贝伐单抗辅助玻璃体切除术治疗增生性糖尿病视网膜病变疗效的系统评价

Efficacy of pars plana vitrectomy assisted by bevacizumab in the treatment of proliferative diabetic retinopathy：a systematic review

摘要:

目的：系统评价贝伐单抗辅助玻璃体切除术（pars plana vitrectomy，PPV）治疗增生性糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）的疗效。方法：计算机检索Cochrane Library、Medline、Embase、中国生物医学文献数据库（CBM）、中文科技期刊数据库（VIP）、中国期刊全文数据库（CNKI）、万方数字化期刊全文数据库，查找以贝伐单抗辅助PPV治疗PDR的随机对照试验（randomized controlled trials，RCTs）或对照试验，对纳入的实验进行质量评价，采用Rev Man 5.1软件进行Meta分析。结果：共纳入7项RCTs，包括319只眼（实验组：167只眼，对照组：152只眼）。Meta分析结果提示，实验组术后视力恢复程度较对照组好（OR=-0.37，95%CI=-0.45~-0.30，P=0.000）且手术时间较短（MD=-17.37，95%CI＝-29.32～-5.42，P=0.004）。实验组术中出血、电凝次数、医源性视网膜裂孔等发生例数较对照组少，术中出血（OR=0.06，95%CI＝0.02~0.18，P=0.000）；电凝次数（OR=0.07，95%CI＝0.02~0.22，P=0.000）医源性视网膜裂孔（MD=-17.37，95%CI＝-29.32～-5.42，P=0.003）；术后玻璃体再积血较对照组少（OR=0.36，95%CI=0.20~0.64，P=0.000）；术后视网膜脱离，眼压升高两组无差异[视网膜脱离（OR=0.35，95%CI＝0.12～1.01，P=0.05０；眼压升高（OR=0.48，95%CI＝0.18～1.23，P=0.13０）]。结论：贝伐单抗辅助PPV治疗PDR疗效较单一PPV治疗好，并且可以减少术中、术后并发症。

Abstract:

Objective：To evaluate the efficacy pars plana vitrectomy（PPV） assisted by bevacizumab in the treatment of proliferative di－abetic retinopathy（PDR）. Methods：Databases of cochrane library，medline，embase，Chinese biomedical literature database（CBM），VIP，CNKI，Wanfang digital journals were searched for randomized controlled trials（RCTs） or comparative study of bevacizumab ad－juvant PPV in treatment of PDR. Quality of enrolled literatures was assessed and software of Rev Man 5.1 was employed to conduct Meta analysis. Results：A total of 8 RCTs were included，including 319 eyes（experimental group：167 eyes，control group：152 eyes）. Meta analysis results suggested that the experimental group had better visual acuity recovery（OR=-0.37，95%CI=-0.45 to -0.30，P=0.000） and shorter mean operation time than controls（MD=-17.37，95%CI=-29.32 to -5.42，P=0.004）. Moreover，cases having less intraoperative bleeding（OR=0.06，95%CI=0.02 to 0.18，P=0.000），endodiathermy frequency（OR=0.07，95%CI=0.02 to 0.22），P=0.000），iatrogenic retinal tear（MD=-17.37，95%CI=-29.32 to -5.42，P=0.004） and recurrent vitreous hemorrhage（OR=0.36，95%CI=0.20 to 0.64，P=0.000） were fewer in experiment group than in control group. There was no significant differences in retinal detach－ment（OR=0.35，95%CI=0.12 to 1.01，P=0.050） and intraocular pressure（OR=0.48，95%CI=0.18 to 1.23，P=0.130） between the two groups. Conclusions：Bevacizumab assisted vitrectomy for PDR is more effective than single PPV treatment and it can reduce postop－erative complications.