原发性巩膜扣带术与玻璃体切除术治疗4A期早产儿视网膜病变：手术结果的系统评价和荟萃分析
Primary scleral buckling vs. vitrectomy for stage 4A retinopathy of prematurity: a systematic review and meta-analysis of surgical outcomes.
作者信息
Saeed Omar B, Siatkowski R Michael, Coussa Razek Georges
机构信息
Department of Ophthalmology, Kettering Health Dayton, Dayton, OH, USA.
Dean McGee Eye Institute, Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
出版信息
Eye (Lond). 2025 Feb;39(3):418-423. doi: 10.1038/s41433-024-03563-7. Epub 2025 Jan 2.
TOPIC
To compare anatomic outcomes of primary scleral buckle (SB) vs. lens sparing pars plana vitrectomy (LSV) in treating retinopathy of prematurity (ROP) associated Stage 4A retinal detachment (RD).
CLINICAL RELEVANCE
ROP is the leading cause of blindness in childhood in industrialized countries worldwide. ROP eyes with Type 1 disease can progress into tractional retinal detachment with or without a rhegmatogenous component despite early medical management with retinal ablation and/or intravitreal anti-VEGF injections, necessitating surgical management.
METHODS
This systematic review and meta-analysis was registered with the Open Science Framework. A PubMed literature search was performed, and ROP-associated Stage 4A RD studies were selected based on preset inclusion criteria. Information on gestational age, age at surgery, type of surgery, and surgical outcomes were collected. Snellen visual acuity (VA) was collected when available. Postoperative anatomic success was defined as complete retinal reattachment, in which both the fovea and retinal periphery were attached. Overall, 231 eyes with confirmed ROP Stage 4A RD were collected from 24 studies. Cross-sectional analyses were used to study the rates of anatomic success and need for re-operation between eyes repaired with primary SB vs. primary LSV.
RESULTS
The mean gestational age was 26.0 weeks old (range 21 to 31). 152 eyes (66%) had primary LSV, 73 eyes (32%) had primary SB, and 6 eyes (8%) had combined SB & LSV. The rate of single surgery anatomic success was 84% for primary LSV, 62% for primary SB (p < 0.05), and 83% for SB & LSV. The final anatomic success rate was 91% for primary LSV, 66% for primary SB (p < 0.05), and 100% for SB & LSV. The mean logMAR VA for eyes with final anatomic success was 0.9 (Snellen equivalent of ~20/159) after primary LSV, and 1.1 (Snellen ~20/250) after primary SB.
CONCLUSION
Our study suggests that primary LSV for patients with ROP-associated Stage 4A RD offers superior anatomic results compared to primary SB. Our study provides important tools for counselling parents regarding anatomic success, and visual prognosis following surgery for ROP-associated RD.
主题
比较原发性巩膜扣带术（SB）与保留晶状体的玻璃体切割术（LSV）治疗早产儿视网膜病变（ROP）相关的4A期视网膜脱离（RD）的解剖学结果。
临床意义
ROP是全球工业化国家儿童失明的主要原因。尽管早期采用视网膜光凝和/或玻璃体腔内抗VEGF注射进行治疗，但1型ROP眼病仍可能进展为牵拉性视网膜脱离，伴或不伴有孔源性成分，因此需要进行手术治疗。
方法
本系统评价和荟萃分析已在开放科学框架注册。进行了PubMed文献检索，并根据预设的纳入标准选择了与ROP相关的4A期RD研究。收集了胎龄、手术年龄、手术类型和手术结果等信息。如有可用数据，收集Snellen视力（VA）。术后解剖学成功定义为视网膜完全复位，即黄斑和视网膜周边均复位。总体而言，从24项研究中收集了231只确诊为ROP 4A期RD的眼睛。采用横断面分析研究原发性SB与原发性LSV修复的眼睛之间的解剖学成功率和再次手术需求率。
结果
平均胎龄为26.0周（范围21至31周）。152只眼（66%）接受原发性LSV，73只眼（32%）接受原发性SB，6只眼（8%）接受SB与LSV联合手术。原发性LSV单次手术解剖学成功率为84%，原发性SB为62%（p<0.05），SB与LSV联合手术为83%。最终解剖学成功率原发性LSV为91%，原发性SB为66%（p<0.05），SB与LSV联合手术为100%。原发性LSV术后最终解剖学成功的眼睛平均logMAR VA为0.9（Snellen视力相当于20/159），原发性SB术后为1.1（Snellen20/250）。
结论
我们的研究表明，对于ROP相关的4A期RD患者，原发性LSV比原发性SB提供更好的解剖学结果。我们的研究为向家长咨询ROP相关RD手术的解剖学成功和视觉预后提供了重要工具。
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