同轴微切口与传统同轴超声乳化术治疗白内障临床疗效的系统评价

Coaxial microincision cataract surgery versus conventional coaxial small-incision cataract surgery：a systematic review of randomized controlled trials

摘要:

目的：系统评价同轴微切口超声乳化吸除术（coaxial microincision cataract surgery，C-MICS）与传统同轴超声乳化吸除术（conventional coaxial small-incision cataract surgery，C-SICS）治疗白内障的有效性。方法：采用Cochrane系统评价方法，计算机检索中国知网、Medline、EMbase（2004年～2014年7月）；Cochrane图书馆临床对照试验资料库（2014年第7期），纳入有关C-MICS和C-SICS治疗白内障的临床随机对照试验。采用RevMan5.3软件对效应指标进行Meta分析。结果：根据文献的纳入和排除标准，共纳入14个随机对照试验（1 283眼）。结果显示2组间有效超声乳化时间（effective phacoemulsification time，EPT）无差异（WMD=-0.25，95%CI=-0.80～0.29），P=0.36）；平均超声乳化能量无差异（WMD=-1.67，95%CI=-4.18～0.84，P=0.19）；2组间术后中央角膜厚度增加（central corneal thickness，CCT）均无差异[术后1天（WMD=-6.38，95%CI=-18.51～5.75，P=0.30）；术后1周（WMD=-2.61，95%CI=-8.23～3.02，P=0.36）；术后1月（WMD=-0.81，95%CI=-3.17～1.56，P=0.50）]；2组间术后1月角膜内皮细胞计数无差异（WMD=53.24，95%CI=-4.55～111.04，P=0.07）；术后裸眼视力C-MICS组均优于C-SICS组[术后1 d（WMD=0.14，95%CI=0.05～0.23，P=0.003）；术后1月（WMD=0.06，95%CI=0.03～0.10，P=0.000）；术后3月（WMD=0.05，95%CI=0.02～0.09，P=0.002）]；术后手术源性散光（surgical induced astigmatism，SIA） C-MICS组均小于C-SICS组[术后1 d（WMD=-0.69，95%CI=-0.83～-0.54，P=0.000）；术后1周（WMD=-0.45，95%CI=-0.68～-0.23，P=0.000）；术后1月（WMD=-0.33，95%CI=-0.39～-0.27，P=0.000）；术后3月（WMD=-0.28，95%CI=-0.36～-0.20，P=0.000）]。结论：现有有限证据表明，C-MICS比C-SICS治疗白内障有较好的临床应用效果。

Abstract:

Objective：To compare the clinical effectiveness of coaxial microincision cataract surgery（C-MICS） versus conventional coaxial small-incision cataract surgery（C-SICS） in the treatment of cataract. Methods：Randomized controlled trials comparing C-MICS with C-SICS were identified by searching CNKI，MEDLINE，Embase（2004 to July，2014） and the Cochrane Library（Issue 7，2014）. Data were synthesized using RevMan software（release 5.3） provided by the Cochrane Collaboration. Results：Through strictly including and excluding standard，a total of 14 trials（1 283 eyes） were included for Meta analysis. There was no significant difference between two groups in effective phacoemulsification time（P=0.36），mean phacoemulsification power（P=0.19），and central corneal thickness change（the first day，P=0.30；the first week，P=0.36；the first month，P=0.50）. There was no significant difference in corneal endothelial cell count at the first month between two groups（P=0.07）. The naked vision was statistically significantly better in C-MICS group than in C-SICS group on the first day，first month and the third month after the operation（the first day，P=0.003；the first month，P=0.000；the third month，P=0.002）. The surgical induced astigmatism was significantly less in C-MICS group than in C-SICS group on the first day，the first week，the first month and the third month after the operation（the first day，P=0.000；the first week，P=0.000；the first month，P=0.000；the third month，P=0.000）. Conclusion:C-MICS is superior to C-SICS in the treatment of cataract.