两种Nd:YAG激光后囊膜切开方式治疗后囊膜混浊的Meta分析

目的：系统评价两种Nd：YAG激光后囊膜切开方式治疗白内障术后后囊膜混浊的效果与安全性，为临床实践中后囊膜切开方式的选择提供可靠依据。

方法：计算机检索中文全文期刊数据库(CNKI)、万方数据库、维普数据库、PubMed、Medline、Cochrane Library搜集不同Nd：YAG激光后囊膜切开方式治疗后囊膜混浊的相关文章，检索时限定义为2000-01-01/2019-12-31，2位评价者独立进行文献检索、筛选、质量评价及数据提取，采用RevMan5.3软件进行Meta分析。以均值差(MD)与95%置信区间(CI)衡量计量资料的效应量，对术后最佳矫正视力(BCVA)、术后眼压、激光使用能量进行合并分析。以比值比(OR)衡量计数资料的效应量，对出现人工晶状体受损以及眼前黑影飘动的比例进行合并分析。

结果：共纳入7篇研究，包括行Nd：YAG激光圆形后囊膜切开和十字形后囊膜切开共计432眼。Meta分析结果显示：圆形后囊膜切开组和十字形后囊膜切开组患者术后BCVA无差异(MD=-0.01，95%CI：-0.03～0.01，P=0.32)； 术后眼压无差异(MD=-0.60，95%CI：-1.31～0.11，P=0.10)； 使用激光能量无差异(MD=18.82，95%CI：-11.88～49.51，P=0.23)； 晶状体受损率无差异(OR=0.97，95%CI：0.50～1.87，P=0.93)； 眼前黑影飘动发生率无差异(OR=2.88，95%CI：0.28～29.26， P=0.37)。

结论：在白内障术后发生后囊膜混浊的患者行Nd：YAG激光后囊膜切开治疗中，圆形后囊膜切开与十字形后囊膜切开在治疗效果与安全性方面均无明显差异。

Meta-analysis of two kinds of Nd:YAG laser posterior capsulotomy in the treatment of posterior capsular opacification

AIM: To systematically evaluate the efficacy and safety of two different kinds of Nd:YAG laser posterior capsulotomy in the treatment of posterior capsular opacification after cataract surgery and provide reliable evidence for the selection of posterior capsulotomy in clinical practice.

METHODS: A literature search was implemented in CNKI, Wanfang database, VIP database, PubMed, Medline and Cochrane Library from 2000-01-01 to 2019-12-31. Two researchers independently performed literature search, screening, quality evaluation, and data extraction. Meta-analysis was performed by RevMan 5.3 software. The mean difference and 95% confidence interval were used to measure the measurement data, including best corrected visual acuity, postoperative intraocular pressure, and laser energy. The odds ratio was used to measure the count data, including the rate of lens damage and the incidence of vitreous floaters.

RESULTS: A total of 7 studies were included, including Nd:YAG laser circular posterior capsulotomy and cruciate posterior capsulotomy in 432 eyes. The Meta-analysis showed that there was no significant difference in postoperative best corrected visual acuity between the circular posterior capsulotomy group and the cruciate posterior capsulotomy group, MD=-0.01(95% CI: -0.03-0.01, P=0.32); there was no significant difference in postoperative IOP between the circular posterior capsulotomy group and the cruciate posterior capsulotomy group, MD=-0.60(95% CI: -1.31-0.11, P=0.10); there was no significant difference in laser energy between the two groups, MD=18.82(95% CI: -11.88-49.51, P=0.23); there was also no significant difference in the rate of lens damage and the incidence of vitreous floaters, OR=0.97(95% CI: 0.50-1.87, P=0.93); OR=2.88(95% CI: 0.28-29.26, P=0.37).

CONCLUSION:In the treatment of posterior capsular opacification after cataract surgery with Nd:YAG laser posterior capsulotomy, there is no significant difference in efficacy and safety between circular posterior capsulotomy and cruciate posterior capsulotomy.