Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, China.
Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, China.
Acta Ophthalmol. 2019 May;97(3):233-239. doi: 10.1111/aos.13974. Epub 2018 Nov 22.
To explore the effectiveness and safety of vitrectomy for congenital cataract surgery.
We searched PubMed, Science Direct, The Cochrane Library, China National Knowledge Infrastructure and the Wanfang Database. Two researchers extracted data and assessed paper quality independently. Posterior capsule opacification (PCO) or visual axis opacification (VAO), reoperation rate, visual acuity, intraocular lenses (IOL) deposit, synechias, uveitis, secondary glaucoma, low-contrast sensitivity and IOL decentration were compared.
We included 11 randomized controlled trials (RCTs) with 634 congenital cataract eyes. Cases of posterior capsule opacification in vitrectomy group were significantly less than that of control group, with risk ratio (RR) of 0.15 [95% confidence interval (CI): 0.09, 0.26], and there was no heterogeneity (I = 0%, p = 0.94). Reoperation rate in vitrectomy group was lower than that of control group either (RR = 0.40, 95%CI: 0.17, 0.94), and there was no heterogeneity (I = 0%, p = 0.85). Best-corrected visual acuity (BCVA) measured in LogMAR unit of vitrectomy group was smaller, with a mean difference (MD) of -0.17 (95%CI: -0.28, -0.05), and I was only 22%, indicating of a small heterogeneity. No statistical difference was found between two groups on IOL deposit (RR = 1.23, 95%CI: 0.70, 2.17), and the heterogeneity was small (I = 16%, p = 0.31). No statistical difference was found between two groups on synechias (RR = 1.08, 95%CI: 0.60, 1.94), with a quite small heterogeneity (I = 3%, p = 0.38). No statistical difference was found between two groups on uveitis (RR = 0.55, 95%CI: 0.15, 2.01), and there was no heterogeneity (I = 0%, p = 0.94). There was no statistical difference on IOP either, with a MD of 0.25 (95%CI: -1.56, 2.07), and there was no heterogeneity (I = 0%). Egger's test showed that there was no publication bias for all assessed outcomes. Low-contrast sensitivity was better in the vitrectomy group. And no evidence indicated vitrectomy could lead to a higher risk on secondary glaucoma or IOL decentration.
Vitrectomy helps lower the PCO risk and reoperation risk after congenital cataract surgery, and also, vitrectomy helps patients gain a better BCVA and achieve a better low-contrast sensitivity, with no trade-off on IOP control, IOL deposit, synechias, uveitis and secondary glaucoma. We recommend performing vitrectomy during congenital cataract surgery.
探讨玻璃体切除术治疗先天性白内障的效果和安全性。
检索 PubMed、Science Direct、The Cochrane Library、中国知网和万方数据库。两名研究人员独立提取数据并评估论文质量。比较后发性白内障（PCO）或视觉轴混浊（VAO）、再次手术率、视力、人工晶状体（IOL）植入物沉积、虹膜粘连、葡萄膜炎、继发性青光眼、低对比敏感度和 IOL 偏心。
我们纳入了 11 项随机对照试验（RCT），共 634 只先天性白内障眼。玻璃体切除组的后发性白内障发生率明显低于对照组，风险比（RR）为 0.15 [95%置信区间（CI）：0.09，0.26]，无异质性（I = 0%，p = 0.94）。玻璃体切除组的再次手术率也低于对照组（RR = 0.40，95%CI：0.17，0.94），无异质性（I = 0%，p = 0.85）。玻璃体切除组的最佳矫正视力（BCVA）以 LogMAR 单位测量时较小，平均差异（MD）为-0.17（95%CI：-0.28，-0.05），I 仅为 22%，表明存在较小的异质性。两组在 IOL 植入物沉积方面无统计学差异（RR = 1.23，95%CI：0.70，2.17），异质性较小（I = 16%，p = 0.31）。两组在虹膜粘连方面无统计学差异（RR = 1.08，95%CI：0.60，1.94），异质性较小（I = 3%，p = 0.38）。两组在葡萄膜炎方面无统计学差异（RR = 0.55，95%CI：0.15，2.01），无异质性（I = 0%，p = 0.94）。眼压也无统计学差异，MD 为 0.25（95%CI：-1.56，2.07），无异质性（I = 0%）。Egger 检验表明，所有评估结果均无发表偏倚。低对比敏感度在玻璃体切除组更好。并且没有证据表明玻璃体切除术会增加继发性青光眼或 IOL 偏心的风险。
玻璃体切除术有助于降低先天性白内障手术后 PCO 的风险和再次手术的风险，并且有助于患者获得更好的 BCVA 和更好的低对比敏感度，同时不影响眼压控制、IOL 植入物沉积、虹膜粘连、葡萄膜炎和继发性青光眼。我们建议在先天性白内障手术中进行玻璃体切除术。
