比較兩種療法：銣‐雅鉻雷射(Nd‐YAG)與玻璃體切除手術（pars plana vitrectomy）對飛蚊症的療效
Abstract
Background
The vitreous is the clear jelly of the eye and contains fine strands of proteins. Throughout life the composition of this vitreous changes, which causes the protein strands in it to bundle together and scatter light before it reaches the retina. Individuals perceive the shadows cast by these protein bundles as 'floaters'. Some people are so bothered by floaters that treatment is required to control their symptoms. Two major interventions for floaters include Nd:YAG laser vitreolysis and vitrectomy. Nd:YAG laser vitreolysis involves using laser energy to fragment the vitreous opacities via a non‐invasive approach. Vitrectomy involves the surgical replacement of the patient's vitreous (including the symptomatic vitreous floaters) with an inert and translucent balanced salt solution, through small openings in the pars plana.
Objectives
To compare the effectiveness and safety of Nd:YAG laser vitreolysis to pars plana vitrectomy for symptomatic vitreous floaters.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 17 January 2017), Embase Ovid (1947 to 17 January 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 17 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 17 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 17 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 17 January 2017. We did not use any date or language restrictions in the electronic searches for trials. We also searched conference proceedings to identify additional studies.
Selection criteria
We included only randomised controlled trials (RCTs) that compared Nd:YAG laser vitreolysis to pars plana vitrectomy for treatment of symptomatic floaters.
Data collection and analysis
We planned to use methods recommended by Cochrane. The primary outcome we planned to measure was change in vision‐related quality of life from baseline to 12 months, as determined by a vision‐related quality of life questionnaire. The secondary outcomes we planned to measure were best corrected logMAR or Snellen visual acuity at 12 months for the treated eye(s) and costs. Adverse outcomes we planned to record were the occurrence of sight‐threatening complications by 12 months (asymptomatic retinal tears, symptomatic retinal tears, retinal detachment, cataract formation, and endophthalmitis).
Main results
No studies met the inclusion criteria of this review.
Authors' conclusions
There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision‐related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.
PICO
Plain language summary
雷射或玻璃體切除手術用於治療飛蚊症
本文獻回顧的目的是什麼？
本考科藍回顧目的在於探討採用雷射手術或玻璃體切除術治療飛蚊症，哪一種療法最安全且有效。
主要結論
目前仍無法確定雷射手術或玻璃體切除術是較好治療飛蚊症方式。
本文獻回顧的研究內容是什麼？
眼球中填滿了透明的膠狀物質稱為玻璃體。有時蛋白質纖維會聚集漂浮在玻璃體中。於是眼中會察覺到移動的懸浮物，或是俗稱「飛蚊症」。這是一種正常無害的的老化現象，通常不需要治療。但是如果懸浮物的體積較大可能會干擾視線，對日常活動如閱讀和駕駛等造成妨礙。
如果懸浮物引起視力問題，可以採用雷射或玻璃體切除術予以治療。雷射治療方式為將懸浮物（飛蚊）以雷射蒸發。玻璃體切除術則是一種將玻璃體完全去除的手術。
本文獻回顧的主要結果是什麼？
考科藍研究人員並未發現任何直接比較這兩種療法的研究。
本文獻回顧資料更新日期為何？
考科藍研究人員搜索發佈日期至2017年1月17日的研究。
