）（2016年第12期）、MEDLINE Ovid（1946年至2017年1月17日）、Embase Ovid（1947年至2017年1月17日）、拉丁美洲和加勒比卫生科学文献数据库（LILACS）（1982年至2017年1月17日）、国际标准随机对照试验编号注册库（www.isrctn.com/editAdvancedSearch）；于2017年1月17日进行检索，检索ClinicalTrials.gov（www.clinicaltrials.gov）；于2017年1月17日进行检索，检索世界卫生组织（WHO）国际临床试验注册平台（ICTRP）（www.who.int/ictrp/search/en）；于2017年1月17日进行检索。在电子检索试验时，我们未设置任何日期或语言限制。我们还检索了会议论文集以识别其他研究。
我们仅纳入了比较Nd：YAG激光玻璃体溶解术与睫状体扁平部玻璃体切除术治疗有症状飞蚊的随机对照试验（RCT）。
我们计划采用Cochrane推荐的方法。我们计划测量的主要结局是根据与视力相关的生活质量问卷确定的从基线到12个月与视力相关的生活质量变化。我们计划测量的次要结局是治疗眼在12个月时的最佳矫正对数最小分辨角（logMAR）或斯内伦视力以及费用。我们计划记录的不良结局是在12个月时发生的威胁视力的并发症（无症状性视网膜裂孔、有症状性视网膜裂孔、视网膜脱离、白内障形成和眼内炎）。
没有研究符合本综述的纳入标准。
目前尚无比较Nd：YAG激光玻璃体溶解术与睫状体扁平部玻璃体切除术治疗有症状飞蚊的随机对照试验。需要设计恰当的随机对照试验来评估上述干预措施的治疗效果。我们建议未来的研究将参与者随机分为Nd：YAG激光玻璃体溶解术组或玻璃体切除术组，每组参与者再分配接受治疗或假干预。未来的研究应在干预后6个月和12个月对参与者进行随访。此外，他们应使用在4米处读取的糖尿病视网膜病变早期治疗研究（ETDRS）视力表测量的最佳矫正视力（BCVA）、与视力相关的生活质量（VRQOL）以及不良结局作为试验的结局指标。
