Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment

 

Abstract

Background

Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina in the region of the retinal break, because such symptomatic retinal tears are associated with a high rate of progression to retinal detachment. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. Nevertheless, treatment of these problems is frequently recommended, in spite of the fact that the effectiveness of this therapy is unproven.

Objectives

The purpose of this review was to evaluate the effectiveness of interventions for asymptomatic retinal breaks and lattice degeneration.

Search methods

We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which includes the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library (Issue 4 2008), MEDLINE (1966 to November 2008) and EMBASE (1980 to November 2008). The electronic databases were last searched on 24 November 2008. Textbooks regarding retinal detachment and the reference lists of relevant reports were reviewed for additional study reports. Experts in the field were contacted for details of other published and unpublished studies.

Selection criteria

This review was designed to include randomized controlled trials in which one treatment for asymptomatic retinal breaks and lattice degeneration was compared to another treatment or to no treatment.

Data collection and analysis

Initially one author assessed the search results and collected relevant studies. Since no studies met the inclusion criteria, no studies were assessed for methodological quality. No data were extracted and no meta-analysis could be performed.

Main results

No trials were found that met the inclusion criteria for this review.

Authors' conclusions

No conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks and/or lattice degeneration. Some current recommendations for treatment, based upon a consensus of expert opinion, are contradicted by the best available evidence.

 

Plain language summary

Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment

A rhegmatogenous retinal detachment develops when a break (tear, hole) occurs in the sensory retina and allows fluid from the vitreous cavity to separate the sensory retina from the underlying retinal pigment epithelium. When retinal breaks occur they may be associated with symptoms such as dark floaters or flashing lights or they may develop without symptoms, in which case they are termed "asymptomatic". Because asymptomatic retinal breaks and lattice degeneration are associated statistically with retinal detachment at variable periods later on, treatment of the lesions with laser or cryotherapy has been proposed to prevent the latter problem. This review discovered no prospective and/or randomized trials comparing treatment and controls, and there is therefore insufficient evidence to demonstrate any benefit of prophylactic therapy for the problems that were studied.

 

摘要

背景

對於無症狀的視網膜裂孔與網格狀變性的介入措施以預防視網膜剝離

無症狀的視網膜裂孔與網格狀變性是可見的病灶，其為之後視網膜剝離的危險因素。視網膜剝離發生在當玻璃體腔內的液體穿過視網膜上的裂縫或孔洞，並將視網膜與其基底的視網膜上皮細胞分離。建議以雷射光凝固療法或冷凍治療來黏合視網膜裂孔與網格狀變性的周圍，作為預防視網膜剝離的有效方法。這種療法對於處理與視網膜撕裂相關之閃光及飛蚊症的症狀，以及在視網膜裂孔的區域沿著視網膜持續的玻璃體牽引是有價值的，因為這樣有症狀的視網膜裂縫有較高的機率會進展至視網膜剝離。與急性症狀及網格狀變性無關的視網膜撕裂與孔洞，明顯地較少為造成之後視網膜剝離之視網膜裂孔的部位。然而，儘管事實上這種療法的效果尚未被證實，這種方法經常被建議用來治療這些問題。

目標

這篇回顧的目的為評估對於無症狀的視網膜裂孔與網格狀變性之介入措施的效果。

搜尋策略

我們檢索考科藍圖書館的the Cochrane Central Register of Controlled Trials  CENTRAL (其包含the Cochrane Eyes and Vision Group Trials Register)(2006年，第4期), MEDLINE (1966至2006年11月)及EMBASE (1980至2006年11月)。檢閱有關視網膜剝離的教科書與相關報告的參考文獻以取得其他的研究報告。聯絡該領域的專家以了解其他已發表與未發表研究的細節。

選擇標準

這篇回顧納入無症狀視網膜裂孔與網格狀變性的治療方式相較於另一種治療或無治療的隨機對照試驗。

資料收集與分析

一開始由一位作者評估研究結果並蒐集相關研究。由於沒有研究符合納入標準，因此沒有評估研究的方法學品質。沒有摘錄資料且無法進行統合分析。

主要結論

沒有試驗符合這篇回顧的納入標準。

作者結論

無法推論用來預防無症狀視網膜裂孔及/或網格狀變性的眼睛發生視網膜剝離之手術介入措施效果的結論。有一些依據專家意見共識的治療建議與現有的最佳證據互相矛盾。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無症狀的視網膜裂孔與網格狀變性用來預防視網膜剝離的介入措施。孔源性視網膜剝離的發展是當感光的視網膜發生裂孔(撕裂，孔洞)，並使玻璃體腔內的液體分離視網膜及其基底的視網膜上皮細胞。當視網膜裂孔發生時也許會產生症狀，如黑暗飛蚊症或閃光，或者他們也許會發生但沒有症狀，在這種情況下稱為“無症狀的”。由於無症狀的視網膜裂孔與網格狀變性兩者與之後不同時期的視網膜剝離有統計相關，因此建議以雷射或冷凍治療病灶以預防後來的問題。這篇回顧沒有發現比較治療與對照的前瞻性及/或隨機試驗，且沒有足夠證據證實預防性療法對於所研究的問題的效益。