黄斑孔非手术治疗方案的范围界定审查

IF 5.1 2区 医学 Q1 OPHTHALMOLOGY Survey of ophthalmology Pub Date : 2024-09-01 DOI:10.1016/j.survophthal.2024.04.005
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引用次数: 0

摘要

黄斑孔(MH)是影响中心视力的全厚视网膜缺损。传统的黄斑裂孔治疗方法是进行玻璃体切除术并剥离内缘膜(ILM),而非手术治疗方法可降低手术风险,因此越来越受到人们的关注。本研究对非手术治疗 MH 进行了全面的文献综述和分析。研究人员在 PubMed、Embase、Scopus 和 Cochrane 图书馆进行了系统的文献检索,检索时间为 1973 年 1 月 1 日至 2023 年 9 月 13 日。治疗方法包括激光疗法、碳酸酐酶抑制剂(CAIs)、非甾体抗炎药(NSAIDs)、类固醇(局部、腱膜下、眼周、玻璃体内)、玻璃体内气体、抗血管内皮生长因子和卵磷脂注射。数据提取涵盖研究细节、患者特征、MH特征、治疗结果和复发率。最初的搜索结果为 3352 篇文章,经过筛选后,符合纳入标准的文章为 83 篇。总体报告显示,激光光凝的解剖闭合率为 36%,玻璃体内奥曲肽的闭合率为 37%,玻璃体内气体的闭合率为 55%。局部使用非甾体抗炎药(79%)、类固醇(84%)和 CAIs(73%)更容易观察到闭合。较小黄斑水肿和存在囊性黄斑水肿的患者更常出现闭合。虽然非手术治疗 MH 的方法显示出保守治疗的潜力,但支持常规使用的证据有限。第一阶段和创伤性MH可能会从短期观察中获益,但全厚MH的金标准方法仍然是玻璃体切除术加ILM剥离。
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Scoping review of nonsurgical treatment options for macular holes

Macular holes (MH) are full-thickness retinal defects affecting central vision. While vitrectomy with inner limiting membrane (ILM) peel is the conventional MH treatment, non-surgical alternatives are gaining interest to mitigate surgical risks. This study conducted a comprehensive literature review and analysis of nonsurgical MH management. A systematic literature search was conducted on PubMed, Embase, Scopus, and the Cochrane Library from January 1, 1973, to September 13, 2023. Treatments included laser therapy, carbonic anhydrase inhibitors (CAIs), nonsteroidal antiinflammatory drugs (NSAIDs), steroids (topical, subtenons, peribulbar, intravitreal), intravitreal gas, anti-vascular endothelial growth factors and ocriplasmin injections. Data extraction covered study details, patient characteristics, MH features, treatment outcomes, and recurrence rates. The initial search yielded 3352 articles, refined to 83 articles that met inclusion criteria following screening. Overall reported anatomical closure rates were 36% with laser photocoagulation, 37% with intravitreal ocriplasmin, 55% with intravitreal gas. Closures were more frequently observed with topical NSAIDs (79%), steroids (84%) and CAIs (73%). Closures were more often observed in patients with smaller MH and in the presence of cystic macular oedema. Although non-surgical MH management approaches show potential for conservative therapy, evidence is limited to support routine use. Stage 1 and traumatic MH may benefit from a short period of observation, but the gold standard approach for full-thickness MH remains to be vitrectomy with ILM peel.

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来源期刊
Survey of ophthalmology
Survey of ophthalmology 医学-眼科学
CiteScore
10.30
自引率
2.00%
发文量
138
审稿时长
14.8 weeks
期刊介绍: Survey of Ophthalmology is a clinically oriented review journal designed to keep ophthalmologists up to date. Comprehensive major review articles, written by experts and stringently refereed, integrate the literature on subjects selected for their clinical importance. Survey also includes feature articles, section reviews, book reviews, and abstracts.
期刊最新文献
The Secondary Childhood Glaucomas. Choroidal biomarkers in age-related macular degeneration. Meta-analysis of treatment outcomes for patients with m.11778G>A MT-ND4 Leber hereditary optic neuropathy. Vision degrading myodesopsia from vitreous floaters in the young: An important aspect of myopia. Pediatric keratoconus.
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