Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Int J Oral Maxillofac Surg. 2020 Apr;49(4):496-504. doi: 10.1016/j.ijom.2019.08.009. Epub 2019 Aug 30.
In Graves' orbitopathy, surgical decompression is often needed for functional and aesthetic reasons. This meta-analysis was performed to assess the efficacy and safety of fat removal orbital decompression (FROD) alone to treat exophthalmos in Graves' orbitopathy. A systematic search was conducted in PubMed/MEDLINE, Web of Science, and Cochrane Library for studies published before August 2018. Random-effects meta-analyses were applied; weighted means and weighted proportions with corresponding 95% confidence intervals (CI) were calculated. Study quality and quality of evidence for each individual outcome were analyzed. Of 1908 records initially identified, 13 observational studies were selected, representing 4820 orbits in 2514 patients. Weighted Hertel exophthalmometry was 23.10mm (95% CI 21.77-24.43mm) preoperative and 19.31mm (95% CI 17.81-20.81mm) postoperative. The weighted mean difference was 3.81mm (95% CI 3.41-4.21mm). Five studies reported an improvement of diplopia after surgery, occurring in 943 of 1172 patients (weighted proportion 0.50, 95% CI 0.15-0.85). Persistent new onset diplopia was reported in five studies, or 124 of 1277 patients (weighted proportion 0.15, 95% CI 0.03-0.27). No serious adverse events were reported. Results support the effectiveness and safety of FROD to treat mild-to-moderate exophthalmos in Graves' orbitopathy. Prospective and controlled trials are needed to improve the level of evidence.
在格雷夫斯眼病中，出于功能和美观的原因，通常需要进行手术减压。本荟萃分析旨在评估单纯脂肪去除眶减压术（FROD）治疗格雷夫斯眼病突眼的疗效和安全性。在 2018 年 8 月之前，在 PubMed/MEDLINE、Web of Science 和 Cochrane Library 中对已发表的研究进行了系统检索。应用随机效应荟萃分析；计算加权均数和加权比例及其相应的 95%置信区间（CI）。对每个单独结局的研究质量和证据质量进行了分析。在最初确定的 1908 条记录中，有 13 项观察性研究入选，涉及 2514 例患者的 4820 只眼。术前加权赫特尔突眼计为 23.10mm（95%CI 21.77-24.43mm），术后为 19.31mm（95%CI 17.81-20.81mm）。加权均数差值为 3.81mm（95%CI 3.41-4.21mm）。5 项研究报告术后复视改善，1172 例患者中有 943 例（加权比例 0.50，95%CI 0.15-0.85）。5 项研究报告术后出现持续性新发复视，1277 例患者中有 124 例（加权比例 0.15，95%CI 0.03-0.27）。未报告严重不良事件。结果支持 FROD 治疗格雷夫斯眼病轻中度突眼的有效性和安全性。需要前瞻性和对照试验来提高证据水平。
