Amaral Dillan Cunha, Monteiro Mário Luiz Ribeiro, Alves Milton Ruiz, Belizario Ivar Vargas, Tebicherane Lucas de Sousa, Jacometti Raíza, Manso José Eduardo Ferreira, Traina Agma Juci Machado, Louzada Ricardo Noguera
Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Divisão de Oftalmologia e Laboratório de Investigação em Oftalmologia (LIM-33), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2024 Dec 6;22:eRW0832. doi: 10.31744/einstein_journal/2024RW0832. eCollection 2024.
Autologous platelet concentrates are rich in growth factors and have shown potential for high anatomical success rates in macular hole treatment. However, no systematic review has yet assessed its impact. Therefore, this study aimed to conduct a comprehensive review and meta-analysis on the comparative efficacy and safety of autologous platelet concentrates in treating macular hole. A systematic review of the literature on autologous platelet concentrate therapy for macular hole was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on September 9, 2023. Databases, including PubMed, the Cochrane Library, Web of Science, and Embase, were queried. A meta-analysis of random effects was performed. Efficacy was evaluated through anatomical closure, reopening of the macular hole at 6 months, average improvement of 2 lines, and visual field loss. Safety was evaluated by monitoring complications. A systematic search of multiple databases identified six studies (three randomized controlled trials and three non-randomized cohort studies) involving 616 patients (626 eyes). Autologous platelets concentrate therapy significantly improved macular hole closure compared to that in the controls (OR=4.35; 95%CI=2.08-9.10; p<0.0001; I²=9%). No significant differences were observed in hole reopening at 6 months, post-operative visual acuity improvement by 2 lines or more, or visual field loss between autologous platelets concentrate and control groups. The overall complication rates were similar between groups. Thus, autologous platelet concentrate therapy shows promise for promoting macular hole closure, particularly in smaller holes. Further research with standardized protocols, prolonged follow-ups, and larger sample sizes is needed to fully understand its benefits and limitations in macular hole closure. (https://www.crd.york.ac.uk/prospero/) under ID CRD42023455815.
自体血小板浓缩物富含生长因子，在黄斑裂孔治疗中已显示出较高解剖学成功率的潜力。然而，尚未有系统评价评估其影响。因此，本研究旨在对自体血小板浓缩物治疗黄斑裂孔的比较疗效和安全性进行全面综述和荟萃分析。2023年9月9日，根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对关于自体血小板浓缩物治疗黄斑裂孔的文献进行了系统综述。查询了包括PubMed、Cochrane图书馆、科学网和Embase在内的数据库。进行了随机效应荟萃分析。通过解剖学闭合、6个月时黄斑裂孔重新开放、平均视力提高2行和视野缺损来评估疗效。通过监测并发症来评估安全性。对多个数据库的系统检索确定了6项研究（3项随机对照试验和3项非随机队列研究），涉及616例患者（626只眼）。与对照组相比，自体血小板浓缩物治疗显著提高了黄斑裂孔闭合率（OR = 4.35；95%CI = 2.08 - 9.10；p < 0.0001；I² = 9%）。在6个月时裂孔重新开放、术后视力提高2行或更多，或自体血小板浓缩物组与对照组之间的视野缺损方面，未观察到显著差异。两组的总体并发症发生率相似。因此，自体血小板浓缩物治疗在促进黄斑裂孔闭合方面显示出前景，尤其是在较小的裂孔中。需要采用标准化方案、延长随访时间和更大样本量进行进一步研究，以充分了解其在黄斑裂孔闭合中的益处和局限性。（https://www.crd.york.ac.uk/prospero/），标识符为CRD42023455815。
