Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
PLoS One. 2020 May 26;15(5):e0233564. doi: 10.1371/journal.pone.0233564. eCollection 2020.
High myopia is a sight-threatening disease that causes axial length elongation and severe complications. Data on the benefits of posterior scleral reinforcement surgery in myopia control have been conflicting. The purpose of this study was to explore the treatment effect and complications of posterior scleral reinforcement in the treatment of myopia.
Articles were retrieved for relevant studies from inception to July 24, 2019, by PubMed, EMBASE, and Ovid. Analyses were conducted to compare the treatment effects of controlling spherical equivalent refraction and axial length elongation. The weighted mean difference and Hedges' adjusted g were used to evaluate the treatment effects, with a random-effects model. Heterogeneity was quantified using I2 statistic and explored by subgroup analysis. Publication bias was addressed by funnel plots and Egger's test.
A total of 11 articles were included in this meta-analysis. On estimating the treatment effect, the mean differences of myopia progression and axial length changes between surgery and control groups were 0.41 diopters per year (95% CI 0.21 to 0.61; P < .001) and -0.17 mm per year (95% CI -0.22 to -0.11; P < .001). Subgroup analysis showed significant treatment effects of the single wide strip operation. Single-arm meta-analysis showed less annual axial elongation in children subgroup. These results were robust by sensitivity analysis. The incidence of some major complications in the operation group were significantly greater (5.8% vs 2.7% for myopic degeneration; 2.3% vs 1.6% for macular hemorrhage; 0.8% vs 0 for retinal detachment).
Posterior scleral reinforcement may be an effective surgery on controlling myopia progression by slowing both refraction and axial length change. However, frequent surgical complications should be considered. Further well-designed studies are needed to determine the long-term safety and efficacy.
高度近视是一种威胁视力的疾病，可导致眼轴延长和严重并发症。关于后巩膜加固术在近视控制中的益处的数据一直存在争议。本研究旨在探讨后巩膜加固治疗近视的疗效和并发症。
通过 PubMed、EMBASE 和 Ovid 检索从建库至 2019 年 7 月 24 日的相关研究，对控制球镜等效折射和眼轴伸长的治疗效果进行分析。采用随机效应模型，用加权均数差和 Hedges 调整 g 评估治疗效果。用 I 2 统计量和亚组分析来量化异质性，并通过漏斗图和 Egger 检验来探讨发表偏倚。
本荟萃分析共纳入 11 项研究。估计治疗效果时，手术组与对照组近视进展和眼轴变化的平均差异分别为每年 0.41 屈光度（95%CI 0.21 至 0.61；P <.001）和每年-0.17 毫米（95%CI -0.22 至-0.11；P <.001）。亚组分析显示单条宽带手术的治疗效果显著。单臂荟萃分析显示儿童亚组的年眼轴伸长较少。敏感性分析结果稳健。手术组一些主要并发症的发生率显著较高（近视变性为 5.8%比 2.7%；黄斑出血为 2.3%比 1.6%；视网膜脱离为 0.8%比 0）。
后巩膜加固术可能是一种有效的手术，可以减缓屈光度和眼轴变化，从而控制近视进展。然而，应考虑频繁的手术并发症。需要进一步设计良好的研究来确定长期安全性和疗效。
