Chen He, Zhao Xin-Yu, Meng Li-Hui, Zhang Wen-Fei, Chen You-Xin
Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
Graefes Arch Clin Exp Ophthalmol. 2022 Feb;260(2):439-450. doi: 10.1007/s00417-021-05364-0. Epub 2021 Aug 28.
To estimate the clinical characteristics of retinal arterial macroaneurysms (RAM) and evaluate the prognosis of different interventions.
This study is a meta-analysis. The databases PubMed, EMBASE, and Ovid from inception to January 2021 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 by means of Freeman-Tukey variant of arcsine square transformation.
Sixty-nine studies involving 1332 patients were finally included. The pooling results indicated that 91% (95% CI [88 ~ 94%]) of the RAM patients were over sixty, 73% (95% CI [68 ~ 77%]) were female, and 73% (95% CI [66 ~ 79%]) have hypertension. By observation, the RAM closure rate was 64% (95% CI [39 ~ 86%]), the visual acuity (VA) improved in 55% (95% CI [40 ~ 71%]) of the patients, and the VA of 64% (95% CI [54 ~ 74%]) hemorrhagic versus 27% (95% CI [15 ~ 41%]) exudative patients improved significantly. By laser, the closure rate was 96% (95% CI [87 ~ 100%]), the VA improved in 73% (95% CI [65 ~ 80%]) of the patients, and the VA of 66% (95% CI [47 ~ 84%]) hemorrhagic versus 35% (95% CI [23 ~ 47%]) exudative patients improved significantly. By anti-VEGF, the closure rate was 98% (95% CI [93 ~ 100%]), the VA improved in 90% (95% CI [74 ~ 100%]) of the patients, and the VA of 58% (95% CI [18 ~ 94%]) hemorrhagic versus 67% (95% CI [31 ~ 96%]) exudative patients improved significantly.
RAM are most commonly seen in the elderly with a marked female predominance and a strong association with hypertension. Patients receiving laser or anti-VEGF treatments get higher closure rate and better visual prognosis than those with observation alone. Hemorrhagic RAM have a better visual prognosis by observation or laser treatment, while exudative RAM have a better visual prognosis by anti-VEGF treatment.
评估视网膜动脉大动脉瘤（RAM）的临床特征，并评价不同干预措施的预后。
本研究为一项荟萃分析。检索了从起始至2021年1月的PubMed、EMBASE和Ovid数据库以识别相关研究。使用R软件3.6.3版进行统计分析。采用反正弦平方变换的Freeman-Tukey变体计算95%置信区间的比例结果。
最终纳入69项研究，涉及1332例患者。汇总结果表明，91%（95%CI[88～94%]）的RAM患者年龄超过60岁，73%（95%CI[68～77%]）为女性，73%（95%CI[66～79%]）患有高血压。通过观察，RAM闭合率为64%（95%CI[39～86%]），55%（95%CI[40～71%]）的患者视力（VA）得到改善，64%（95%CI[54～74%]）的出血性患者与27%（95%CI[15～41%]）的渗出性患者的VA显著改善。通过激光治疗，闭合率为96%（95%CI[87～100%]），73%（95%CI[65～80%]）的患者VA得到改善，66%（95%CI[47～84%]）的出血性患者与35%（95%CI[23～47%]）的渗出性患者的VA显著改善。通过抗VEGF治疗，闭合率为98%（95%CI[93～100%]），90%（95%CI[74～100%]）的患者VA得到改善，58%（95%CI[18～94%]）的出血性患者与67%（95%CI[31～96%]）的渗出性患者的VA显著改善。
RAM最常见于老年人，女性占明显优势，且与高血压密切相关。接受激光或抗VEGF治疗的患者比仅接受观察的患者有更高的闭合率和更好的视力预后。出血性RAM通过观察或激光治疗有更好的视力预后，而渗出性RAM通过抗VEGF治疗有更好的视力预后。
