| Background: Acute retinal necrosis is not a very common disease but it is also a very dangerous one.It can lead to blindness when not treated promptly,and sometimes even with proper treatment the patient can still become blind.The treatments available today are: antivirus drugs(acyclovir,valacyclovir,famciclovir,cidofovir),corticosteroids,prophylactic vitrectomy,prophylactic photocoagulation and remedial vitrectomy.Up to this date the prognosis in these patients were still poor.So it is crucial to find treatment that can prevent blindness and bring better prognosis to patients with acute retinal necrosis.Objective: In this study we aim to realize a meta-analysis and to systematically review the outcome of prophylactic vitrectomy and prophylactic photocoagulation in patients with ARN.We also aim to systematically review the BCVA in remedial vitrectomy.In this study we accessed the rate of occurence of retinal detachment in acute retinal necrosis patients in prophylactic vitrectomy and prophylactic photocoagulation,and we also accessed the best corrected visual acuity in patients that received remedial vitrectomy.Methods: A systemic electronically search of articles was performed in databases such as PubMed,Embase,Cochrane Library,Web of Science and Wangfang Database.For PubMed,Embase,Cochrane Library,Web of Science the keywords were written in English and for Wangfang Database they were written in Chinese.We followed the meta-analysis of observational studies in epidemiology(MOOSE)guidelines to conduct this meta-analysis.The rate of occurrence of retinal detachment in prophylactic vitrectomy and prophylactic photocoagulation,and the BCVA in patients that received remedial vitrectomy were analyzed.Results:The keywords used to search were:“Retinal Necrosis Syndrome,Acute",“Retinal Necrosis,Acute”,“Prophylactic Vitrectomy”,“Vitrectomy”,“Prophylactic Photocoagulation”,“急性视网膜坏死”“预防性玻璃体切除”“玻璃体切除”,“预防性激光”.In total we retrieved in total 899 articles and according with inclusion criteria set by us,the authors,10 studies were included in this meta-analysis.The 10 included studies were published in USA,Australia,Japan,Iran,UK,Germany and China,and published from 1988 to 2012.They were all retrospective studies.The sample sizes of the included studies ranged from 6 to 104 eyes,with a combined total of 329 eyes.The follow-up time ranged from 12.36 months to 60 months.We analyzed the rate of occurrence of retinal detachment in prophylactic vitrectomy(4 studies)and prophylactic photocoagulation(3 studies),and also the BCVA in patients that received remedial vitrectomy(3 studies).In order to analyze rate of occurrence of retinal detachment in prophylactic vitrectomy we included the following studies: C.Iwahashi-Shima et al(2012)study included 104 eyes(104 patients),the treatment group included 48 eyes and retinal detachment occurred in 20 eye and the control included 56 eyes and retinal detachment occurred in 39 of them.Hillenkamp et al(2009)included 30 eyes(27patients),10 eyes in the treatment group,where retinal detachment occurred in 4 eyes,and 20 eyes in the control group,where retinal detachment occurred in 18 eyes.T.Ishida et al(2009)study included 18 eyes(17 patients),11 eyes in the treatment group,where retinal detachment occurred in 3 eyes,and 7 eyes in the control group,where retinal detachment occurred in 3 eyes.Luo et al(2012)study included 37 eyes(30 patients),16 eyes in the treatment group,where retinal detachment occurred in 2eyes,and 21 eyes in the control group,where retinal detachment occurred in 9 eyes.In order to analyze rate of occurrence of retinal detachment in prophylactic photocoagulation we included the following studies: Chung H.Lau et al,(2007)included 27 eyes(22 patients),12 of those eyes were included in the treatment group,where retinal detachment occurred in 6 eyes,and 10 eyes were included in the routine treatment,where retinal detachment occurred in 8 eyes.Sims et al,(2009)included 23eyes(22 patients),15 of those eyes were included in the treatment group,where retinal detachment occurred in 5 eyes,and 8 eyes were included in the routine treatment,where retinal detachment occurred in 4 eyes.Tibbetts et al,(2010)included 58 eyes(58 patients),19 of those eyes were included in the treatment group,where retinal detachment occurred in 11 eyes,and 39 eyes were included in the routine treatment,where retinal detachment occurred in 18 eyes.In order to analyze the BCVA in patients that received remedial vitrectomy we included the following studies Ahmadieh et al(2003)included 18 eyes(16 patients),the mean BCVA before surgery was 1.9 logMAR unit and the mean BCVA after surgery was 1.24 logMAR unit.Blumenkranz et al(1988)included 6 eyes(6 patients),the mean BCVA before surgery was 1.93 logMAR unit and the mean BCVA after surgery was 0.6 logMAR unit.Crapotta et al(1993)included 13 eyes(12 patients),the mean BCVA before surgery was 0.7 logMAR unit and the mean BCVA after surgery was 0.5 logMAR unit.Patients who received prophylactic vitrectomy had a lower rate of retinal detachment than those who received routine treatment(OR = 0.26,95%CI :[0.14,0.49] P < 0.05).The rate of retinal detachment had no statistic significant difference between patients who received prophylactic photocoagulation and those who received routine treatment(OR = 0.73,95% CI: [0.24,2.25];P > 0.05).Patients receiving remedial vitrectomy had BCVA improvement(MD =-0.72,95% CI:[-1.29,-0.15];P < 0.05).Conclusion: To acute retinal necrosis patients,Prophylactic vitrectomy that resects the vitreous and clears lesions at the inflammatory stage,contributes to the prevention the retinal detachment.The use of Prophylactic photocoagulation seems to be no use for preventing retinal detachment,probably because it’s difficult to proceed in advanced stage due to dense vitreous opacities and when retinal breaks occur in the anterior vitreous base are difficult to be directed and get laser.Remedial vitrectomy should be performed after rhegmatogenous retinal detachment,which shows efficacy in improving BCVA. |
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