Shandong Traditional Chinese Medicine University, Jinan, China.
Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
PLoS One. 2024 Nov 14;19(11):e0310859. doi: 10.1371/journal.pone.0310859. eCollection 2024.
Rhegmatogenous retinal detachment (RRD) is the most common ophthalmic emergency threatening vision, with an incidence ranging from 6.3 to 17.9 per 100,000 people per year. However, optimal surgical management of RRD remains controversial. This network meta-analysis compared the efficacy and safety of different surgical options in patients with RRD.
We systematically searched PubMed, Embase, Cochrane Library and Web of science for randomized controlled trials (RCT) from inception to 24th September 2023. Frequentist network meta-analyses with the random-effects model was used to synthesize data. The risk of bias for the included RCTs was evaluated using the Cochrane tool for assessing risk of bias, and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. And we performed the network meta-analysis utilizing R 4.1.3 software and Stata 16SE.
A total of 19 RCTs enrolled 2589 eyes were included. With high-to-very low certainty of evidence, compared with pneumatic retinopexy (PR), scleral buckling (SB) (odd ratio (OR) = 0.52, 95% confidence interval (CI) [0.30; 0.91]), pars plana vitrectomy (PPV) (OR = 2.35, 95% CI [1.32; 4.20]), PPV+SB (OR = 2.59, 95% CI [1.32; 5.09]) and PPV combined with phacomulsification (PCV) (OR = 7.72, 95% CI [1.07; 55.87]) were more effect in improving primary reattachment rate; for postoperative 6-month vision, SB was superior to PPV+SB (mean difference (MD) = 0.14, 95% CI [0.01; 0.27]). When compared with SB, PPV (OR = 5.27, 95% CI [3.13; 8.86]) and PPV+SB (OR = 10.12, 95% CI [4.31; 23.77]) shows a higher incidence of postoperative cataract progression. Compared to PR, the same is true for PPV (OR = 7.51, 95% CI [3.33; 16.91]) and PPV+SB (OR = 14.43, 95% CI [4.97; 41.93]).
PR appears to be associated with a lower rate of primary reattachment rate and postoperative cataract progression. In view of the small sample sizes of the included studies and the low certainty of evidence, these findings must be interpreted with caution. A large number of high-quality trials should be conducted to verify the effects of different surgical techniques in the future.
孔源性视网膜脱离（RRD）是最常见的威胁视力的眼科急症，年发病率为 6.3 至 17.9/10 万。然而，RRD 的最佳手术治疗仍存在争议。本网络荟萃分析比较了 RRD 患者不同手术选择的疗效和安全性。
我们系统地检索了 PubMed、Embase、Cochrane 图书馆和 Web of science 从成立到 2023 年 9 月 24 日的随机对照试验（RCT）。使用随机效应模型的频率主义网络荟萃分析来综合数据。使用 Cochrane 评估偏倚风险工具评估纳入 RCT 的偏倚风险，并使用推荐评估、制定和评估方法（Grading of Recommendations, Assessment, Development, and Evaluation，GRADE）评估证据的确定性。我们使用 R 4.1.3 软件和 Stata 16SE 进行网络荟萃分析。
共纳入 19 项 RCT，涉及 2589 只眼。高到极低确定性证据表明，与气动视网膜固定术（PR）相比，巩膜扣带术（SB）（比值比（OR）=0.52，95%置信区间（CI）[0.30；0.91]）、玻璃体切除术（PPV）（OR=2.35，95%CI [1.32；4.20]）、PPV+SB（OR=2.59，95%CI [1.32；5.09]）和 PPV 联合超声乳化术（PCV）（OR=7.72，95%CI [1.07；55.87]）在提高初次复位率方面更有效；术后 6 个月视力方面，SB 优于 PPV+SB（平均差值（MD）=0.14，95%CI [0.01；0.27]）。与 SB 相比，PPV（OR=5.27，95%CI [3.13；8.86]）和 PPV+SB（OR=10.12，95%CI [4.31；23.77]）显示术后白内障进展发生率更高。与 PR 相比，PPV（OR=7.51，95%CI [3.33；16.91]）和 PPV+SB（OR=14.43，95%CI [4.97；41.93]）也是如此。
PR 似乎与较低的初次复位率和术后白内障进展发生率相关。鉴于纳入研究的样本量较小和证据确定性较低，这些发现必须谨慎解释。未来应开展大量高质量试验来验证不同手术技术的效果。
