Parisi Guglielmo, Fallico Matteo, Maugeri Andrea, Barchitta Martina, Agodi Antonella, Russo Andrea, Longo Antonio, Avitabile Teresio, Castellino Niccolò, Bonfiglio Vincenza, Dell'Omo Roberto, Furino Claudio, Cennamo Gilda, Rejdak Robert, Nowomiejska Katarzyna, Toro Mario, Marolo Paola, Ventre Luca, Reibaldi Michele
Department of Ophthalmology, University of Catania, Catania, Italy.
Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy.
PLoS One. 2021 Mar 5;16(3):e0246667. doi: 10.1371/journal.pone.0246667. eCollection 2021.
To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies.
PubMed, Medline and Embase databases were searched up to May 2020. Included cohorts were divided into three groups: degenerative LMH group, lamellar hole associated epiretinal proliferation (LHEP) group and tractional LMH group. LHEP is likely to be associated with degenerative LMHs, but less commonly could be associated with mixed LMHs. To reduce risk of possible misclassification bias, eyes with LHEP which could not have been precisely classified by the authors, were included into the LHEP group. The primary outcome was to investigate the visual change following primary vitrectomy in the degenerative LMH and LHEP group versus the tractional LMH group. A sensitivity analysis excluding the LHEP group was also performed on the primary outcome. Mean difference (MD) in best corrected visual acuity between baseline and post-treatment was calculated, along with 95% confidence interval (CI). Rate of incidence of post-operative full-thickness macular hole (FTMH) was assessed as secondary outcome.
Thirteen studies were included. Pooled analyses including all groups showed a significant visual improvement following vitrectomy (pre-post MD = -0.17;95%CI = -0.22,-0.12;p<0.001), with no difference in visual improvement between the degenerative LMH and LHEP group and the tractional LMH group. The sensitivity analysis excluding LHEP group confirmed no difference in visual change between the degenerative LMH group (pre-post MD = -0.18;95%CI = -0.24,-0.12;p<0.001) and the tractional LMH group (MD = -0.16;95%CI = -0.26,-0.07;p<0.001). The incidence rate of post-operative FTMH was higher in the degenerative LMH and LHEP group than in the tractional LMH group (p = 0.002).
Primary vitrectomy for LMH ensured a favorable visual outcome, with no difference in visual gain between degenerative and tractional LMHs. However, a higher incidence of post-operative FTMHs was found in eyes with the degenerative LMH subtype.
通过对已发表研究的荟萃分析，评估玻璃体切除术治疗退行性和牵拉性板层黄斑裂孔（LMH）的疗效。
检索截至2020年5月的PubMed、Medline和Embase数据库。纳入的队列分为三组：退行性LMH组、板层裂孔相关视网膜前增殖（LHEP）组和牵拉性LMH组。LHEP可能与退行性LMH相关，但较少与混合性LMH相关。为降低可能的错误分类偏倚风险，作者无法精确分类的LHEP眼被纳入LHEP组。主要结局是研究退行性LMH和LHEP组与牵拉性LMH组初次玻璃体切除术后的视力变化。还对主要结局进行了排除LHEP组的敏感性分析。计算基线和治疗后最佳矫正视力的平均差（MD）以及95%置信区间（CI）。评估术后全层黄斑裂孔（FTMH）的发生率作为次要结局。
纳入13项研究。包括所有组的汇总分析显示，玻璃体切除术后视力有显著改善（术前术后MD = -0.17；95%CI = -0.22，-0.12；p<0.001），退行性LMH和LHEP组与牵拉性LMH组之间的视力改善无差异。排除LHEP组的敏感性分析证实，退行性LMH组（术前术后MD = -0.18；95%CI = -0.24，-0.12；p<0.001）和牵拉性LMH组（MD = -0.16；95%CI = -0.26，-0.07；p<0.001）之间的视力变化无差异。退行性LMH和LHEP组术后FTMH的发生率高于牵拉性LMH组（p = 0.002）。
LMH的初次玻璃体切除术确保了良好的视力结局，退行性和牵拉性LMH之间的视力改善无差异。然而，退行性LMH亚型的眼中术后FTMH的发生率较高。
