玻璃体腔穿刺注射雷珠单抗与激光光凝治疗糖尿病性黄斑水肿的疗效与安全性的Meta分析

目的：综合评价玻璃体穿刺注射雷珠单抗和视网膜激光光凝2种方案治疗糖尿病性黄斑水肿的疗效与安全性的差异。方法检索Pubmed（1966年－2014年1月）、EMbase（1966年－2014年1月）、Cochrane对照试验登记中心（2014年1月）、中国生物医学文献数据（CBM）（1979年-2014年1月）、中国科技期刊全文数据库（VIP）（2014年）、中国期刊网全文数据库（CNKI）（2014年）有关玻璃体腔穿刺注射雷珠单抗和视网膜激光光凝对比治疗糖尿病性黄斑水肿的随机临床对照研究文献资料。采用Cochrane系统评价的方法，按照纳入和排除标准限定，使用 RevMan 5．2统计软件进行 Meta分析，以获得2种方案治疗糖尿病性黄斑水肿的疗效及安全性是否有差异的相关证据。结果纳入玻璃体腔穿刺注射雷珠单抗和视网膜激光光凝对比治疗糖尿病性黄斑水肿的随机临床对照研究共5篇（玻璃腔注射雷珠单抗组305只眼，视网膜激光光凝组289只眼）。Meta分析结果显示，玻璃体腔注射雷珠单抗组与视网膜激光光凝组患者的黄斑中央凹厚度降低幅度比较差异有统计学意义[95％CI（0．36，0．84），z＝2．77（P ＝0．006）]；最佳矫正视力（以BCVA计算）提高幅度的差异有统计学意义[95％CI（0．22，0．47）， z＝5．84（P ＜0．0001）]。结论2种方案治疗糖尿病性黄斑水肿时，玻璃体腔穿刺注射雷珠单抗在降低中央黄斑厚度和提高最佳矫正视力方面疗效方面均明显优于视网膜激光光凝；2种方案在安全性上尚无明显差异，但尚需更多前瞻性大样本及长期的临床随机对照试验数据支持。

Meta-analysis of efficacy of ranibizumab and laser treatment for diabetic macular edema

Objecticve To evaluate the difference of the efficacy and safety between retinal laser photocoag-ulation and intravitreal inj ection of ranibizumab.Methods We retrieved the data of the contrastive studies on intravitreal inj ection of Ranibizumab and retinal laser photocoagulation about treatment of diabetic mac-ular edema from databases such as Pubmed （1966-January 2014）,EMbase （1966-January 2014）,Cochrane library （January 2014）,CBM （1979-January 2014）,VIP （2014）,CNKI （2014）.We tried to obtain the evi-dence of efficacy and safety of the two methods according to Jadad quality assessment rating scale by using Cochrane systematic review methods and RevMan 5 .2 statistical software to do Meta-analysis.Results Five randomized controlled clinical studies about intravitreal Ranibizumab inj ection puncture and laser pho-tocoagulation to cure diabetic macular edema were included in our study （ranibizumab：305 eyes;laser：289 eyes）.Meta-analysis showed that there is statistical difference in the efficacy and safety between the two treatments.Patients treated with Ranibizumab showed improvement in visual acuity [95%CI（0.36, 0.84）,z=2.77（P=0.006）]and reduction in central macular thickness [95%CI （0.22,0.47）,z=5.84 （P〈0.0001）].Conclusion In terms of efficacy of improvement in corrected vision and reduction of central macular thickness,puncture inj ection of intravitreal Ranibizumab treatment is superior to retinal laser pho-tocoagulation method in treating diabetic macular edema.Although there showed no significant difference in the safety of two operations so far,a larger sample and long-term prospective randomized controlled clinical trial data is needed to support and convince us of the difference.