Song Desheng, Ma Yanqiu, Ji Hua, Zhou Qing, Cheng Haixia
Department of Ophthalmology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Gulou District, Nanjing, 210008, Jiangsu Province, China.
Department of nursing, Children's Hospital of Nanjing Medical University, Nanjing, 210008, Jiangsu Province, China.
BMC Ophthalmol. 2024 Dec 19;24(1):527. doi: 10.1186/s12886-024-03804-z.
This study aimed to conduct a network meta-analysis to evaluate the efficacy of various non-surgical treatments for intermittent exotropia(IXT).
A comprehensive search of the PubMed, EMbase, and Cochrane Library databases was performed to identify relevant randomized controlled trials (RCTs) up to June 2024. Following independent screening, data extraction, and bias assessment by two researchers, network meta-analysis was conducted using R 4.2.2 software.
A total of 11 RCTs involving 1411 patients were included. Treatment options included overminus lenses (OML), conventional prisms(base-in prism) (CP), part time occlusion (PTO), and binocular vision training (BVT). OML demonstrated superior efficacy in improving distance and near control(1.1, 95% confidence interval (CI), 0.22 ∼ 1.8); 0.67, 95% CI :0.027 ∼ 1.2), as well as reducing near exodeviation compared to observation(4.5, 95% CI, 1.9 ∼ 6.9), but failed to reduce distance angle of deviation(3.2, 95%CI, -1.1 ∼ 6.4). No significant effect in improving control and reducing exodeviation angle at both distance and near was observed in PTO, BVT, and CP. Probability ranking indicated that the top-ranking three non-surgical interventions were OML, BVT and PTO for improving distance control and reducing near exodeviation; the top three non-surgical interventions for reducing distance exodevition were OML, PTO and BVT; the best non-surgical intervention for improving near control was OML, BVT、 PTO and CP have similar effects. The four non-surgical treatments had no significant impact on near stereoacuity.
Overall, OML ranks first among the four conservative treatment methods. These four commonly used non-surgical interventions did not significantly impact near stereoacuity. Clinicians should tailor personalized treatment strategies for patients with intermittent exotropia based on disease severity, characteristics, efficacy, and cost considerations.
本研究旨在进行一项网状Meta分析，以评估各种非手术治疗间歇性外斜视（IXT）的疗效。
全面检索了PubMed、EMbase和Cochrane图书馆数据库，以识别截至2024年6月的相关随机对照试验（RCT）。在两名研究人员进行独立筛选、数据提取和偏倚评估后，使用R 4.2.2软件进行网状Meta分析。
共纳入11项涉及1411例患者的RCT。治疗选择包括负球镜（OML）、传统棱镜（底向内棱镜）（CP）、部分时间遮盖（PTO）和双眼视觉训练（BVT）。与观察相比，OML在改善远距离和近距离控制方面显示出更好的疗效（1.1，95%置信区间（CI），0.22～1.8；0.67，95%CI：0.027～1.2），以及减少近距离外斜视（4.5，95%CI，1.9～6.9），但未能减少远距离偏斜角（3.2，95%CI，-1.1～6.4）。在PTO、BVT和CP中，未观察到在改善控制和减少远距离及近距离外斜视角度方面有显著效果。概率排序表明，在改善远距离控制和减少近距离外斜视方面，排名前三的非手术干预措施是OML、BVT和PTO；在减少远距离外斜视方面，排名前三的非手术干预措施是OML、PTO和BVT；在改善近距离控制方面，最佳的非手术干预措施是OML，BVT、PTO和CP效果相似。这四种非手术治疗对近距离立体视锐度没有显著影响。
总体而言，OML在四种保守治疗方法中排名第一。这四种常用的非手术干预措施对近距离立体视锐度没有显著影响。临床医生应根据疾病严重程度、特征、疗效和成本考虑，为间歇性外斜视患者制定个性化的治疗策略。
