糖尿病患者白内障手术后预防黄斑水肿的预防性干预措施：一项随机对照试验的贝叶斯网络荟萃分析。
Prophylactic interventions for preventing macular edema after cataract surgery in patients with diabetes: A Bayesian network meta-analysis of randomized controlled trials.
作者信息
Zhang Ruiheng, Dong Li, Yang Qiong, Liu Yueming, Li Heyan, Zhou Wenda, Wu Haotian, Li Yifan, Li Yitong, Yu Chuyao, Wei Wenbin
机构信息
Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
出版信息
EClinicalMedicine. 2022 May 20;49:101463. doi: 10.1016/j.eclinm.2022.101463. eCollection 2022 Jul.
BACKGROUND
Diabetes significantly increases the risk of postoperative macular edema (PME) after cataract surgery, leading to potential worst post-operative outcomes. This study aims to compare the effect of different prophylactic interventions in improving postoperative anatomic and visual acuity outcomes of diabetes patients who underwent cataract surgery.
METHODS
We searched MEDLINE, Embase, Web of Science databases from inception until February 2nd, 2022, for studies including studies reporting PME events and/or best-corrected visual acuity (BCVA) outcomes. Random-effects Bayesian network meta-analysis was performed to compare the efficiency of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF), nonsteroidal anti-inflammatory drugs (NSAIDs) and topical steroids eye drop at 1 week, 1 month, 3 months, 6 months after cataract surgery.
FINDINGS
The total of 2566 participants from 17 randomized controlled trials were included in the network meta-analysis, with moderate risk of bias and no evidence of publication of bias. Compared to placebo/steroid eye drop alone, patients received additional topical NSAIDs or intravitreal anti-VEGF injections had lower risk of PME at 1 month (NSAIDs: OR=0·221, 95% Confidence interval [CI], 0·044-0·755, =0·0%, 5 studies; anti-VEGF: OR=0·151, 95%CI, 0·037-0·413, =0·0%, 5 studies) and 3 month (NSAIDs: OR=0·370, 95%CI, 0·140-0·875, =0·0%, 8 studies; anti-VEGF: OR=0·203, 95%CI, 0·101-0·353, =0·0%, 4 studies) after cataract surgery. Further, additional anti-VEGF exhibited better BCVA outcome at 1 month (mean difference of LogMAR: -0·083, 95%CI, -0·17 to -0·014, =62·0%, 5 studies), and 3 months (mean difference of LogMAR: -0·061, 95%CI, -0·11 to -0·011, =0·0%, 5 studies) after cataract surgery. Such additional benefits did not reach statistic significant at 6 months after surgery.
INTERPRETATION
Our data suggests that compared to placebo/steroid eye drop alone, additional prophylactic anti-VEGF intervention could be considered for preventing the occurrence of PME after cataract surgery in patients with diabetes.
FUNDING
Research and Development of Special (2020-1-2052); Science & Technology Project of Beijing Municipal Science & Technology Commission (Z201100005520045, Z181100001818003).
背景
糖尿病显著增加白内障手术后黄斑水肿（PME）的风险，导致潜在的最差术后结果。本研究旨在比较不同预防性干预措施对改善接受白内障手术的糖尿病患者术后解剖结构和视力结果的效果。
方法
我们检索了MEDLINE、Embase、Web of Science数据库，从数据库建立至2022年2月2日，查找包括报告PME事件和/或最佳矫正视力（BCVA）结果的研究。进行随机效应贝叶斯网络荟萃分析，以比较玻璃体腔内注射抗血管内皮生长因子（抗VEGF）、非甾体抗炎药（NSAIDs）和局部类固醇滴眼液在白内障手术后1周、1个月、3个月、6个月时的效果。
结果
网络荟萃分析纳入了来自17项随机对照试验的2566名参与者，偏倚风险为中度，且无发表偏倚的证据。与单独使用安慰剂/类固醇滴眼液相比，接受额外局部NSAIDs或玻璃体腔内抗VEGF注射的患者在白内障手术后1个月（NSAIDs：比值比[OR]=0.221，95%置信区间[CI]，0.044 - 0.755，I²=0.0%，5项研究；抗VEGF：OR=0.151，95%CI，0.037 - 0.413，I²=0.0%，5项研究）和3个月（NSAIDs：OR=0.370，95%CI，0.140 - 0.875，I²=0.0%，8项研究；抗VEGF：OR=0.203，95%CI，0.101 - 0.353，I²=0.0%，4项研究）时发生PME的风险较低。此外，额外使用抗VEGF在白内障手术后1个月（LogMAR平均差：-0.083，95%CI，-0.17至-0.014，I²=62.0%，5项研究）和3个月（LogMAR平均差：-0.061，95%CI，-0.11至-0.011，I²=0.0%，5项研究）时的BCVA结果更好。术后6个月时，这些额外的益处未达到统计学显著水平。
解读
我们的数据表明，与单独使用安慰剂/类固醇滴眼液相比，对于糖尿病患者白内障手术后预防PME的发生，可考虑额外的预防性抗VEGF干预措施。
资助
重大专项研发（2020 - 1 - 2052）；北京市科学技术委员会科技计划项目（Z201100005520045，Z181100001818003）
Zotero 插件