Xia Song, Zhao Xin-Yu, Wang Er-Qian, Chen You-Xin
Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang, 550000, China.
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
BMC Ophthalmol. 2019 Jan 28;19(1):34. doi: 10.1186/s12886-019-1047-8.
A few randomized controlled trials (RCTs) have evaluated face-down posturing (FDP) with the far less physically challenging nonsupine posturing (NSP) in the treatment of idiopathic full-thickness macular holes (MHs). The objective of our study was to evaluate the efficacy of postoperative posturing on the anatomical and functional outcomes of MH surgery.
The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched from their earliest entries through December 2016 to identify the studies that had evaluated the effects of postoperative posturing with FDP or NSP for patients with MH surgery. The PRISMA guidelines were followed. The relevant data were analyzed using StataSE 12.0 software. The weighted mean difference (WMD), relative risk (RR) and their 95% confidence intervals (95% CIs) were used to assess the strength of the association.
Our search yielded 181 records from which 11 studies comprising 726 cases that had examined the effects of postoperative posturing with FDP for patients compared with NSP after MH surgery were included for review and analysis. Our meta-analyses showed that postoperative FDP could generally improve the overall MH closure rate compared to NSP (OR = 1.828, 95% CI: 1.0633.143, P = 0.029). Subgroup analysis of the size of MH suggested a significant benefit of FDP for large MHs (≥400 μm) (OR = 4.361, 95% CI: 1.42913.305, P = 0.010) while there was no difference in the MH closure rate for small MHs (< 400 μm) (OR = 1.731, 95% CI: 0.4127.270, P = 0.453). Moreover, ILM peeling for large MHs could significantly increase the MH closure rate of the FDP group (OR = 2.489, 95% CI: 1.0216.069, P = 0.045), while no difference existed for small MHs (OR = 3.572, 95% CI: 0.54723.331, P = 0.184). Combined cataract surgery might not influence the MH closure rate under any circumstance (OR = 0.513, 95% CI: 0.0892.944, P = 0.454).
Based on all the available evidence, our study found that FDP after MH surgery could generally improve the overall MH closure rate compared to NSP. For MHs larger than 400 μm, ILM peeling combined with FDP could significantly increase the MH closure rate. Combined cataract surgery might not influence the MH closure rate.
少数随机对照试验（RCT）评估了在治疗特发性全层黄斑裂孔（MH）时，采用体力要求低得多的非仰卧位姿势（NSP）的俯卧位姿势（FDP）。我们研究的目的是评估术后姿势对MH手术的解剖和功能结果的疗效。
检索了PubMed、Embase和Cochrane对照试验中央注册库数据库，从最早的记录到2016年十二月，以确定评估FDP或NSP术后姿势对MH手术患者影响的研究。遵循PRISMA指南。使用StataSE 12.0软件分析相关数据。加权平均差（WMD）、相对风险（RR）及其95%置信区间（95%CI）用于评估关联强度。
我们的检索产生了181条记录，其中11项研究（共726例）纳入了回顾和分析，这些研究比较了MH手术后患者采用FDP与NSP术后姿势的效果。我们的荟萃分析表明，与NSP相比，术后FDP通常可提高总体MH闭合率（OR = 1.828，95%CI：1.0633.143，P = 0.029）。对MH大小的亚组分析表明，FDP对大MH（≥400μm）有显著益处（OR = 4.361，95%CI：1.42913.305，P = 0.010），而小MH（<400μm）的MH闭合率无差异（OR = 1.731，95%CI：0.4127.270，P = 0.453）。此外，对于大MH进行内界膜剥除可显著提高FDP组的MH闭合率（OR = 2.489，95%CI：1.0216.069，P = 0.045），而小MH则无差异（OR = 3.572，95%CI：0.54723.331，P = 0.184）。联合白内障手术在任何情况下都可能不影响MH闭合率（OR = 0.513，95%CI：0.0892.944，P = 0.454）。
基于所有现有证据，我们的研究发现，与NSP相比，MH手术后采用FDP通常可提高总体MH闭合率。对于大于400μm的MH，内界膜剥除联合FDP可显著提高MH闭合率。联合白内障手术可能不影响MH闭合率。
