Ibrahim Kocak, Nihat Sayin, Sadik Etka Bayramoglu, Lukman Thalib
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Study quality was assessed using the Cochrane Risk of Bias (ROB2) tool, and the certainty of evidence was evaluated using the GRADE approach. Three RCTs with 145 eyes met the eligibility criteria. The meta-analysis showed a pooled RR estimate of 0.64 (95 % CI 0.30-1.38), indicating a 36 % reduction in the risk of recurrent RD in MTX-treated eyes, although this was not statistically significant. No significant differences were observed in visual acuity improvement (SMD = 0.04; 95 % CI -0.53-0.60). Additionally, our meta-analysis of 5 non-randomized studies involving 277 eyes found no evidence to suggest that MTX reduces the incidence of recurrent retinal detachment in eyes undergoing surgery for PVR (RR = 0.90; 95 % CI 0.49-1.64). The RCTs were rated as having moderate risk of bias, while most non-randomized studies were assessed as having high risk of bias. Funnel plots indicated potential publication bias, and the certainty of evidence was rated as moderate according to GRADE. Although MTX was associated with a clinically relevant 36 % reduction in recurrent RD risk, the effect was not statistically significant. Larger, high-quality RCTs with adequate power are needed to confirm these findings.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9000,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of methotrexate in preventing retinal detachment after proliferative vitreoretinopathy surgery: A systematic review and meta-analysis.\",\"authors\":\"Ibrahim Kocak, Nihat Sayin, Sadik Etka Bayramoglu, Lukman Thalib\",\"doi\":\"10.1016/j.survophthal.2025.09.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Intravitreal methotrexate (MTX) is increasingly administered as an adjunctive therapy alongside surgical intervention in patients with proliferative vitreoretinopathy (PVR) or those at high risk of its development, with the aim of preventing recurrent PVR and subsequent retinal detachment; however, its efficacy remains uncertain. 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引用次数: 0
摘要
玻璃体甲氨蝶呤(MTX)越来越多地作为手术干预的辅助治疗,用于增殖性玻璃体视网膜病变(PVR)或其发展的高风险患者,目的是预防复发性PVR和随后的视网膜脱离;然而,其功效仍不确定。我们检索了PubMed, EMBASE, CINAHL和Cochrane图书馆,从成立到2024年12月,以评估玻璃体内MTX作为PVR手术辅助治疗的研究。主要分析包括随机对照试验(rct),补充分析包括非随机研究。所有meta分析均采用随机效应模型进行。使用Cochrane风险偏倚(ROB2)工具评估研究质量,使用GRADE方法评估证据的确定性。3项随机对照试验145只眼符合入选标准。荟萃分析显示,合并RR估计为0.64 (95% CI 0.30-1.38),表明mtx治疗的眼睛复发RD的风险降低了36%,尽管这没有统计学意义。两组在视力改善方面无显著差异(SMD = 0.04; 95% CI -0.53 ~ 0.60)。此外,我们对涉及277只眼睛的5项非随机研究的荟萃分析发现,没有证据表明MTX可以降低PVR手术中复发性视网膜脱离的发生率(RR = 0.90; 95% CI 0.49-1.64)。随机对照试验被评为具有中等偏倚风险,而大多数非随机研究被评估为具有高偏倚风险。漏斗图显示潜在的发表偏倚,证据的确定性根据GRADE被评为中等。尽管MTX与临床相关的复发性RD风险降低36%相关,但效果没有统计学意义。需要更大规模、高质量的随机对照试验来证实这些发现。
Effect of methotrexate in preventing retinal detachment after proliferative vitreoretinopathy surgery: A systematic review and meta-analysis.
Intravitreal methotrexate (MTX) is increasingly administered as an adjunctive therapy alongside surgical intervention in patients with proliferative vitreoretinopathy (PVR) or those at high risk of its development, with the aim of preventing recurrent PVR and subsequent retinal detachment; however, its efficacy remains uncertain. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library from inception to December, 2024, for studies evaluating intravitreal MTX as an adjuvant therapy in PVR surgery. The primary analysis included randomized controlled trials (RCTs), while supplementary analyses incorporated non-randomized studies. All meta- analyses were conducted using random-effect models. Study quality was assessed using the Cochrane Risk of Bias (ROB2) tool, and the certainty of evidence was evaluated using the GRADE approach. Three RCTs with 145 eyes met the eligibility criteria. The meta-analysis showed a pooled RR estimate of 0.64 (95 % CI 0.30-1.38), indicating a 36 % reduction in the risk of recurrent RD in MTX-treated eyes, although this was not statistically significant. No significant differences were observed in visual acuity improvement (SMD = 0.04; 95 % CI -0.53-0.60). Additionally, our meta-analysis of 5 non-randomized studies involving 277 eyes found no evidence to suggest that MTX reduces the incidence of recurrent retinal detachment in eyes undergoing surgery for PVR (RR = 0.90; 95 % CI 0.49-1.64). The RCTs were rated as having moderate risk of bias, while most non-randomized studies were assessed as having high risk of bias. Funnel plots indicated potential publication bias, and the certainty of evidence was rated as moderate according to GRADE. Although MTX was associated with a clinically relevant 36 % reduction in recurrent RD risk, the effect was not statistically significant. Larger, high-quality RCTs with adequate power are needed to confirm these findings.
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.