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原发性内界膜剥除术在视网膜脱离修复中的应用:系统评价和荟萃分析。

Primary ILM peeling during retinal detachment repair: a systematic review and meta-analysis.

机构信息

Department of Ophthalmology, Hospital de Conxo, University Hospital of Santiago de Compostela, Ramón Baltar s/n, 15706, Santiago de Compostela, Spain.

Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain.

出版信息

Sci Rep. 2023 Mar 3;13(1):3586. doi: 10.1038/s41598-023-30060-w.

Abstract

Epiretinal membrane (ERM) formation is a known postoperative complication following retinal detachment (RD) repair surgery. Prophylactic peeling of the internal limiting membrane (ILM) during surgery has been shown to reduce the risk of developing postoperative ERM formation. Some baseline characteristics and degrees of surgical complexity may act as risk factors for ERM development. In this review we aimed to investigate the benefit of ILM peeling in patients without significant proliferative vitreoretinopathy (PVR) who underwent pars plana vitrectomy for RD repair. A literature search using PubMed and various keywords retrieved relevant papers from which data were extracted and analyzed. Finally, the results of 12 observational studies (3420 eyes) were summarized. ILM peeling significantly reduced the risk of postoperative ERM formation (RR = 0.12, 95% CI 0.05-0.28). The groups did not differ in final visual acuity (SMD 0.14 logMAR (95% CI - 0.03-0.31)). The risk of RD recurrence (RR = 0.51, 95% CI 0.28-0.94) and the need for secondary ERM surgery (RR = 0.05, 95% CI 0.02-0.17) were also higher in the non-ILM peeling groups. In summary, although prophylactic ILM peeling appears to reduce the rate of postoperative ERM, this benefit does not translate into consistent visual recovery across studies and potential complications must be considered.

摘要

视网膜脱离(RD)修复手术后,视网膜内界膜(ILM)上皮细胞增生形成的内界膜(ERM)是一种已知的术后并发症。研究表明,在手术中预防性剥除 ILM 可以降低术后 ERM 形成的风险。一些基线特征和手术复杂性程度可能是 ERM 发展的危险因素。在本综述中,我们旨在研究对于无明显增生性玻璃体视网膜病变(PVR)的 RD 修复患者,行标准经睫状体平坦部玻璃体切除术(PPV)时是否进行 ILM 剥除的获益。我们通过 PubMed 检索和使用各种关键词进行文献检索,提取并分析了相关数据。最后,总结了 12 项观察性研究(3420 只眼)的结果。ILM 剥除显著降低了术后 ERM 形成的风险(RR=0.12,95%CI 0.05-0.28)。两组在最终视力(SMD 0.14 logMAR(95%CI -0.03-0.31))方面无差异。无 ILM 剥除组的 RD 复发风险(RR=0.51,95%CI 0.28-0.94)和需要二次 ERM 手术的风险(RR=0.05,95%CI 0.02-0.17)更高。总之,虽然预防性 ILM 剥除似乎可以降低术后 ERM 的发生率,但这种获益并不能转化为研究间一致的视力恢复,且必须考虑潜在的并发症。

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