Zhang Charles, Palka Charles, Zhu Daniel, Lai Daniel, Winokur Jules, Shwani Treefa, DeAngelis Margaret M, Reynolds Andrew L
Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA.
Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 955 Main Street, Buffalo, NY 14203, USA.
J Clin Med. 2024 May 24;13(11):3071. doi: 10.3390/jcm13113071.
The purpose of the study is to compare the visual outcomes and complications of sutured scleral fixation (SSF), a traditional and conservative surgical approach, and the newer and faster Yamane technique for secondary intraocular lens placement. A literature search was performed on PubMed, Embase, and Scopus on studies published between 1 July 2017 to 29 September 2023. Outcomes analyzed included the final best corrected visual acuity (BCVA) between 3 and 12 months to assess the effectiveness of the procedure, post-operative month (POM) 1 BCVA to assess the speed of visual recovery, endothelial cell count (ECC), absolute refractive error, surgical duration, and complication rates. Additional subgroup analyses were performed based on surgeon experience with the technique. Single-surgeon studies had an average of 26 procedures performed, whereas multiple-surgeon studies averaged only 9 procedures performed; these were then used to delineate surgeon experience. A sample-size weighted mean difference (MD) meta-analysis was performed across all variables using RevMan 5.4.1; < 0.05 was considered statistically significant. Thirteen studies with 737 eyes were included: 406 eyes were included in the SSF group, and 331 eyes were included in the Yamane group. There was no significant difference in the final BCVA between groups in both the single-surgeon versus multiple-surgeon studies (MD = -0.01, 95% CI: [-0.06, 0.04], = 0.73). In the single-surgeon studies, the BCVA at POM1 was significantly improved in the Yamane group compared to SSF (MD = -0.10, 95% CI: [-0.16, -0.04], = 0.002). In the multiple-surgeon studies, there was no significant difference in BCVA at POM1 (MD = -0.06, 95% CI: [-0.16, 0.04], = 0.23). The Yamane group had a shorter surgical duration than SSF in both single-surgeon and multiple-surgeon studies (MD = -24.68, 95% CI: [-35.90, -13.46], < 0.0001). The ECC, refractive error, and complication rates did not significantly differ amongst all groups. The Yamane technique demonstrated similar long-term visual outcomes and complication rates to the traditional SSF. Visual recovery was significantly faster in the Yamane group in the single-surgeon studies. The operative times were shorter across all Yamane groups. Based on these findings, it is advisable to consider the Yamane technique as a viable, and perhaps preferable, option for patients requiring secondary IOL placement, alongside traditional SSF methods.
本研究的目的是比较缝合巩膜固定术（SSF，一种传统且保守的手术方法）与更新、更快的山根技术在二期人工晶状体植入术中的视觉效果和并发症情况。我们在PubMed、Embase和Scopus上对2017年7月1日至2023年9月29日发表的研究进行了文献检索。分析的结果包括3至12个月时的最终最佳矫正视力（BCVA），以评估手术效果；术后第1个月（POM1）的BCVA，以评估视觉恢复速度；内皮细胞计数（ECC）、绝对屈光不正、手术时长和并发症发生率。还根据外科医生对该技术的经验进行了额外的亚组分析。单外科医生研究平均进行了26例手术，而多外科医生研究平均仅进行了9例手术；这些数据随后被用于界定外科医生的经验。使用RevMan 5.4.1对所有变量进行样本量加权平均差（MD）荟萃分析；P<0.05被认为具有统计学意义。纳入了13项研究共737只眼：SSF组纳入406只眼，山根组纳入331只眼。在单外科医生与多外科医生研究中，两组间最终BCVA均无显著差异（MD = -0.01，95%CI：[-0.06, 0.04]，P = 0.73）。在单外科医生研究中，与SSF相比，山根组在POM1时的BCVA有显著改善（MD = -0.10，95%CI：[-0.16, -0.04]，P = 0.002）。在多外科医生研究中，POM1时的BCVA无显著差异（MD = -0.06，95%CI：[-0.16, 0.04]，P = 0.23）。在单外科医生和多外科医生研究中，山根组的手术时长均比SSF组短（MD = -24.68，95%CI：[-35.90, -13.46]，P<0.0001）。所有组间的ECC、屈光不正和并发症发生率均无显著差异。山根技术与传统SSF相比，显示出相似的长期视觉效果和并发症发生率。在单外科医生研究中，山根组的视觉恢复明显更快。所有山根组的手术时间都更短。基于这些发现，对于需要二期人工晶状体植入的患者，除了传统的SSF方法外，建议将山根技术视为一种可行的、甚至可能更优的选择。
