目的系统评价首次硅油取出术后视网膜再脱离的影响因素。
方法检索中国数据库(知网、中国生物医学文献数据库、维普、万方)、英文数据库(PubMed、Cochrane、Embase、Web of science)，查找自建库至2023年8月20日关于首次行玻璃体切割(PPV)联合硅油填充的患眼硅油取出术后视网膜再脱离的影响因素研究文献。根据纽卡斯尔－渥太华量表(NOS)文献质量评价标准进行质量评价。提取文献中首次硅油取出术后视网膜再脱离发生相关的影响因素，剔除提及文献<3篇的影响因素。运用RevMan5.3软件对收集的数据进行综合定量分析。
结果共纳入14篇文献，包括3 393术眼，其中复发组498眼，未复发组2 895眼。meta分析结果显示，高度近视[比值比( OR)＝1.40，95%置信区间( CI)∶1.08～1.81]、巨大视网膜裂孔( OR＝2.36，95% CI：1.63～3.41)、玻璃体残留( OR＝130.02，95% CI：66.03～256.02)、PPV术前人工晶状体状态( OR＝1.86，95% CI：1.26～2.75)是硅油取出后视网膜再脱离的危险因素，而孔源性视网膜脱离( OR＝0.68，95% CI：0.50～0.92)、PPV联合巩膜外加压( OR＝0.63，95% CI：0.45～0.88)、取硅油前2～4周眼底激光光凝( OR＝0.25，95% CI：0.13～0.49)是硅油取出后视网膜再脱离的保护性因素。敏感性分析结果显示，改变分析模型后分析结果无明显改变。所纳入研究的文献间均无发表偏倚。
结论高度近视、巨大视网膜脱离、玻璃体残留、PPV术前人工晶状体状态增加了首次硅油取出后视网膜再脱离发生的风险。孔源性视网膜脱离、PPV联合巩膜外加压、取硅油前2～4周眼底激光光凝可能是其保护因素。
ObjectiveTo systematically evaluate the influencing factors of retinal re-detachment after the first silicone oil removal.
MethodsChinese databases (CNKI, CBM, VIP, Wanfang) and English databases (PubMed, Cochrane, Embase, Web of science) were searched to retrieve the factors affecting the retinal re-detachment after the first pars plana vitrectomy (PPV) combined with silicone oil removal from the inception of the databases to August 20, 2023.The quality of literature was evaluated according to the Newcastle-Ottawa Scale (NOS).The influencing factors related to the retinal re-detachment after the first silicone oil removal were extracted from the literature, and the influencing factors mentioned in <3 literatures were excluded.RevMan5.3 software was used for quantitative and comprehensive analysis.
ResultsA total of 14 articles were included, including 3 393 eyes, with 498 eyes in the recurrent group, and 2 895 eyes in the non-recurrent group.The results of meta-analysis showed that high myopia (odds ratio [ OR]=1.40, 95% confidence interval [ CI]: 1.08-1.81), giant retinal hole( OR=2.36, 95% CI: 1.63-3.41), vitreous residue ( OR=130.02, 95% CI: 66.03-256.02), intraocular lens status before PPV ( OR=1.86, 95% CI: 1.26-2.75) were the risk factors for retinal re-detachment after silicone oil removal.Rhegmatogenous retinal detachment ( OR=0.68, 95% CI: 0.50-0.92), PPV combined with external scleral compression ( OR=0.63, 95% CI: 0.45-0.88) and fundus laser photocoagulation 2-4 weeks before silicone oil removal ( OR=0.25, 95% CI: 0.13-0.49) were protective factors for retinal detachment after silicone oil removal.The results of sensitivity analysis showed that there was no significant change in the analysis results after changing the analysis model.There was no publication bias among the included studies.
ConclusionsHigh myopia, giant retinal detachment, vitreous residue and intraocular lens status before PPV increased the risk of retinal re-detachment after the first silicone oil removal, Rhegmatogenous retinal detachment, PPV combined with external scleral pressure and fundus laser photocoagulation 2-4 weeks before silicone oil removal may be protective factors.
陆嘉桃,郑政,胡鹏程,等. 首次硅油取出术后视网膜再脱离影响因素的meta分析[J]. 中华实验眼科杂志,2025,43(01)：60-68.
DOI:10.3760/cma.j.cn115989-20240320-00077版权归中华医学会所有。
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除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
陆嘉桃：论文选题和设计、实施研究、采集及分析数据、统计分析、撰写文章；郑政：论文选题和设计、分析数据、对文章的知识性内容作批评性审阅；胡鹏程：论文选题和设计、统计分析；王曦、黄潇颖：采集、分析数据
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