Mihalache Andrew, Huang Ryan S, Ahmed Haleema, Patil Nikhil S, Popovic Marko M, Kertes Peter J, Muni Rajeev H
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Ophthalmologica. 2024;247(1):30-43. doi: 10.1159/000534851. Epub 2023 Oct 28.
The safety and effectiveness of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling remains poorly understood for the treatment of epiretinal membrane (ERM).
Our study aims to compare the safety and effectiveness of PPV with and without ILM peeling for ERM.
A systematic literature search was conducted on Ovid MEDLINE, Embase, Cochrane Library, and Google Scholar from January 2000 to January 2023 for comparative studies reporting visual and anatomical outcomes for patients with ERM that received PPV with or without ILM peeling. Primary outcomes included best-corrected visual acuity (BCVA) at last study observation and change in BCVA from baseline. Secondary outcomes included retinal thickness (RT) at last study observation, change in RT from baseline, risk of ERM recurrence, and adverse events. A random-effects meta-analysis was performed. Risk of bias of randomized controlled trials was assessed using the Risk of Bias 2 tool of observational studies using the Risk of Bias in Non-randomized Studies of Interventions-I tool. The certainty of evidence of outcomes was evaluated using Grading of Recommendations, Assessment, Development and Evaluation criteria.
Nineteen studies reporting on 1,291 eyes at baseline were included. PPV with and without ILM peel achieved a similar BCVA at last study observation (p = 0.68) and change in BCVA from baseline (p = 0.79). These findings remained consistent irrespective of whether simultaneous phacoemulsification was performed. PPV with ILM peel achieved a significantly lower incidence of ERM recurrence (risk ratio [RR] = 0.26, 95% CI = [0.13, 0.51], p < 0.0001) and additional surgery (RR = 0.17, 95% CI = [0.04, 0.74], p = 0.02) compared to PPV without ILM peel.
PPV with and without ILM peel achieved a similar BCVA at last study observation in ERM patients. Patients treated with PPV and ILM peel also had a reduced risk of ERM recurrence and lower reoperation risk. These conclusions are associated with a moderate certainty of evidence and potential for bias from multiple non-randomized studies.
对于视网膜前膜（ERM）的治疗，玻璃体视网膜手术（PPV）联合内界膜（ILM）剥除术的安全性和有效性仍知之甚少。
我们的研究旨在比较PPV联合和不联合ILM剥除术治疗ERM的安全性和有效性。
于2000年1月至2023年1月在Ovid MEDLINE、Embase、Cochrane图书馆和谷歌学术上进行了系统的文献检索，以查找比较接受PPV联合或不联合ILM剥除术的ERM患者视觉和解剖学结果的研究。主要结局包括最后一次研究观察时的最佳矫正视力（BCVA）以及BCVA相对于基线的变化。次要结局包括最后一次研究观察时的视网膜厚度（RT）、RT相对于基线的变化、ERM复发风险和不良事件。进行了随机效应荟萃分析。使用观察性研究的偏倚风险2工具评估随机对照试验的偏倚风险，使用干预性非随机研究中的偏倚风险-I工具评估观察性研究的偏倚风险。使用推荐分级、评估、制定和评价标准评估结局证据的确定性。
纳入了19项在基线时报告1291只眼情况的研究。最后一次研究观察时，PPV联合和不联合ILM剥除术的BCVA相似（p = 0.68），且BCVA相对于基线的变化相似（p = 0.79）。无论是否同时进行超声乳化术，这些结果均保持一致。与不联合ILM剥除术的PPV相比，联合ILM剥除术的PPV的ERM复发率（风险比[RR] = 0.26，95%置信区间[CI] = [0.13, 0.51]，p < 0.0001）和再次手术率（RR = 0.17，95% CI = [0.04, 0.74]，p = 0.02）显著更低。
在最后一次研究观察时，PPV联合和不联合ILM剥除术在ERM患者中获得了相似的BCVA。接受PPV联合ILM剥除术治疗的患者的ERM复发风险也较低，再次手术风险也较低。这些结论的证据确定性中等，且存在来自多项非随机研究的偏倚可能性。
