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20%六氟化硫与100%空气用于角膜内皮移植术(DMEK)前房填塞的Meta分析

Sulfur Hexafluoride 20% Versus Air 100% for Anterior Chamber Tamponade in DMEK: A Meta-Analysis.

作者信息

Marques Raquel Esteves, Guerra Paulo Silva, Sousa David Cordeiro, Ferreira Nuno Pinto, Gonçalves Ana Inês, Quintas Ana Miguel, Rodrigues Walter

机构信息

Department of Ophthalmology, Hospital Santa Maria, Lisboa, Portugal.

Ophthalmology Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.

出版信息

Cornea. 2018 Jun;37(6):691-697. doi: 10.1097/ICO.0000000000001581.

Abstract

PURPOSE

To compare intracameral 20% sulfur hexafluoride (SF6) versus 100% air as tamponade for graft attachment in Descemet membrane endothelial keratoplasty (DMEK).

METHODS

Using an electronic database search on MEDLINE and CENTRAL from inception to December 2017, we performed a literature review and meta-analysis including all comparative studies of SF6 at a 20% concentration (20% SF6) versus pure air (100% air) for anterior chamber tamponade in DMEK. The primary outcome was the rebubbling rate at the final observation. The secondary outcomes were 1) the graft detachment rate, 2) mean difference (MD) in best-corrected visual acuity (BCVA), 3) manifest refraction spherical equivalent, 4) central corneal thickness (CCT), 5) percentage of endothelial cell loss (ECL), and 6) rate of pupillary block by the final observation. Statistical analysis was performed using RevMan5.3 software.

RESULTS

Five retrospective studies were included, assessing 1195 eyes (SF6 277; air 918). The main indication for surgery was Fuchs endothelial dystrophy (SF6 85.2%; air 86.2%) and bullous keratopathy (SF6 10.8%; air 10.0%). Overall, studies were of moderate to good methodological quality. Patients in the SF6 group required 58% less rebubbling procedures (risk ratio 0.42, 95% confidence interval (CI), 0.31-0.56, P < 0.0001). No differences were found regarding BCVA improvement (MD 0.03, 95% CI, -0.05 to 0.11, P = 0.49). SF6 was associated with a minor hyperopic shift (MD 0.37 D, 95% CI, -0.95 to -0.21, P = 0.21). No differences were found regarding CCT, ECL, and rate of pupillary block (P > 0.05).

CONCLUSIONS

In DMEK, 20% SF6 tamponade and longer postoperative time supine were associated with 58% fewer rebubbling procedures, and an ECL not statistically different from using 100% air.

摘要

目的

比较前房内注射20%六氟化硫(SF6)与100%空气作为Descemet膜内皮角膜移植术(DMEK)中移植物附着的填充剂的效果。

方法

通过对MEDLINE和CENTRAL数据库从建库至2017年12月进行电子检索,我们进行了一项文献综述和荟萃分析,纳入了所有比较20%浓度的SF6(20% SF6)与纯空气(100%空气)用于DMEK前房填充的对照研究。主要结局是最终观察时的再气泡形成率。次要结局包括:1)移植物脱离率;2)最佳矫正视力(BCVA)的平均差值(MD);3)明显验光球镜等效值;4)中央角膜厚度(CCT);5)内皮细胞丢失百分比(ECL);6)最终观察时的瞳孔阻滞率。使用RevMan5.3软件进行统计分析。

结果

纳入了5项回顾性研究,共评估1195只眼(SF6组277只;空气组918只)。手术的主要适应证为Fuchs内皮营养不良(SF6组85.2%;空气组86.2%)和大疱性角膜病变(SF6组10.8%;空气组10.0%)。总体而言,研究的方法学质量为中等至良好。SF6组患者所需的再气泡形成操作减少58%(风险比0.42,95%置信区间(CI),0.31 - 0.56,P < 0.0001)。在BCVA改善方面未发现差异(MD 0.03,95% CI, - 0.05至0.11,P = 0.49)。SF6与轻微的远视性移位相关(MD 0.37 D,95% CI, - 0.95至 - 0.21,P = 0.21)。在CCT、ECL和瞳孔阻滞率方面未发现差异(P > 0.05)。

结论

在DMEK中,20% SF6填充及术后更长时间仰卧位与再气泡形成操作减少58%相关,且ECL与使用100%空气时无统计学差异。

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