高度近视眼黄斑裂孔性视网膜脱离玻璃体切除术中倒置内界膜瓣技术与内界膜剥除术的比较：一项更新的Meta分析

Inverted Internal Limiting Membrane Flap Technique versus Internal Limiting Membrane Peeling for Vitrectomy in Highly Myopic Eyes with Macular Hole-Induced Retinal Detachment: An Updated Meta-Analysis.

作者信息

Ling Ling, Liu Yao, Zhou Baixing, Gao Feifei, Hu Zhe, Tian Man, Xing Yiqiao, Ji Kaibao, Sun Tao, Zhou Wentian

机构信息

Affiliated Eye Hospital of Nanchang University, Nanchang, Jiangxi, China.

Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.

出版信息

J Ophthalmol. 2020 Aug 24;2020:2374650. doi: 10.1155/2020/2374650. eCollection 2020.

BACKGROUND

The aim of this meta-analysis was to compare morphological and functional outcomes between vitrectomy with the inverted internal limiting membrane (ILM) flap technique and vitrectomy with internal limiting membrane peeling in highly myopic eyes with macular hole- (MH-) induced retinal detachment (MHRD).

METHODS

The PubMed, Web of Science, Embase, and Cochrane Library databases were comprehensively searched from inception to November 10, 2019, for published studies comparing the two techniques for the treatment of MHRD. The outcomes in the collected articles included the postoperative MH closure rate, retinal reattachment rate, and best-corrected visual acuity (BCVA). Review Manager (version 5.3) was used for analyses.

RESULTS

In total, seven retrospective studies comparing the inverted ILM flap technique with ILM peeling for the treatment of MHRD were included. The MH closure rate was significantly higher in the inverted ILM flap group than in the ILM peeling group at 6 and 12 months after initial surgery (OR = 15.39; 95% CI: 6.68 to 35.43; < 0.00001 and OR = 12.58, 95% CI: 3.51 to 45.08; =0.0001), while the retinal reattachment rate was similar in both groups at 6 months after initial surgery (OR = 2.40; 95% CI: 0.89 to 6.50; =0.08). Besides, the postoperative BCVA was significantly better in the inverted ILM flap group than in the ILM peeling group at 12 months after initial surgery (MD = -0.35; 95% CI: -0.52 to -0.18; < 0.0001).

CONCLUSIONS

Thus, the MH closure rate and postoperative BCVA may be better with the inverted ILM flap technique than with ILM peeling for myopic MHRD, while the postoperative retinal reattachment rate appears to be similar with both techniques. Therefore, in the future, vitrectomy with the inverted ILM flap technique should be preferred over standard ILM peeling technique for the treatment of MHRD in highly myopic eyes.

背景

本荟萃分析的目的是比较在高度近视合并黄斑裂孔性视网膜脱离（MHRD）患者中，采用倒置内界膜（ILM）瓣技术的玻璃体切除术与内界膜剥除术的形态学和功能学结局。

方法

全面检索了PubMed、Web of Science、Embase和Cochrane图书馆数据库，从建库至2019年11月10日发表的比较这两种治疗MHRD技术的研究。收集文章中的结局指标包括术后黄斑裂孔闭合率、视网膜复位率和最佳矫正视力（BCVA）。使用Review Manager（5.3版）进行分析。

结果

总共纳入了7项比较倒置ILM瓣技术与ILM剥除术治疗MHRD的回顾性研究。初次手术后6个月和12个月时，倒置ILM瓣组的黄斑裂孔闭合率显著高于ILM剥除组（OR = 15.39；95% CI：6.68至35.43；<0.00001，以及OR = 12.58，95% CI：3.51至45.08；=0.0001），而初次手术后6个月时两组的视网膜复位率相似（OR = 2.40；95% CI：0.89至6.50；=0.08）。此外，初次手术后12个月时，倒置ILM瓣组的术后BCVA显著优于ILM剥除组（MD = -0.35；95% CI：-0.52至-0.18；<0.0001）。