Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and.
Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Retina. 2021 May 1;41(5):965-978. doi: 10.1097/IAE.0000000000002971.
To estimate the rate of retinal detachment (RD) after acute retinal necrosis (ARN) and evaluate the efficacies of different interventions.
The databases Medline and EMBASE from inception to March 2020 were searched to identify the relevant studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval were calculated using generalized linear mixed models.
Sixty-seven studies involving 1,811 patients were finally included. The pooling results suggested the general RD rate of ARN was 47%. The RD rate increased with the extent of retinitis and was slightly lower when involved Zone III. The RD rate was 37% for herpes simplex virus ARN and 46% for varicella-zoster virus ARN; 52% for immunocompetent patients and 39% for immunocompromised patients. Retinal detachment presented in 2% of eyes at the first visit. Systemic antiviral therapy could lower the RD rate significantly from 67% to 43%, and prophylactic vitrectomy could lower the RD rate significantly from 45% to 22%. Systemic antiviral therapy plus vitrectomy achieved the lowest RD rate to 18%. Although the efficacy of prophylactic laser or intravitreal antiviral therapy was still limited. Prophylactic vitrectomy might significantly increase the incidence of proliferative vitreoretinopathy from 7% to 32%.
About half of the eyes might develop RD during the entire course of ARN. Systemic antiviral therapy and prophylactic vitrectomy are effective interventions to prevent RD, whereas the roles of prophylactic laser or adjunctive intravitreal antiviral therapy are still unclear. Varicella-zoster virus ARN and cases with extensive retinitis might need intensified interventions.
估计急性视网膜坏死（ARN）后视网膜脱离（RD）的发生率，并评估不同干预措施的疗效。
检索 Medline 和 EMBASE 数据库，检索时间从建库至 2020 年 3 月，以确定相关研究。使用 R 软件版本 3.6.3 进行统计分析。使用广义线性混合模型计算具有 95%置信区间的比例结果。
最终纳入 67 项研究，共 1811 例患者。汇总结果表明，ARN 的总体 RD 发生率为 47%。RD 发生率随视网膜炎的范围而增加，累及Ⅲ区时略低。单纯疱疹病毒 ARN 的 RD 发生率为 37%，水痘-带状疱疹病毒 ARN 的 RD 发生率为 46%；免疫功能正常患者的 RD 发生率为 52%，免疫功能低下患者的 RD 发生率为 39%。首次就诊时，有 2%的眼出现 RD。全身抗病毒治疗可使 RD 发生率从 67%显著降低至 43%，预防性玻璃体切除术可使 RD 发生率从 45%显著降低至 22%。全身抗病毒治疗联合玻璃体切除术可使 RD 发生率降低至 18%。虽然预防性激光或眼内抗病毒治疗的疗效仍有限。预防性玻璃体切除术可使增生性玻璃体视网膜病变的发生率从 7%显著增加至 32%。
ARN 整个病程中约有一半的眼可能发生 RD。全身抗病毒治疗和预防性玻璃体切除术是预防 RD 的有效干预措施，而预防性激光或辅助眼内抗病毒治疗的作用仍不明确。水痘-带状疱疹病毒 ARN 和广泛视网膜病变的病例可能需要强化干预。
