Temerty Faculty of Medicine, University of Toronto (RSH, AM), Toronto, Ontario, Canada.
Department of Ophthalmology and Visual Sciences, McGill University (THAL), Montreal, Quebec, Canada.
Am J Ophthalmol. 2024 Oct;266:144-155. doi: 10.1016/j.ajo.2024.05.008. Epub 2024 May 28.
To compare the efficacy and safety of pars plana vitrectomy (PPV) with silicone oil compared to gas tamponade for uncomplicated rhegmatogenous retinal detachment (RRD).
Systematic review and meta-analysis.
A systematic literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Library from January 2000 to September 2023 for comparative studies evaluating the efficacy and safety of PPV with either silicone oil or gas tamponade in the setting of uncomplicated RRD. Our primary outcome was best-corrected visual acuity at the last study observation. Secondary outcomes included the rates of retinal reattachment, retinal thickness, and the incidence of adverse events. We performed a meta-analysis using a random-effects model.
Nine observational studies reporting on 491 RRD eyes were included. The mean best-corrected visual acuity at the last study observation was significantly better in the gas tamponade group than in the silicone oil group (weighted mean difference [WMD] = 0.17 logMAR, 95% confidence interval [CI] = [0.06, 0.27], P = .002). Rates of primary retinal reattachment were similar between the silicone oil and gas tamponade groups (P = .89). The ganglion cell layer was significantly thinner in the silicone oil group compared to the gas tamponade group (WMD =-3.70 µm, 95% CI = [-5.87, -1.53, P = .0008), as was the inner plexiform layer (WMD = -2.45, 95% CI = [-4.50, -0.40], P = .02) and outer nuclear layer (WMD = -11.74 µm, 95% CI = [-18.39, -5.10], P = .0005).
PPV with gas tamponade was associated with better functional outcomes compared to PPV with silicone oil, although both tamponades yielded comparable primary reattachment rates. The absence of randomized trials and the potential for selection bias underscore the importance of further investigation in diverse patient populations.
比较单纯性孔源性视网膜脱离（RRD）患者行巩膜外环扎加压术联合硅油或气体填充的疗效和安全性。
系统评价和荟萃分析。
系统检索 Ovid MEDLINE、Embase 和 Cochrane 图书馆，检索时间从 2000 年 1 月至 2023 年 9 月，收集评估单纯性 RRD 患者行巩膜外环扎加压术联合硅油或气体填充的疗效和安全性的对照研究。主要结局指标为末次研究观察时的最佳矫正视力。次要结局指标包括视网膜复位率、视网膜厚度和不良事件发生率。采用随机效应模型进行荟萃分析。
纳入 9 项观察性研究共 491 只眼。末次研究观察时，气体填充组的最佳矫正视力明显优于硅油组（加权均数差[WMD]=0.17 对数视力矫正值，95%置信区间[CI]：[0.06，0.27]，P=0.002）。硅油组和气体填充组的原发性视网膜复位率相似（P=0.89）。与气体填充组相比，硅油组的神经节细胞层厚度明显变薄（WMD=-3.70μm，95%CI：[-5.87，-1.53]，P=0.0008），内丛状层（WMD=-2.45，95%CI：[-4.50，-0.40]，P=0.02）和外核层（WMD=-11.74μm，95%CI：[-18.39，-5.10]，P=0.0005）也变薄。
与硅油相比，巩膜外环扎加压术联合气体填充可获得更好的功能结局，尽管两种填充物的原发性复位率相似。由于缺乏随机试验和选择偏倚的潜在影响，需要在不同的患者群体中进一步研究。
