Tsai Hou-Ren, Chen Tai-Li, Chang Chun-Yu, Huang Huei-Kai, Lee Yuan-Chieh
Department of Medical Education, Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan.
School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
J Clin Med. 2021 Oct 24;10(21):4895. doi: 10.3390/jcm10214895.
Evidence regarding the effect of a face-down posture (FDP) for large idiopathic macular hole (IMH) is inconsistent. We conducted a systematic review and meta-analysis to determine whether a postoperative FDP is required for the treatment of large IMH. Eligible randomized controlled trials published before September 2021 were retrieved from the Medline, Embase, and Cochrane Library databases. The efficacy outcome was the IMH closure rate and the visual acuity improvement rate. A meta-analysis was performed using a random effects model. The "Grading of Recommendations Assessment, Development, and Evaluation" approach was implemented, and the numbers needed-to-treat (NNTs) were calculated. Seven studies comprising 640 patients were included. We performed a predefined subgroup analysis of IMH size using a cut-off point of 400 µm. Compared with non-FDP, a significant effect of FDP was found in the IMH > 400 µm group (OR = 3.34; 95% CI = 1.57-7.14; trial sequential analysis-adjusted CI = 1.20-11.58; NNTs = 7.9). After stratifying by the posturing periods, the beneficial effect of FDP lasting at least five days, but not three days was observed for large IMH. Maintaining a FDP for at least five days postoperatively is an effective strategy (certainty of evidence: "moderate") for treating large IMH.
关于俯卧位（FDP）对特发性大黄斑裂孔（IMH）疗效的证据并不一致。我们进行了一项系统评价和荟萃分析，以确定治疗特发性大黄斑裂孔术后是否需要采用俯卧位。从Medline、Embase和Cochrane图书馆数据库中检索了2021年9月之前发表的符合条件的随机对照试验。疗效指标为黄斑裂孔闭合率和视力改善率。采用随机效应模型进行荟萃分析。采用“推荐分级评估、制定和评价”方法，并计算治疗所需人数（NNTs）。纳入了7项研究，共640例患者。我们使用400µm的截断点对黄斑裂孔大小进行了预定义的亚组分析。与非俯卧位相比，在黄斑裂孔>400µm组中发现俯卧位有显著效果（OR = 3.34；95%CI = 1.57 - 7.14；试验序贯分析调整后的CI = 1.20 - 11.58；NNTs = 7.9）。按体位摆放时间分层后，观察到俯卧位对大黄斑裂孔的有益效果持续至少5天，但不是3天。术后保持俯卧位至少5天是治疗大黄斑裂孔的有效策略（证据确定性：“中等”）。
