Hanai Mário, Amaral Dillan Cunha, Jacometti Raiza, Aguiar Eduardo Henrique Cassins, Gomes Fernando Cotrim, Cyrino Laura Goldfarb, Alves Milton Ruiz, Monteiro Mário Luiz Ribeiro, Fuganti Raphaela Masetto, Casella Antonio Marcelo Barbante, Louzada Ricardo Noguera
Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Division of Ophthalmology and the Laboratory for Investigation in Ophthalmology (LIM-33), Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Int J Retina Vitreous. 2024 Aug 22;10(1):56. doi: 10.1186/s40942-024-00573-1.
Macular holes are breaks in the retinal tissue at the center of the macula, affecting central vision. The standard treatment involves vitrectomy with membrane peeling and gas tamponade. However, for larger or chronic holes, alternative techniques like autologous retinal graft have emerged. This meta-analysis evaluates the efficacy and safety of retinal transplantation in managing large macular holes.
We conducted a systematic review and meta-analysis following PRISMA guidelines. The study was prospectively registered in PROSPERO (CRD42024504801). We searched PubMed, Web of Science, Cochrane, and Embase databases for observational studies including individuals with large macular holes with or without retinal detachments and retinal transplantation as the main therapy. We used a random-effects model to compute the mean difference with 95% confidence intervals and performed statistical analysis using R software.
We conducted a comprehensive analysis of 19 studies involving 322 patients diagnosed with various types of macular holes (MHs). These included cohorts with refractory MH, high myopia associated with MH, primary MH, and MH with retinal detachment (RD). The findings were promising, revealing an overall closure rate of 94% of cases (95% CI 88-98, I = 20%). Moreover, there was a significant improvement in postoperative visual acuity across all subgroups, averaging 0.45 (95% CI 0.33-0.58 ; I = 72%; p < 0.01) overall. However, complications occurred with an overall incidence rate of 15% (95% CI 7-25; I = 59%).
ART for large MH shows promising results, including significant improvements in visual acuity and a high rate of MH closure with low complication risks overall and for subgroups.
黄斑裂孔是黄斑中心视网膜组织的断裂，影响中心视力。标准治疗包括玻璃体切除术、膜剥除术和气液填充。然而，对于较大或慢性裂孔，自体视网膜移植等替代技术已经出现。本荟萃分析评估视网膜移植治疗大黄斑裂孔的疗效和安全性。
我们按照PRISMA指南进行了系统评价和荟萃分析。该研究已在PROSPERO（CRD42024504801）上进行前瞻性注册。我们在PubMed、Web of Science、Cochrane和Embase数据库中搜索观察性研究，纳入有或无视网膜脱离的大黄斑裂孔患者，并以视网膜移植作为主要治疗方法。我们使用随机效应模型计算95%置信区间的平均差，并使用R软件进行统计分析。
我们对19项研究进行了全面分析，涉及322例被诊断为各种类型黄斑裂孔（MH）的患者。这些患者包括难治性MH队列、与MH相关的高度近视队列、原发性MH队列以及伴有视网膜脱离（RD）的MH队列。研究结果令人鼓舞，显示总体病例闭合率为94%（95%CI 88-98，I=20%）。此外，所有亚组术后视力均有显著改善，总体平均提高0.45（95%CI 0.33-0.58；I=72%；p<0.01）。然而，并发症总体发生率为15%（95%CI 7-25；I=59%）。
自体视网膜移植治疗大黄斑裂孔显示出有前景的结果，包括视力显著改善、黄斑裂孔闭合率高，总体及各亚组并发症风险低。
