目的系统评价重复低强度红光(RLRL)照射对儿童近视进展的控制效果。
方法检索Medline、Embase、Cochrane Library、Web of Science、ClinicalTrial.gov和中国知网、维普全文数据库、万方数据库、中国临床试验注册中心(www.chictr.org.cn)中关于RLRL照射控制儿童近视进展的随机对照试验(RCT)，检索时限为建库起至2022年9月，补充检索灰色数据库。根据PICOS原则制定纳入和排除标准。由2位研究者独立筛选文献，提取资料并依据Cochrane风险偏倚评估工具评估纳入研究的偏倚风险后，将数据导入RevMan 5.4软件进行Meta分析。采用均值和标准差计算各研究数据的均值差和95%置信区间，比较单焦点框架眼镜联合RLRL照射治疗(试验组)与单独使用单焦点框架眼镜(对照组)干预前后等效球镜度(SE)、眼轴长度(AL)的变化值。采用GRADE系统对结局指标进行证据质量分级。
结果检索到157篇文献，经过筛选后共纳入7项符合标准的高质量RCT研究，共1 038例儿童。Meta分析结果显示，与对照组相比，不同随访时间点(1、3、6、12、24个月)，试验组均可显著控制近视儿童SE进展，减少AL增长；随着随访时间的延长(1~24个月)，试验组控制SE进展效果越强(0.14~0.93 D)，减少AL增长效果越明显(0.07~0.48 mm)。635 nm和650 nm波长红光照射均可显著控制近视患者SE进展，减少AL增长。GRADE评级显示，SE变化量和AL变化量这2个结局指标为中等强度证据。
结论基于当前中等强度证据显示，与单独使用单焦点框架眼镜相比，联合RLRL照射对儿童近视进展的控制效果更好。
ObjectiveTo systematically evaluate the effect of repeated low-level red light (RLRL) therapy on controlling the progression of myopia in children.
MethodsMedline, Embase, Cochrane Library, Web of Science, ClinicalTrial.gov and the CNKI, VIP, Wanfang database, and Chinese Clinical Trial Registry (www.chictr.org.cn) were searched from their establishment to September 2022 to obtain the randomized controlled trial (RCT) about RLRL controlling myopia progression in children.Grey literature was also searched.Inclusion and exclusion criteria were developed according to the PICOS principle.Two researchers screened the literature independently, extracted data, and assessed the risk of bias in the included studies using the Cochrane collaboration tool for assessing risk of bias.The data were imported into RevMan 5.4 software for meta-analysis.Mean and standard deviation of data were used to obtain mean differences and 95% confidence intervals of included studies.Changes in spherical equivalent (SE) and axial length (AL) were compared between before and after the intervention in RLRL and single-vision spectacle (experimental group) and single-vision spectacle (control group). The GRADE system was used to grade the quality of evidence for the outcome indicators.
ResultsA total of 157 studies were obtained.After the screening, 7 RCT studies including 1 038 study subjects met the inclusion criteria.Meta-analysis results showed that retarded SE progression was retarded and AL elongation was reduced significantly after different follow-up durations (1, 3, 6, 12 and 24 months) in experimental group compared with control group.As the follow-up duration extended from 1 month to 24 months, the retard of SE progression increased from 0.14 to 0.93 D, and the reduction of AL increased from 0.07 to 0.48 mm.Both 635 and 650 nm red light significantly retarded SE progression and reduced AL elongation.The two outcome indicators, SE change and AL change were moderate-strength evidence by GRADE.
ConclusionsThe current moderate-strength evidence shows that RLRL can better retard myopia progression in children than single-vision spectacle glasses.
张红梅,朱云,刘盛鑫,等. 重复低强度红光照射对儿童近视进展控制效果的Meta分析[J]. 中华实验眼科杂志,2023,41(04)：357-365.
DOI:10.3760/cma.j.cn115989-20221003-00466版权归中华医学会所有。
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张红梅：直接参与选题、酝酿和设计试验、实施研究、采集数据、分析/解释数据、起草文章、对文章知识性内容的审阅和智力性内容的修改及定稿；朱云、刘盛鑫：实施研究、采集数据、分析/解释数据；李炳钦：实施研究、采集数据；魏瑞华：酝酿和设计试验、对文章知识性内容的审阅和智力性内容的修改及定稿
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