开放性球体损伤后初次修复时机的提前与延后:系统回顾与荟萃分析。

IF 13.1 1区 医学 Q1 OPHTHALMOLOGY Ophthalmology Pub Date : 2024-08-31 DOI:10.1016/j.ophtha.2024.08.030
David McMaster, James Bapty, Lana Bush, Giuseppe Serra, Theo Kempapidis, Scott F McClellan, Fasika A Woreta, Grant A Justin, Rupesh Agrawal, Annette K Hoskin, Kara Cavuoto, James Leong, Andrés Rousselot Ascarza, John Cason, Kyle E Miller, Matthew C Caldwell, William G Gensheimer, Tom H Williamson, Felipe Dhawahir-Scala, Peter Shah, Andrew Coombes, Gangadhara Sundar, Robert A Mazzoli, Malcolm Woodcock, Stephanie L Watson, Ferenc Kuhn, Marcus Colyer, Renata S M Gomes, Richard J Blanch
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引用次数: 0

摘要

主题:在世界各地的主要创伤中心,对开阔性眼球损伤进行初级修复的时机各不相同,对最佳时机也缺乏共识:临床相关性:手术是处理开球伤的主要方法,适当的手术修复时机可将眼内炎等潜在致盲并发症的风险降至最低,从而优化视觉效果:按照 PRISMA 指南(PROSPERO 注册号:CRD42023442972)进行了系统性文献综述。检索了从开始到 2023 年 10 月 29 日的 CENTRAL、MEDLINE、Embase、ISRCTN 注册表和 ClinicalTrials.gov。研究对象包括初次修复后随访至少一个月的开球损伤患者的前瞻性和回顾性非随机研究。主要结果包括最后一次随访时的视力和发生眼内炎的患者比例。采用 GRADE(建议、评估、发展和评价分级)方法对证据的确定性进行评估:共有 16 项研究符合纳入标准,共报告了 8497 只眼睛。最常见的损伤类型是穿透性损伤和眼内异物(IOFB)。Meta 分析发现,与创伤后 24 小时以上进行的初级修复相比,开球损伤后 24 小时以内进行的初级修复发生眼内炎的几率为 0.30(OR 0.39;95% CI 0.19-0.79;I2 95%;P = 0.01)。与创伤后 24 小时以内进行初次修复的患者相比,创伤后 24 小时以上进行初次修复的患者的视觉效果无明显差异(OR 0.89;95% CI 0.61-1.29;I2 70%;P = 0.52)。所有纳入的研究均为回顾性和非随机研究,在 GRADE 评估中证据的确定性总体较低:结论:关于开球修复时机的影响,目前仅有回顾性数据,因此现有证据的确定性较低。然而,这份主要包括穿透性和 IOFB 损伤的现有证据综述表明,与较长的延迟时间相比,在开球损伤后 24 小时内进行初次修复与眼内炎发生率降低相关,这与初次修复延迟会增加眼内炎风险的观点一致。
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Early versus Delayed Timing of Primary Repair after Open-Globe Injury: A Systematic Review and Meta-analysis.

Topic: The timing of primary repair of open-globe injury is variable in major trauma centers worldwide, and consensus on optimal timing is lacking.

Clinical relevance: Surgery is the mainstay of open-globe injury management, and appropriate timing of surgical repair may minimize the risk of potentially blinding complications such as endophthalmitis, thereby optimizing visual outcomes.

Methods: A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (International Prospective Register of Systematic Reviews identifier, CRD42023442972). The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ISRCTN registries and ClinicalTrials.gov were searched from inception through October 29, 2023. Prospective and retrospective nonrandomized studies of patients with open-globe injury with a minimum of 1 month of follow-up after primary repair were included. Primary outcomes included visual acuity at last follow-up and the proportion of patients with endophthalmitis. Certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.

Results: Fifteen studies met inclusion criteria, reporting a total of 8497 eyes. The most common injury types were penetrating and intraocular foreign body (IOFB). Meta-analysis found that primary repair less than 24 hours after open-globe injury was associated with 0.30 odds of endophthalmitis compared with primary repair conducted more than 24 hours after trauma (odds ratio, 0.39; 95% confidence interval [CI], 0.19-0.79; I2 = 95%; P = 0.01). No significant difference was found in reported visual outcomes between patients whose open-globe injuries were repaired more than, compared with less than, 24 hours after trauma (odds ratio, 0.89; 95% CI, 0.61-1.29; I2 = 70%; P = 0.52). All included studies were retrospective and nonrandomized, demonstrating an overall low certainty of evidence on GRADE assessment.

Discussion: Only retrospective data exist around the effect of timing of open-globe repair, resulting in low certainty of the available evidence. However, this review of current evidence, predominantly including penetrating and IOFB injuries, suggests that primary repair performed less than 24 hours after open-globe injury is associated with a reduced endophthalmitis rate compared with longer delays, consistent with delay to primary repair increasing endophthalmitis risk.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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来源期刊
Ophthalmology
Ophthalmology 医学-眼科学
CiteScore
22.30
自引率
3.60%
发文量
412
审稿时长
18 days
期刊介绍: The journal Ophthalmology, from the American Academy of Ophthalmology, contributes to society by publishing research in clinical and basic science related to vision.It upholds excellence through unbiased peer-review, fostering innovation, promoting discovery, and encouraging lifelong learning.
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