Meta-analysis of Surgical Treatments for Rhegmatogenous Retinal Detachment_West China Medical Journal

Authors：

SUN Qiao , SUN Tao , XU Yi , YANG Xiaolu ,  XU Xun

Department of Ophthalmology, School of Medicine, the First People’s Hospital of Shanghai Jiaotong University, Shanghai 200080, P. R. China;

Corresponding author：

XU Xun, Email: verasun.med@gmail.com.cn

Keywords：

孔源性视网膜剥离; 手术治疗; Meta分析

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【摘要】　目的　对比玻璃体手术和巩膜环扎术对治疗非复杂性孔源性视网膜剥离（rhegmotogenous retinal detachment，RRD）的疗效。　方法　检索Pubmed、Embase、Cochrane对照试验中心注册数据库，对相关的随机对照临床试验（randomized controlled trialc，RCT）按Cochrane协作网推荐的方法进行Meta分析。　结果　有晶状体组包括3篇RCT共523例，人工晶状体/无状晶体组包括4篇RCT共690例。有晶状体组玻璃体手术（pars plana vitrectomy，PPV）术后白内障的发生率更高[OR=4.18，95%CI（2.75，6.35），P lt;0.000 01]。人工晶状体/无晶状体组PPV术后最终解剖复位率更高[OR=1.97，95%CI（1.04，3.73），P=0.04]。　结论　巩膜环扎术通过降低术后白内障的发生率在治疗非复杂性有晶状体眼RRD中占有优势；PPV可提高最终解剖复位率，更适合人工晶状体/无晶状体眼RRD。
【Abstract】　Objective　 To compare the efficacy of pars plana vitrectomy (PPV) and scleral buckling (SB) in treating uncomplicated rhegmatogenous retinal detachment (RRD).　Methods　 Randomized controlled trials (RCTs) were searched from Pubmed, Embase and the Cochrane Central Register. Meta-analysis was conducted using the methods recommended by the Cochrane Collaboration.　Results　 Three RCTs with 523 phakic eyes and four RCTs with 690 pseudophakic/aphakic eyes were included. In the phakic group, the rate of postopertative cataract was higher with PPV [OR=4.18, 95% CI (2.75,6.35), P lt;0.000 01]. In the pseudophakic/aphakic group, final anatomic success outcome was in favor of PPV [OR=1.97, 95% CI (1.04,3.73), P=0.04].　Conclusions　 SB results better in terms of postoperative cataract in phakic RRDs. PPV is more likely to achieve a favorable final reattachment in pseudophakic/aphakic RRDs.

Citation： SUN Qiao,SUN Tao,XU Yi,YANG Xiaolu,XU Xun. Meta-analysis of Surgical Treatments for Rhegmatogenous Retinal Detachment. West China Medical Journal, 2011, 26(6): 912-918. doi: Copy

1.	Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment[J]. Arch Ophthalmol, 1982, 100(2): 289-292.
2.	Wilkes SR, Beard CM, Kurland LT, et al. The incidence of retinal detachment in Rochester, Minnesota, 1970-1978[J]. Am J Ophthalmol, 1982, 94(5): 670-673.
3.	Tornquist R, Stenkula S, Tornquist P. Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. I. Epidemiology[J]. Acta Ophthalmol (Copenh), 1987, 65(2): 213-222.
4.	Yoshida A, Ogasawara H, Jalkh AE, et al. Retinal detachment after cataract surgery[J]. Ophthalmology, 1992, 99(3): 460-465.
5.	Pastor JC, Fernandez I, Rodriguez de la Rua E, et al. Surgical outcomes for primary rhegmatogenous retinal detachments in phakic and pseudophakic patients: the retina 1 project-report 2[J]. Br J Ophthalmol, 2008, 92(3): 378-382.
6.	Feltgen N, Weiss C, Wolf S, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study (SPR Study): recruitment list evaluation. Study report No. 2[J]. Graefes Arch Clin Exp Ophthalmol, 2007, 245(6): 803-809.
7.	Ho JD, Liou SW, Tsai CY, et al. Trends and outcomes of treatment for primary rhegmatogenous retinal detachment: a 9-year nationwide population-based study[J]. Eye (Lond) 2009, 23(3): 669-675.
8.	Arya AV, Emerson JW, Engelbert M, et al. Surgical management of pseudophakic retinal detachments: a meta-analysis[J]. Ophthalmology, 2006, 113(10): 1724-1733.
9.	Heimann H, Bartz-Schmidt KU, Bornfeld N, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study[J]. Ophthalmology, 2007, 114(12): 2142-2154.
10.	Lincoff H, Lincoff A, Stopa M. Systematic review of efficacy and safty of surgery for primary retinal detachment[M]// Kreissig I. Primary retinal detachment: options for repair. Berlin Heidelberg: Springer-Verlag, 2005: 161-175.
11.	Han DP, Rychwalski PJ, Mieler WF, et al. Management of complex retinal detachment with combined relaxing retinotomy and intravitreal perfluoro-n-octane injection[J]. Am J Ophthalmol, 1994, 118(1): 24-32.
12.	Stangos AN, Petropoulos IK, Brozou CG, et al. Pars-plana vitrectomy alone vs vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment[J]. Am J Ophthalmol, 2004, 138(6): 952-958.
13.	Siqueira RC, Gomes CV, Dalloul C, et al. Vitrectomy with and without scleral buckling for retinal detachment[J]. Arq Bras Oftalmol, 2007, 70(2): 298-302.
14.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? [J]. Control Clin Trials, 1996, 17(1): 1-12.
15.	Sharma YR, Karunanithi S, Azad RV, et al. Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment[J]. Acta Ophthalmol Scand, 2005, 83(3): 293-297.
16.	Brazitikos PD, Androudi S, Christen WG, et al. Primary pars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment: a randomized clinical trial[J]. Retina, 2005, 25(8): 957-964.
17.	Azad RV, Chanana B, Sharma YR, et al. Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment[J]. Acta Ophthalmol Scand, 2007, 85(5): 540-545.
18.	Koriyama M, Nishimura T, Matsubara T, et al. Prospective study comparing the effectiveness of scleral buckling to vitreous surgery for rhegmatogenous retinal detachment[J]. Jpn J Ophthalmol, 2007, 51(5): 360-367.
19.	Ahmadieh H, Moradian S, Faghihi H, et al. Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month follow-up results of a single operation-report No. 1[J]. Ophthalmology, 2005, 112(8): 1421-1429.
20.	Passemard M, Yakoubi Y, Muselier A, et al. Long-term outcome of idiopathic macular hole surgery[J]. Am J Ophthalmol, 2010, 149(1): 120-126.
21.	Fine HF, Iranmanesh R, Iturralde D, et al. Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease[J]. Ophthalmology, 2007, 114(6): 1197-1200.
22.	Gupta OP, Ho AC, Kaiser PK, et al. Short-term outcomes of 23-gauge pars plana vitrectomy[J]. Am J Ophthalmol, 2008, 146(2): 193-7.
23.	Schocket LS, Witkin AJ, Fujimoto JG, et al. Ultrahigh-resolution optical coherence tomography in patients with decreased visual acuity after retinal detachment repair[J]. Ophthalmology, 2006, 113(4): 666-672.
24.	Lincoff H, Stopa M, Kreissig I, et al. Cutting the encircling band. Retina[J], 2006, 26(6): 650-654.
25.	Kim YK, Woo SJ, Park KH, et al. Comparison of persistent submacular fluid in vitrectomy and scleral buckle surgery for macula-involving retinal detachment[J]. Am J Ophthalmol, 2010, 149(4): 623-629.
26.	Barr CC. The histopathology of successful retinal reattachment[J]. Retina, 1990, 10(3): 189-194.
27.	Campo RV, Sipperley JO, Sneed SR, et al. Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments[J]. Ophthalmology, 1999, 106(9): 1811-1815.

1. 　Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment[J]. Arch Ophthalmol, 1982, 100(2): 289-292.
2. 　Wilkes SR, Beard CM, Kurland LT, et al. The incidence of retinal detachment in Rochester, Minnesota, 1970-1978[J]. Am J Ophthalmol, 1982, 94(5): 670-673.
3. 　Tornquist R, Stenkula S, Tornquist P. Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. I. Epidemiology[J]. Acta Ophthalmol (Copenh), 1987, 65(2): 213-222.
4. 　Yoshida A, Ogasawara H, Jalkh AE, et al. Retinal detachment after cataract surgery[J]. Ophthalmology, 1992, 99(3): 460-465.
5. 　Pastor JC, Fernandez I, Rodriguez de la Rua E, et al. Surgical outcomes for primary rhegmatogenous retinal detachments in phakic and pseudophakic patients: the retina 1 project-report 2[J]. Br J Ophthalmol, 2008, 92(3): 378-382.
6. 　Feltgen N, Weiss C, Wolf S, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment study (SPR Study): recruitment list evaluation. Study report No. 2[J]. Graefes Arch Clin Exp Ophthalmol, 2007, 245(6): 803-809.
7. 　Ho JD, Liou SW, Tsai CY, et al. Trends and outcomes of treatment for primary rhegmatogenous retinal detachment: a 9-year nationwide population-based study[J]. Eye (Lond) 2009, 23(3): 669-675.
8. 　Arya AV, Emerson JW, Engelbert M, et al. Surgical management of pseudophakic retinal detachments: a meta-analysis[J]. Ophthalmology, 2006, 113(10): 1724-1733.
9. 　Heimann H, Bartz-Schmidt KU, Bornfeld N, et al. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study[J]. Ophthalmology, 2007, 114(12): 2142-2154.
10. 　Lincoff H, Lincoff A, Stopa M. Systematic review of efficacy and safty of surgery for primary retinal detachment[M]// Kreissig I. Primary retinal detachment: options for repair. Berlin Heidelberg: Springer-Verlag, 2005: 161-175.
11. 　Han DP, Rychwalski PJ, Mieler WF, et al. Management of complex retinal detachment with combined relaxing retinotomy and intravitreal perfluoro-n-octane injection[J]. Am J Ophthalmol, 1994, 118(1): 24-32.
12. 　Stangos AN, Petropoulos IK, Brozou CG, et al. Pars-plana vitrectomy alone vs vitrectomy with scleral buckling for primary rhegmatogenous pseudophakic retinal detachment[J]. Am J Ophthalmol, 2004, 138(6): 952-958.
13. 　Siqueira RC, Gomes CV, Dalloul C, et al. Vitrectomy with and without scleral buckling for retinal detachment[J]. Arq Bras Oftalmol, 2007, 70(2): 298-302.
14. 　Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? [J]. Control Clin Trials, 1996, 17(1): 1-12.
15. 　Sharma YR, Karunanithi S, Azad RV, et al. Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment[J]. Acta Ophthalmol Scand, 2005, 83(3): 293-297.
16. 　Brazitikos PD, Androudi S, Christen WG, et al. Primary pars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment: a randomized clinical trial[J]. Retina, 2005, 25(8): 957-964.
17. 　Azad RV, Chanana B, Sharma YR, et al. Primary vitrectomy versus conventional retinal detachment surgery in phakic rhegmatogenous retinal detachment[J]. Acta Ophthalmol Scand, 2007, 85(5): 540-545.
18. 　Koriyama M, Nishimura T, Matsubara T, et al. Prospective study comparing the effectiveness of scleral buckling to vitreous surgery for rhegmatogenous retinal detachment[J]. Jpn J Ophthalmol, 2007, 51(5): 360-367.
19. 　Ahmadieh H, Moradian S, Faghihi H, et al. Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month follow-up results of a single operation-report No. 1[J]. Ophthalmology, 2005, 112(8): 1421-1429.
20. 　Passemard M, Yakoubi Y, Muselier A, et al. Long-term outcome of idiopathic macular hole surgery[J]. Am J Ophthalmol, 2010, 149(1): 120-126.
21. 　Fine HF, Iranmanesh R, Iturralde D, et al. Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease[J]. Ophthalmology, 2007, 114(6): 1197-1200.
22. 　Gupta OP, Ho AC, Kaiser PK, et al. Short-term outcomes of 23-gauge pars plana vitrectomy[J]. Am J Ophthalmol, 2008, 146(2): 193-7.
23. 　Schocket LS, Witkin AJ, Fujimoto JG, et al. Ultrahigh-resolution optical coherence tomography in patients with decreased visual acuity after retinal detachment repair[J]. Ophthalmology, 2006, 113(4): 666-672.
24. 　Lincoff H, Stopa M, Kreissig I, et al. Cutting the encircling band. Retina[J], 2006, 26(6): 650-654.
25. 　Kim YK, Woo SJ, Park KH, et al. Comparison of persistent submacular fluid in vitrectomy and scleral buckle surgery for macula-involving retinal detachment[J]. Am J Ophthalmol, 2010, 149(4): 623-629.
26. 　Barr CC. The histopathology of successful retinal reattachment[J]. Retina, 1990, 10(3): 189-194.
27. 　Campo RV, Sipperley JO, Sneed SR, et al. Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments[J]. Ophthalmology, 1999, 106(9): 1811-1815.

West China Medical Journal

Meta-analysis of Surgical Treatments for Rhegmatogenous Retinal Detachment

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