{"title":"眼弓形虫病继发视网膜脱离和黄斑孔的手术治疗：系统综述和荟萃分析。","authors":"Dillan Cunha Amaral, Mark Lane, Eduardo Henrique Cassins Aguiar, Guilherme Nunes Marques, Luiza Visentin Cavassani, Márcio Penha Morterá Rodrigues, Milton Ruiz Alves, José Eduardo Ferreira Manso, Mário Luiz Ribeiro Monteiro, Ricardo Noguera Louzada","doi":"10.1186/s40942-024-00540-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Toxoplasma gondii causes ocular toxoplasmosis (OT), involving inflammation, scarring, and retinal complications. The OT complications were retinal detachment (RD), and retinal breakage (RB). Surgical interventions like scleral buckling (SB) and vitrectomy are common. Limited understanding exists of the safety and efficacy of surgical management of RD/RB secondary to OT. Another complication is toxoplasmosis-related macular holes (tMH), with sparse evidence on surgical outcomes. This meta-analysis aims to clarify clinical characteristics, and surgical results, and enhance understanding of RD, RB, and MH secondary to OT.</p><p><strong>Methods: </strong>PubMed, Cochrane, Embase and Web of Science database were queried for retrospective studies, case series and case reports that provided information on RD, RB and MH associated with OT and reported the outcomes of: (1) Retinal reattachment of RD/RB and tMH closure; (2) Best-corrected visual acuity (BCVA) improvement; and (3) Complications. Heterogeneity was examined with I<sup>2</sup> statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria).</p><p><strong>Results: </strong>Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/RB of 97% (95% Confidence Interval [CI] 92-100%; I<sup>2</sup> = 0%), retinal reattachment of just RD of 96% (95% CI 89-100%; I<sup>2</sup> = 30%) and tMH closure 97% (95% CI 87-100; I<sup>2</sup> = 12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35-0.65; I<sup>2</sup> = 20%) and MH (MD 0.67; 95% CI 0.50-0.84; I<sup>2</sup> = 0%). The overall complication rate associated with surgical procedures in RD/RB secondary to OT was confirmed to be 25%.</p><p><strong>Conclusions: </strong>The systematic review and meta-analysis showed that the treatment approaches currently in use are effective, with a remarkable rate of retinal reattachment of RD/RB, tMH closure, and substantial improvements in visual acuity. More randomized, long-term studies on disease and surgical factors can provide valuable insights into their impact on anatomical and visual outcomes.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10903043/pdf/","citationCount":"0","resultStr":"{\"title\":\"Surgical management of retinal detachment and macular holes secondary to ocular toxoplasmosis: a systematic review and meta-analysis.\",\"authors\":\"Dillan Cunha Amaral, Mark Lane, Eduardo Henrique Cassins Aguiar, Guilherme Nunes Marques, Luiza Visentin Cavassani, Márcio Penha Morterá Rodrigues, Milton Ruiz Alves, José Eduardo Ferreira Manso, Mário Luiz Ribeiro Monteiro, Ricardo Noguera Louzada\",\"doi\":\"10.1186/s40942-024-00540-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Toxoplasma gondii causes ocular toxoplasmosis (OT), involving inflammation, scarring, and retinal complications. 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A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria).</p><p><strong>Results: </strong>Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/RB of 97% (95% Confidence Interval [CI] 92-100%; I<sup>2</sup> = 0%), retinal reattachment of just RD of 96% (95% CI 89-100%; I<sup>2</sup> = 30%) and tMH closure 97% (95% CI 87-100; I<sup>2</sup> = 12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35-0.65; I<sup>2</sup> = 20%) and MH (MD 0.67; 95% CI 0.50-0.84; I<sup>2</sup> = 0%). 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引用次数: 0
摘要
背景：弓形虫会引起眼部弓形虫病（OT），包括炎症、瘢痕和视网膜并发症。OT并发症包括视网膜脱离（RD）和视网膜破损（RB）。巩膜扣带术（SB）和玻璃体切除术等手术干预措施很常见。人们对继发于 OT 的 RD/RB 手术治疗的安全性和有效性了解有限。另一种并发症是弓形虫相关黄斑孔（tMH），有关手术效果的证据很少。本荟萃分析旨在阐明临床特征和手术结果，加深对继发于 OT 的 RD、RB 和 MH 的理解：方法：在PubMed、Cochrane、Embase和Web of Science数据库中查询了提供与OT相关的RD、RB和MH信息的回顾性研究、系列病例和病例报告，并报告了以下结果：(1) RD/RB 视网膜再接合和 tMH 闭合；(2) 最佳矫正视力 (BCVA) 改善；以及 (3) 并发症。异质性用I2统计量进行检验。对异质性较高的结果采用随机效应模型。统计分析使用 R 软件（4.2.3 版，奥地利维也纳 R 统计计算基金会）进行：对14项最终研究进行了分析，共涉及96名患者，其中81人患有RD或RB，15人患有tMH。总体而言，手术治疗具有以下优势：RD/RB视网膜再接合率高达97%（95% 置信区间[CI] 92-100%；I2 = 0%），仅RD视网膜再接合率为96%（95% CI 89-100%；I2 = 30%），tMH闭合率为97%（95% CI 87-100；I2 = 12%）。RD/RB（MD 0.60；95% CI 0.35-0.65；I2 = 20%）和 MH（MD 0.67；95% CI 0.50-0.84；I2 = 0%）研究的术后 BCVA 有明显差异。经证实，继发于OT的RD/RB手术相关总并发症发生率为25%：系统回顾和荟萃分析表明，目前使用的治疗方法是有效的，RD/RB 的视网膜再接合率、tMH 闭合率和视力改善率都非常显著。对疾病和手术因素进行更多的随机、长期研究，可为了解其对解剖和视觉结果的影响提供宝贵的见解。
Surgical management of retinal detachment and macular holes secondary to ocular toxoplasmosis: a systematic review and meta-analysis.
Background: Toxoplasma gondii causes ocular toxoplasmosis (OT), involving inflammation, scarring, and retinal complications. The OT complications were retinal detachment (RD), and retinal breakage (RB). Surgical interventions like scleral buckling (SB) and vitrectomy are common. Limited understanding exists of the safety and efficacy of surgical management of RD/RB secondary to OT. Another complication is toxoplasmosis-related macular holes (tMH), with sparse evidence on surgical outcomes. This meta-analysis aims to clarify clinical characteristics, and surgical results, and enhance understanding of RD, RB, and MH secondary to OT.
Methods: PubMed, Cochrane, Embase and Web of Science database were queried for retrospective studies, case series and case reports that provided information on RD, RB and MH associated with OT and reported the outcomes of: (1) Retinal reattachment of RD/RB and tMH closure; (2) Best-corrected visual acuity (BCVA) improvement; and (3) Complications. Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria).
Results: Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/RB of 97% (95% Confidence Interval [CI] 92-100%; I2 = 0%), retinal reattachment of just RD of 96% (95% CI 89-100%; I2 = 30%) and tMH closure 97% (95% CI 87-100; I2 = 12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35-0.65; I2 = 20%) and MH (MD 0.67; 95% CI 0.50-0.84; I2 = 0%). The overall complication rate associated with surgical procedures in RD/RB secondary to OT was confirmed to be 25%.
Conclusions: The systematic review and meta-analysis showed that the treatment approaches currently in use are effective, with a remarkable rate of retinal reattachment of RD/RB, tMH closure, and substantial improvements in visual acuity. More randomized, long-term studies on disease and surgical factors can provide valuable insights into their impact on anatomical and visual outcomes.
期刊介绍：
International Journal of Retina and Vitreous focuses on the ophthalmic subspecialty of vitreoretinal disorders. The journal presents original articles on new approaches to diagnosis, outcomes of clinical trials, innovations in pharmacological therapy and surgical techniques, as well as basic science advances that impact clinical practice. Topical areas include, but are not limited to: -Imaging of the retina, choroid and vitreous -Innovations in optical coherence tomography (OCT) -Small-gauge vitrectomy, retinal detachment, chromovitrectomy -Electroretinography (ERG), microperimetry, other functional tests -Intraocular tumors -Retinal pharmacotherapy & drug delivery -Diabetic retinopathy & other vascular diseases -Age-related macular degeneration (AMD) & other macular entities
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