Vitrectomy with or without internal limiting membrane peeling for idiopathic epiretinal membrane: A meta-analysis.
Vitrectomy with or without internal limiting membrane peeling for idiopathic epiretinal membrane: A meta-analysis.
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DOI：
10.1371/journal.pone.0179105
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Liu JH
中科院分区：
文献类型：
--
作者：
Chang WC;Lin C;Lee CH;Sung TL;Tung TH;Liu JH
关于玻璃体切除术联合和不联合内界膜（ILM）剥离治疗特发性视网膜前膜（ERM）的研究在临床结局和复发率方面产生了不确定的结果。比较玻璃体切除联合和不联合ILM剥离治疗特发性ERM的临床结局。检索了截至2016年7月发表的数据库，包括PubMed、Embase、科克伦、Web of Science、Google Scholar、CNKI数据库、FDA.gov和ClinicalTrials.gov，以识别比较玻璃体切除术联合ERM和ILM剥离与仅ERM剥离治疗特发性ERM后临床结局的研究。选择了具有足够数据的研究。合并结果表示为玻璃体切除术联合和不联合ILM剥离的术后最佳矫正视力（BCVA）、中央视网膜厚度（CRT）和ERM复发率的平均差异（MD）和风险比（RR）及其相应的95%置信区间（CI）。11项回顾性研究和1项随机对照试验涉及756只眼。这表明非ILM剥离组的术后12个月内BCVA明显更好（MD = 0.04，95% CI：0.00 - 0.08; P = 0.0460），但ILM剥离组患者在18个月后的术后BCVA明显更好（MD = −0.13，95%CI：−0.23至−0.04; P = 0.0049）。与ILM剥离组相比，非ILM剥离组的术后CRT减少率更高（MD = 51.55，95% CI：−84.23至−18.88; P = 0.0020），ERM复发率更高（RR = 0.34，95% CI：0.16至0.72; P = 0.0048）。然而，两组之间BCVA（RR = 1.03，95% CI：0.72至1.47; P = 0.8802）和术后CRT（MD = 18.15，95% CI：-2.29至38.60; P = 0.0818）的改善率相似。玻璃体切除联合ILM剥离在长期随访中可获得更好的视力改善，并降低ERM复发率，玻璃体切除联合仅ERM剥离在减少CRT方面比玻璃体切除联合ILM剥离更有效。
Studies on vitrectomy with and without internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM) have yielded uncertain results regarding clinical outcomes and recurrence rates. To compare the clinical outcomes of vitrectomy with and without ILM peeling for idiopathic ERM. Databases, including PubMed, Embase, Cochrane, Web of Science, Google Scholar, CNKI databases, FDA.gov, and ClinicalTrials.gov, published until July 2016, were searched to identify studies comparing the clinical outcomes following vitrectomy with ERM and ILM peeling and with only ERM peeling, for treating idiopathic ERM. Studies with sufficient data were selected. Pooled results were expressed as mean differences (MDs) and risk ratios (RRs) with corresponding 95% confidence intervals (CI) for vitrectomy with and without ILM peeling with regard to postoperative best corrected visual acuity (BCVA), central retinal thickness (CRT), and ERM recurrence rate. Eleven retrospective studies and one randomized controlled trial involving 756 eyes were identified. This demonstrated that the postoperative BCVA within 12 months was significantly better in the non-ILM peeling group (MD = 0.04, 95% CI: 0.00 to 0.08; P = 0.0460), but that the patients in the ILM peeling group had significantly better postoperative BCVA after 18 months (MD = −0.13, 95% CI: −0.23 to −0.04; P = 0.0049) than did those in the non-ILM peeling group. The non-ILM peeling group exhibited a higher reduction in postoperative CRT (MD = 51.55, 95% CI:−84.23 to −18.88; P = 0.0020) and a higher recurrence rate of ERM (RR = 0.34, 95% CI:0.16 to 0.72; P = 0.0048) than did the ILM peeling group. However, the improvement rates of BCVA (RR = 1.03, 95% CI:0.72 to 1.47; P = 0.8802) and postoperative CRTs (MD = 18.15, 95% CI:−2.29 to 38.60; P = 0.0818) were similar between the two groups. Vitrectomy with ILM peeling results in better visual improvement in long-term follow-ups and lower ERM recurrence rates, and vitrectomy with only ERM peeling is more efficacious in reduction of CRT than is vitrectomy with ILM peeling.