视网膜色素变性中黄斑囊样水肿的管理：一项系统评价和荟萃分析。
Management of Cystoid Macular Edema in Retinitis Pigmentosa: A Systematic Review and Meta-Analysis.
作者信息
Chen Chen, Liu Xia, Peng Xiaoyan
机构信息
Department of Ophthalmology, The Second People's Hospital of Yunnan Province (Affiliated Hospital of Yunnan University, Fourth Affiliated Hospital of Kunming Medical University), Kunming, China.
Yunnan Clinical Medicine Center for Ocular Disease, Yunnan Eye Institute, Kunming, China.
出版信息
Front Med (Lausanne). 2022 May 16;9:895208. doi: 10.3389/fmed.2022.895208. eCollection 2022.
BACKGROUND
To date, various treatments for cystoid macular edema (CME) in retinitis pigmentosa (RP) have been reported. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of current treatments for RP-CME.
METHODS
PubMed, Embase and the Cochrane library were searched from inception to August 2021. ClinicalTrials.gov, WHO ICTRP and ISRCTN were also searched for relevant studies. Only studies published in English were included. The RoB 2 tool was used to evaluate the risk of bias of randomized controlled trials (RCTs), and the MINORS scale was used to assess the methodological quality of non-RCTs. Review manager (Revman) was used to pool the data. The primary outcomes included the change of central macular thickness (CMT) and best-corrected visual acuity (BCVA) from baseline. The secondary outcomes included fluorescein angiography (FA) leakage, rebound of CME and adverse effects.
RESULTS
Thirty-two studies were included in the current systematic review and 7 studies were used for meta-analysis. Treatments for RP-CME included oral and topical carbonic anhydrase inhibitors (CAIs), systematic and local steroids, anti-VEGF therapy, NSAIDS, grid LASER photocoagulation, subliminal micropulse LASER, vitrectomy, lutein supplement and oral minocycline. CAIs and local steroids were proved to be effective in reducing CMT. The effects of anti-VEGF reagents varied among studies. Regarding other treatments, only one study for each method fitted the inclusion criteria, so the evidence was very limited.
CONCLUSION
Topical CAIs, oral CAIs and local steroids are effective in treating RP-CME. However, due to the overall inferior design and small patient number of the included studies, the quality of evidence was poor. Systematic steroids, LASER, NSAIDS and vitrectomy may also be effective, nevertheless, considering the limited number of studies, no conclusion could be drawn regarding these treatments. More well-designed and conducted studies are needed in this field.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021273979, identifier CRD42021273979.
背景
迄今为止，已有多种治疗视网膜色素变性（RP）相关黄斑囊样水肿（CME）的方法被报道。我们进行了一项系统评价和荟萃分析，以评估目前治疗RP-CME的疗效和安全性。
方法
检索了从建库至2021年8月的PubMed、Embase和Cochrane图书馆。还检索了ClinicalTrials.gov、世界卫生组织国际临床试验注册平台（WHO ICTRP）和国际标准随机对照试验编号注册库（ISRCTN）以查找相关研究。仅纳入英文发表的研究。采用RoB 2工具评估随机对照试验（RCT）的偏倚风险，采用MINORS量表评估非RCT的方法学质量。使用Review Manager（Revman）汇总数据。主要结局包括中心黄斑厚度（CMT）和最佳矫正视力（BCVA）相对于基线的变化。次要结局包括荧光素血管造影（FA）渗漏、CME复发和不良反应。
结果
本系统评价纳入了32项研究，7项研究用于荟萃分析。RP-CME的治疗方法包括口服和局部碳酸酐酶抑制剂（CAIs）、全身和局部类固醇、抗VEGF治疗、非甾体抗炎药（NSAIDS）、格栅激光光凝、阈下微脉冲激光、玻璃体切除术、叶黄素补充剂和口服米诺环素。已证实CAIs和局部类固醇在降低CMT方面有效。抗VEGF药物的效果在不同研究中有所差异。对于其他治疗方法，每种方法仅有一项研究符合纳入标准，因此证据非常有限。
结论
局部CAIs、口服CAIs和局部类固醇在治疗RP-CME方面有效。然而，由于纳入研究的总体设计质量较差且患者数量较少，证据质量较低。全身类固醇、激光、NSAIDS和玻璃体切除术可能也有效，不过，考虑到研究数量有限，无法就这些治疗方法得出结论。该领域需要更多设计良好且实施规范的研究。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021273979，标识符CRD42021273979。
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