玻璃体切除联合内界膜剥除术治疗糖尿病性黄斑水肿临床疗效的Meta分析

Meta-Analysis of the Clinical Efficacy of Vitrectomy Combined with Internal Limiting Membrane Peeling in the Treatment of Diabetic Macular Edema

摘要: 目的：运用Meta方法评价玻璃体切除(PPV)联合内界膜剥除术(ILMP)治疗糖尿病性黄斑水肿(DME)临床疗效。方法：检索自从建库以来至2022年12月的维普中文期刊数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库(Wanfang Data)、中国知网(CNKI)、PubMed、Embase、Cochrane、等相关文献，搜集PPV联合ILMP治疗DME的临床随机对照试验(RCT)的相关文献研究，使用RevMan5.4、Stata17.0等软件对纳入文献的相关数据进行统计学分析。结果：本研究纳入7项文献，合计431只眼。Meta分析结果表明，1) 最佳矫正视力(BCVA)：术后1个月(MD = −0.26, 95%CI [−0.37, −0.14], z = 4.30, P < 0.0001)、3个月(MD = −0.13, 95%CI [−0.21, −0.04], z = 2.94, P = 0.003 < 0.05)、6个月(MD = −0.11, 95%CI [−0.16, −0.06], z = 4.22, P < 0.0001)、12个月(MD = −0.08, 95%CI [−0.13, −0.03], z = 3.36, P = 0.0008 < 0.05)的BCVA的平均变化均可证明玻璃体切除术联合内界膜剥除术在提高最佳矫正视力方面明显优于单纯玻璃体切除术。2) 视网膜中央厚度(CMT)：术后3个月(MD = −47.11, 95%CI [−50.69, −43.53], z = 25.77, P < 0.00001)、6个月(MD = −53.62, 95%CI [−100.78, −6.45], z = 2.23, P = 0.03 < 0.05)的CMT的平均变化均可证明玻璃体切除术联合内界膜剥除术在改善视网膜中央厚度方面明显优于单纯玻璃体切除术。结论：PPV联合ILMP治疗DME的临床疗效明显优于单纯PPV。

Abstract: Objective: To evaluate the clinical efficacy of vitrectomy combined with inner limiting membrane peeling (ILMP) in the treatment of diabetic macular edema (DME). Methods: Relevant articles were searched from VIP, CBM, Wanfang Data, CNKI, PubMed, Embase, Cochrane Library and other databases from the establishment of the database to December 2022. The relevant literatures of randomized controlled trials (RCTS) of PPV combined with ILMP in the treatment of DME were collected. Stata17.0 and RevMan5.4 software were used for Meta-analysis of the inclusion study. Results: A total of 7 RCTS were included in the experiment with a total of 431 eyes. The results of Meta-analysis showed that 1) Best corrected visual acuity (BCVA): The mean changes in BCVA at 1 month (MD = −0.26, 95%CI [−0.37, −0.14], z = 4.30, P < 0.0001), 3 months (MD = −0.13, 95%CI [−0.21, −0.04], z = 2.94, P = 0.003 < 0.05), 6 months (MD = −0.11, 95%CI [−0.16, −0.06], z = 4.22, P < 0.0001) and 12 months (MD = −0.08, 95%CI [−0.13, −0.03], z = 3.36, P = 0.0008 < 0.05) after surgery can prove that compared with vitrectomy alone, vitrectomy combined with internal limiting membrane peeling could significantly improve best corrected visual acuity. 2) Central retinal thickness (CMT): Mean changes in CMT at 6 months (MD = −53.62, 95%CI [−100.78, −6.45], z = 2.23, P = 0.03 < 0.05) and 3 months (MD = −47.11, 95%CI [−50.69, −43.53], z = 25.77, P < 0.00001) after surgery can prove that compared with vitrectomy alone, vitrectomy combined with internal limiting membrane peeling could significantly lower central retinal thickness. Conclusions: PPV combined with ILMP in the treatment of DME is better than PPV alone.