Parisi Guglielmo, Fallico Matteo, Avitabile Teresio, Longo Antonio, Ortisi Elina, Russo Andrea, Petrillo Francesco, Maugeri Andrea, Barchitta Martina, Bonfiglio Vincenza, Furino Claudio, Cennamo Gilda, Caselgrandi Paolo, Marolo Paola, Ventre Luca, Reibaldi Michele
Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin 10122, Italy.
Department of Ophthalmology, University of Catania, Catania 95100, Italy.
J Ophthalmol. 2021 Apr 16;2021:6627677. doi: 10.1155/2021/6627677. eCollection 2021.
To evaluate the efficacy of intravitreal dexamethasone implant (DEX) for the treatment of macular oedema secondary to vitrectomy for epiretinal membrane (ERM) and retinal detachment (RD) by conducting a systematic review with meta-analysis of published studies.
Studies reporting clinical outcomes of DEX use for the treatment of macular oedema secondary to ERM and RD vitrectomy were searched on PubMed and Embase databases. The primary outcome was best-corrected visual acuity (BCVA) change between baseline and post-DEX treatment, reported as mean difference (MD) with 95% confidence interval (CI). Mean central macular thickness (CMT) change was assessed as a secondary outcome. Postimplant adverse events, including intraocular pressure rise and cataract development, were reported as well.
Five uncontrolled studies, 1 nonrandomized controlled study, and 1 randomized controlled study were included, with a total of 5 cohorts and 3 cohorts in the ERM group and RD group, respectively. Considering the last available follow-up, a significant improvement in postimplant BCVA was found in the overall population, irrespective of the indication for vitrectomy (MD = -0.28, 95% CI = -0.37, -0.20; < 0.001), but with significant heterogeneity. In either group, mean BCVA significantly improved following the implant (in the ERM group, MD = -0.31, 95% CI = -0.40, -0.22; in the RD group, MD = -0.22, 95% CI = -0.41, -0.03), with no difference between the two groups (=0.41). However, there was significant heterogeneity in both groups. Considering the last available follow-up, a significant CMT reduction was found in the overall population, irrespective of the indication for vitrectomy (MD = -129.75, 95% CI = -157.49, -102.01; < 0.001). In the ERM group, a significant CMT reduction was shown following DEX (MD = -133.41, 95% CI = -155.37, -111.45; < 0.001), with no heterogeneity. In the RD group, mean CMT reduction was borderline significant (MD = -128.37, 95% CI = -253.57, -3.18; =0.040), with significant heterogeneity. No difference in CMT improvement was found between the two groups (=0.94).
This meta-analysis showed that DEX yielded a significant improvement in visual and anatomical outcomes, even if limited by significant heterogeneity. Dexamethasone implant represents an effective treatment for postoperative macular oedema secondary to ERM and RD vitrectomy.
通过对已发表研究进行系统评价和荟萃分析，评估玻璃体内注射地塞米松植入物（DEX）治疗视网膜前膜（ERM）和视网膜脱离（RD）玻璃体切除术后黄斑水肿的疗效。
在PubMed和Embase数据库中检索关于DEX用于治疗ERM和RD玻璃体切除术后黄斑水肿的临床结局的研究。主要结局是基线至DEX治疗后最佳矫正视力（BCVA）的变化，以平均差（MD）及95%置信区间（CI）报告。平均中心黄斑厚度（CMT）变化作为次要结局进行评估。还报告了植入后不良事件，包括眼压升高和白内障形成。
纳入了5项非对照研究、1项非随机对照研究和1项随机对照研究，共5个队列，其中ERM组和RD组分别有3个队列。考虑最后一次可用随访，总体人群中植入后BCVA有显著改善，无论玻璃体切除的指征如何（MD = -0.28，95%CI = -0.37，-0.20；P < 0.001），但存在显著异质性。在任何一组中，植入后平均BCVA均显著改善（ERM组，MD = -0.31，95%CI = -0.40，-0.22；RD组，MD = -0.22，95%CI = -0.41，-0.03），两组间无差异（P = 0.41）。然而，两组均存在显著异质性。考虑最后一次可用随访，总体人群中CMT显著降低，无论玻璃体切除的指征如何（MD = -129.75，95%CI = -157.49，-102.01；P < 0.001）。在ERM组中，DEX治疗后CMT显著降低（MD = -133.41，95%CI = -155.37，-111.45；P < 0.001），无异质性。在RD组中，平均CMT降低接近显著（MD = -128.37，95%CI = -253.57，-3.18；P = 0.040），存在显著异质性。两组间CMT改善无差异（P = 0.94）。
这项荟萃分析表明，即使受显著异质性限制，DEX在视力和解剖学结局方面仍有显著改善。地塞米松植入物是治疗ERM和RD玻璃体切除术后黄斑水肿的有效方法。
