Liang Jing
Department of Ophthalmology, Tianjin 4th Center Hospital, Tianjin, China.
Eur J Ophthalmol. 2019 Mar;29(2):223-228. doi: 10.1177/1120672118770557. Epub 2018 Jul 19.
: Retinopathy of prematurity is a leading cause of potentially avertable childhood blindness around the world. And laser photocoagulation is currently performed as a gold standard for retinopathy of prematurity treatment, but it may contribute to elevated myopia and decreased visual field. Therefore, the objective of this meta-analysis is to explore the negative impact of laser photocoagulation for retinopathy of prematurity in terms of anatomic outcomes and structural outcomes.
: Studies were retrieved through literature searches in PubMed and EMBASE from 1990 to 2017 in English. Case-control studies that reported anatomic and structural changes or significant complications after laser coagulation or cryotherapy for retinopathy of prematurity were eligible.
: This meta-analysis included eight original studies related to laser treatment for retinopathy of prematurity at any stages. A total of 1422 infants were participated, of which 1156 documented subthreshold or threshold retinopathy of prematurity without laser treatment were selected as comparison group and the rest treated with diode or argon laser coagulation were chosen for experiment group. Taking all included studies into account, spherical equivalent (mean difference -2.53, 95% confidence interval: -5.23 to 0.18, I = 96%, P < 0.00001), anterior chamber depth (mean difference -0.52, 95% confidence interval: -0.76 to -0.28, I = 55%, P = 0.11), astigmatism (odds ratio 3.19, 95% confidence interval: 1.61 to 6.32, I = 0%, P = 0.54), and myopia (odds ratio 8.08, 95% confidence interval: 3.79 to 17.23, I = 37%, P = 0.21) were associated with laser treatment for retinopathy of prematurity. Axial length (mean difference -0.01, 95% confidence interval: -0.28 to 0.27, I = 0%, P = 0.62) and anisometropia (odds ratio 4.21, 95% confidence interval: 0.54 to 33.17, I = 1%, P = 0.31) had no statistical significance on laser coagulation for retinopathy of prematurity.
: This meta-analysis showed that spherical equivalent, anterior chamber depth, astigmatism, and myopia were associated with the negative outcomes of laser coagulation, while axial length and anisometropia had no statistical importance on the defects of laser coagulation. Therefore, patients treated with laser coagulation should follow periodic cycloplegic refraction and receive early optical correction.
早产儿视网膜病变是全球儿童潜在可避免失明的主要原因。激光光凝术目前是早产儿视网膜病变治疗的金标准，但它可能导致近视度数升高和视野缩小。因此，本荟萃分析的目的是探讨激光光凝术对早产儿视网膜病变在解剖学结局和结构结局方面的负面影响。
通过1990年至2017年在PubMed和EMBASE中进行的英文文献检索来获取研究。符合条件的是那些报告了激光凝固或冷冻疗法治疗早产儿视网膜病变后解剖学和结构变化或重大并发症的病例对照研究。
本荟萃分析纳入了八项与任何阶段早产儿视网膜病变激光治疗相关的原始研究。共有1422名婴儿参与，其中1156名记录有未接受激光治疗的阈下或阈值早产儿视网膜病变的婴儿被选为对照组，其余接受二极管或氩激光凝固治疗的婴儿被选为实验组。综合所有纳入研究，等效球镜度（平均差-2.53，95%置信区间：-5.23至0.18，I=96%，P<0.00001）、前房深度（平均差-0.52，95%置信区间：-0.76至-0.28，I=55%，P=0.11）、散光（比值比3.19，95%置信区间：1.61至6.32，I=0%，P=0.54）和近视（比值比8.08，95%置信区间：3.79至17.23，I=37%，P=0.21）与早产儿视网膜病变的激光治疗相关。眼轴长度（平均差-0.01，95%置信区间：-0.28至0.27，I=0%，P=0.62）和屈光参差（比值比4.21，95%置信区间：0.54至33.17，I=1%，P=0.31）对早产儿视网膜病变的激光凝固无统计学意义。
本荟萃分析表明，等效球镜度、前房深度、散光和近视与激光凝固的负面结局相关，而眼轴长度和屈光参差对激光凝固的缺陷无统计学重要性。因此，接受激光凝固治疗的患者应定期进行睫状肌麻痹验光并尽早接受光学矫正。
