Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Surv Ophthalmol. 2022 Jul-Aug;67(4):932-949. doi: 10.1016/j.survophthal.2021.12.005. Epub 2021 Dec 9.
Pars plana vitrectomy (PPV) and scleral buckling (SB) are two of the most common surgical treatments for rhegmatogenous retinal detachment (RRD). This meta-analysis compares the efficacy and safety of PPV and SB for RRD. A systematic literature review was performed using Ovid MEDLINE, EMBASE and Cochrane CENTRAL from 2000 to June, 2021. Comparative studies, randomized controlled trials and observational studies investigating PPV and SB for RRD repair were included. The primary endpoint was final best- corrected visual acuity (BCVA). Secondary endpoints were reattachment rates, total operation time, and incidence of adverse events. Subgroup analyses including phakic status, presence of PVR-C or greater at baseline, and macular attachment status were conducted. Across 41 studies (8 RCTs, 33 observational studies), 5,401 SB and 10,546 PPV eyes were included. SB achieved a statistically significant, but likely not clinically significant, better final BCVA than PPV (0.38 ± 0.53 vs. 0.33 ± 0.53 logMAR (20/48 vs. 20/43 Snellen); weighted mean difference [WMD]: 0.07; 95% confidence interval: [0.02-0.11]; P = 0.005). SB had a better final BCVA compared to PPV in observational studies (P = 0.007) but not in RCTs (P = 0.21). SB had a lower incidence of post-operative cataract formation (P < 0.00001) and iatrogenic breaks (P < 0.00001), but a higher incidence of choroidal/subretinal hemorrhage (P = 0.007), choroidal detachment (P = 0.004), and residual subretinal fluid (RSRF) (P < 0.00001). Primary (86.5% vs. 84.8%; P = 0.13) and final (96.7% vs. 97.7%; P = 0.12) reattachment rates were similar between PPV and SB. PPV had a significantly higher primary reattachment rate in RCTs (P = 0.02) but not in observational studies (P = 0.30). SB was associated with a better final BCVA than PPV; however, this result was primarily driven by observational studies and phakic patients who developed cataracts. Primary and final reattachment rates were similar between the comparators. SB was associated with a significantly lower incidence of iatrogenic breaks and cataracts, while PPV was associated with a reduced risk of choroidal detachment, subretinal hemorrhage, and RSRF.
经扁平部玻璃体切除术（PPV）和巩膜扣带术（SB）是治疗孔源性视网膜脱离（RRD）最常用的两种手术治疗方法。本荟萃分析比较了 PPV 和 SB 治疗 RRD 的疗效和安全性。系统检索了 2000 年至 2021 年 6 月期间 Ovid MEDLINE、EMBASE 和 Cochrane CENTRAL 中的文献，纳入了比较 PPV 和 SB 治疗 RRD 修复的前瞻性研究、随机对照试验和观察性研究。主要终点是最终最佳矫正视力（BCVA）。次要终点是再附着率、总手术时间和不良事件发生率。包括晶体状态、基线时存在 PVR-C 或更高、黄斑附着状态等亚组分析。纳入了 41 项研究（8 项 RCT、33 项观察性研究），包括 5401 例 SB 和 10546 例 PPV 眼。SB 术后最终 BCVA 明显优于 PPV（0.38 ± 0.53 与 0.33 ± 0.53 logMAR（20/48 与 20/43 视力表）；加权均数差值[WMD]：0.07；95%置信区间：[0.02-0.11]；P=0.005），但差异可能无临床意义。SB 在观察性研究中优于 PPV（P=0.007），但在 RCT 中无差异（P=0.21）。SB 术后白内障形成（P<0.00001）和医源性裂孔（P<0.00001）的发生率较低，但脉络膜/视网膜下出血（P=0.007）、脉络膜脱离（P=0.004）和残余视网膜下液（RSRF）（P<0.00001）的发生率较高。PPV 和 SB 的原发性（86.5% vs. 84.8%；P=0.13）和最终（96.7% vs. 97.7%；P=0.12）再附着率相似。PPV 在 RCT 中的原发性再附着率明显高于 SB（P=0.02），但在观察性研究中无差异（P=0.30）。SB 的最终 BCVA 优于 PPV，但这一结果主要由观察性研究和发生白内障的有晶状体眼患者驱动。两种比较方法的原发性和最终再附着率相似。SB 与较低的医源性裂孔和白内障发生率相关，而 PPV 与脉络膜脱离、视网膜下出血和 RSRF 的风险降低相关。
