动脉溶栓治疗视网膜中央动脉阻塞Meta分析

doi:10.6040/j.issn.1673-3770.1.2020.057

Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (4): 28-34.doi: 10.6040/j.issn.1673-3770.1.2020.057

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Intra-arterial thrombolysis for central retinal artery occlusion: a Meta-analysisCHEN Xi, LI Shanshan, ZHAO Lu, YOU Ran, WANG Yanling Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, ChinaAbstract:

ObjectiveTo compare the effects of intra-arterial thrombolysis and traditional treatment in central retinal artery occlusion(CRAO). MethodsWe searched the Pubmed, Embase, Clinical.gov, CNKI, and Wan Fang databases for related studies that were published up to May 14, 2020. We included clinical controls that compared intra-arterial thrombolysis and conventional treatment in CRAO. The random effect model and R software were used for data analysis. ResultsWe identified seven studies including 563 CRAO patients. Meta-analysis results of two randomized controlled trials(RCTs)showed that there was no significant difference in visual acuity improvement between CRAO patients treated with arterial thrombolysis therapy and those with conventional therapy(RR: 1.17, 95% confidence interval 0.80-1.72, P=0.409). Meta-analysis results of five cohort studies indicated that compared with conventional therapy, arterial thrombolysis therapy significantly improved visual acuity(RR: 1.86, 95% confidence interval 1.43-2.41, P<0.001). The difference between thrombolysis therapy and conventional therapy may be caused by the different treatment time windows in patients. Concerning the adverse reactions after treatment, two RCTs and five cohort studies showed that the adverse reactions in the thrombolysis group are significantly higher than those in the conventional treatment group. ConclusionAlthough intra-arterial thrombolysis therapy has therapeutic potential in CRAO patients, there is still insufficient clinical evidence to prove its effectiveness and safety. Further studies with a large sample and high quality RCTs are required.

Key words: Central retinal artery occlusion;
Intra-arterial thrombolysis;
Systematic review;
Meta-analysis视网膜中央动脉阻塞(central retinal artery occlusion, CRAO)常常迅速导致严重的视力损害甚至完全丧失^［1］, 病理过程为视网膜中央动脉阻塞导致视网膜急性缺血缺氧^［2］, 是缺血性卒中的眼部表现形式之一^［1-3］。早期治疗对于挽救CRAO患者视功能十分关键^［4］, 直接影响此类患者的视功能预后^［5］。CRAO治疗的目的是尽快恢复视网膜血液循环及其功能^［6］。现有对CRAO传统治疗的方法主要包括有扩张血管、解除痉挛及吸氧治疗, 增加视网膜血供, 改善组织缺血缺氧^［7］;
降眼压治疗, 增加视网膜血液灌注^［8］;
按摩眼球, 驱使栓子进入小支血管。

Received:2020-06-01 Online:2020-07-20 Published:2020-08-28

Abstract

Abstract: Objective To compare the effects of intra-arterial thrombolysis and traditional treatment in central retinal artery occlusion(CRAO). Methods We searched the Pubmed, Embase, Clinical.gov, CNKI, and Wan Fang databases for related studies that were published up to May 14, 2020. We included clinical controls that compared intra-arterial thrombolysis and conventional treatment in CRAO. The random effect model and R software were used for data analysis. Results We identified seven studies including 563 CRAO patients. Meta-analysis results of two randomized controlled trials(RCTs)showed that there was no significant difference in visual acuity improvement between CRAO patients treated with arterial thrombolysis therapy and those with conventional therapy(RR: 1.17, 95% confidence interval 0.80-1.72, P=0.409). Meta-analysis results of five cohort studies indicated that compared with conventional therapy, arterial thrombolysis therapy significantly improved visual acuity(RR: 1.86, 95% confidence interval 1.43-2.41, P<0.001). The difference between thrombolysis therapy and conventional therapy may be caused by the different treatment time windows in patients. Concerning the adverse reactions after treatment, two RCTs and five cohort studies showed that the adverse reactions in the thrombolysis group are significantly higher than those in the conventional treatment group. Conclusion Although intra-arterial thrombolysis therapy has therapeutic potential in CRAO patients, there is still insufficient clinical evidence to prove its effectiveness and safety. Further studies with a large sample and high quality RCTs are required.

Key words: Central retinal artery occlusion, Intra-arterial thrombolysis, Systematic review, Meta-analysis

CLC Number:

R774.1

ObjectiveTo compare the effects of intra-arterial thrombolysis and traditional treatment in central retinal artery occlusion(CRAO). MethodsWe searched the Pubmed, Embase, Clinical.gov, CNKI, and Wan Fang databases for related studies that were published up to May , . We included clinical controls that compared intra-arterial thrombolysis and conventional treatment in CRAO. The random effect model and R software were used for data analysis. ResultsWe identified seven studies including CRAO patients. Meta-analysis results of two randomized controlled trials(RCTs)showed that there was no significant difference in visual acuity improvement between CRAO patients treated with arterial thrombolysis therapy and those with conventional therapy(RR: ., % confidence interval .-., P=.). Meta-analysis results of five cohort studies indicated that compared with conventional therapy, arterial thrombolysis therapy significantly improved visual acuity(RR: ., % confidence interval .-., P<.). The difference between thrombolysis therapy and conventional therapy may be caused by the different treatment time windows in patients. Concerning the adverse reactions after treatment, two RCTs and five cohort studies showed that the adverse reactions in the thrombolysis group are significantly higher than those in the conventional treatment group. ConclusionAlthough intra-arterial thrombolysis therapy has therapeutic potential in CRAO patients, there is still insufficient clinical evidence to prove its effectiveness and safety. Further studies with a large sample and high quality RCTs are required.. Intra-arterial thrombolysis for central retinal artery occlusion: a Meta-analysisCHEN Xi, LI Shanshan, ZHAO Lu, YOU Ran, WANG Yanling Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, ChinaAbstract:[J].Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 28-34.

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