治疗眼外伤的临时角膜移植术和原发性角膜移植术：系统回顾和荟萃分析。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-09-28 DOI:10.1016/j.ajo.2024.09.025

DAVID MCMASTER , SOPHIA HALLIDAY , JAMES BAPTY , SCOTT F MCCLELLAN , SARAH C MILLER , GRANT A JUSTIN , RUPESH AGRAWAL , ANNETTE K HOSKIN , KARA CAVUOTO , JAMES LEONG , ANDRÉS ROUSSELOT ASCARZA , FASIKA A WORETA , JOHN CASON , KYLE E MILLER , MATTHEW C CALDWELL , WILLIAM G GENSHEIMER , TOM H WILLIAMSON , FELIPE DHAWAHIR-SCALA , PETER SHAH , ANDREW COOMBES , RICHARD J BLANCH

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引用次数: 0

摘要

目的：当严重的视网膜和角膜损伤同时发生时，临时角膜前膜（TKP）往往是最后的选择，它可以使后节可视化，以便进行玻璃体视网膜手术，随后进行穿透性角膜成形术（PKP），一次手术即可恢复角膜的清晰度。我们旨在评估眼外伤病例使用 TKP 联合 PKP 和玻璃体视网膜手术后的视觉效果：按照 PRISMA 指南（PROSPERO 注册号：CRD42023423518）进行了系统性文献综述：方法：检索了从开始到 2023 年 4 月 27 日的 CENTRAL、MEDLINE、Embase、ISRCTN 注册表和 ClinicalTrials.gov。对眼外伤后联合玻璃体视网膜手术和使用TKP的PKP术后视觉效果进行评估的随机和非随机研究均符合纳入条件。结果包括最佳矫正视力的变化、角膜移植存活率和最终随访时的视网膜再粘连情况。比例荟萃分析用于估算主要结果的总体发生率。采用乔安娜-布里格斯研究所（Joanna Briggs Institute，JBI）的病例系列关键评估清单对非随机研究的偏倚风险进行了评估：共有 19 项研究符合纳入标准，共报告了 352 只眼睛。所有研究均为回顾性和非随机研究，随访时间从6个月到91个月不等，至少79%的研究结果是在6个月后报告的。联合手术后，角膜移植成活率为 52% (95% CI 0.41-0.62; I2 60%)，视网膜成功附着率为 79% (95% CI 0.73-0.84; I2 0%)，视力改善率为 45% (95% CI 0.32-0.59; I2 66%)：结论：影响前后节的严重损伤患者的治疗选择非常有限。本系统性综述发现，在进行玻璃体视网膜手术和带TKP的PKP联合手术时，约有一半的角膜移植体能存活，解剖学上视网膜重新接合很可能成功，与术前功能相比，有类似比例的患者在视力改善方面获益。对现有文献的系统性回顾有助于外科医生了解在眼外伤病例中使用 TKP 的益处。

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Temporary Keratoprosthesis and Primary Corneal Graft for Ocular Trauma: A Systematic Review and Meta-Analysis

Purpose

When severe retinal and corneal injury occur together, a temporary keratoprosthesis (TKP) is often a last resort to allow posterior segment visualization to enable vitreoretinal surgery, followed by a penetrating keratoplasty (PKP) which can restore corneal clarity in a single operation. We aimed to assess visual outcomes following combined PKP and vitreoretinal surgery with the use of a TKP for cases of ocular trauma.

Design

A systematic literature review was performed following PRISMA guidelines (PROSPERO registration number: CRD42023423518).

Methods

CENTRAL, MEDLINE, Embase, ISRCTN registry, and ClinicalTrials.gov were searched from inception to 27 April 2023. Randomized and nonrandomized studies assessing visual outcomes after combined vitreoretinal surgery and PKP with the use of a TKP after ocular trauma were eligible for inclusion. Outcomes included change in best corrected visual acuity, corneal graft survival and retinal reattachment at final follow up. Proportional meta-analysis was used to estimate the overall rate of the primary outcomes. Risk of bias for nonrandomized studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist for case series.

Results

A total of 19 studies met inclusion criteria reporting a total of 352 eyes. All studies were retrospective and nonrandomized with follow up times ranging from 6 to 91 months, with at least 79% of outcomes reported after 6 months. After combined surgery the rate of corneal graft survival was 52% (95% CI 0.41-0.62; I² 60%) successful retinal attachment was 79% (95% CI 0.73-0.84; I² 0%). and improved visual acuity, when compared to no change or decrease in visual acuity, was 45% (95% CI 0.32-0.59; I² 66%).

Conclusion

Patients with severe injury affecting the anterior and posterior segments have very limited treatment options. This systematic review found that when combined vitreoretinal surgery and PKP with a TKP are performed, approximately half of corneal grafts survive, anatomically successful retinal reattachment is likely, and a similar proportion of patients benefit in terms of improved visual acuity, compared to their preoperative function. This systematic review of the available literature may help inform surgeons of the benefits of using a TKP for cases of ocular trauma.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.