Preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment: a network meta-analysis_Chinese Journal of Ocular Fundus Diseases

Authors：

Chen Limei , Miao Xiaoxia , Xu Shuzhan ,  Liu Juping

Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China;

Corresponding?author：

Liu Juping, Email: tydljp@126.com

Keywords：

Rhegmatogenous retinal detachment; Choroidal detachment; Corticosteroids; Pars plana vitrectomy

DOI：

10.3760/cma.j.cn511434-20230621-00277

Video：

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Objective To systematically review the efficacy of preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD). Methods A evidence-based medicine study. The National Library of Medicine's PubMed, Web of Science, CNKI, and WanFang database were searched. Clinical controlled studies were selected the study object was RRDCD patients and the interventions were preoperative corticosteroids used as an adjunctive treatment. The search was conducted from January 2000 to January 2022. Duplicated, incomplete, or irrelevant articles were excluded. The conventional meta-analysis was used to evaluate the efficacy of corticosteroids used before surgery. The network meta-analysis was used to directly or indirectly compare the efficacy of oral corticosteroids or intravenous dexamethasone, peribulbar injection of glucocorticoids, prednisolone acetate eye-drops, intravitreal injection of triamcinolone acetonide (TA) and posterior sub-tenon injection of triamcinolone acetonide. Publication bias was evaluated by funnel plot. Results According to the search strategy, 43 articles were initially retrieved, and 929 eyes of 13 articles were finally included for analysis; 6 and 10 articles were included in the traditional meta-analysis and the network meta-analysis. Among the 6 studies included in the conventional meta-analysis, 5 studies were retrospective and 1 study was a randomized controlled trial, involving a total of 575 eyes. The analysis results showed that there was no significant difference in the primary retinal reattachment rate between the corticosteroids group and the control group [odds ratio (OR)= 1.53, 95% confidence interval (CI) 0.67-3.53, P=0.314]. Among the 10 studies included in the network meta-analysis, 7 studies were retrospective trials, 2 studies were randomized controlled trials, and 1 study was prospective trial, involving a total of 575 eyes. The analysis results showed that there were significant differences in the primary retinal reattachment rate between the triamcinolone acetonide intravitreal injection group and the no corticosteroid treatment group (OR=4.09, 95%CI 1.06-15.79). Sub-tenon injection triamcinolone acetonide had a higher incidence rate of ocular hypertension than oral glucocorticoid or intravenous dexamethasone (OR= 4.47, 95%CI 1.42-14.13). Conclusions Triamcinolone acetonide intravitreal injection before surgery can improve the primary retinal reattachment rate in RRDCD patients. Patients with the posterior sub-tenon injection of triamcinolone acetonide should be alert to elevated intraocular pressure.

Citation： Chen Limei, Miao Xiaoxia, Xu Shuzhan, Liu Juping. Preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment: a network meta-analysis. Chinese Journal of Ocular Fundus Diseases, 2023, 39(12): 997-1003. doi: 10.3760/cma.j.cn511434-20230621-00277 Copy

1.	Seelenfreund MH, Kraushar MF, Schepens CL, et al. Choroidal detachment associated with primary retinal detachment[J]. Arch Ophthalmol, 1974, 91(4): 254-258. DOI: 10.1001/archopht.1974.03900060264003.
2.	Yu YJ, An M, Mo B, et al. Risk factors for choroidal detachment following rhegmatogenous retinal detachment in a Chinese population[J]. BMC Ophthalmol, 2016, 16: 140. DOI: 10.1186/s12886-016-0319-9.
3.	Adelman RA, Parnes AJ, Sipperley JO, et al. Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2[J]. Ophthalmology, 2013, 120(9): 1809-1813. DOI: 10.1016/j.ophtha.2013.01.056.
4.	Shi H, Guo T, Liu PC, et al. Steroids as an adjunct for reducing the incidence of proliferative vitreoretinopathy after rhegmatogenous retinal detachment surgery: a systematic review and meta-analysis[J]. Drug Des Devel Ther, 2015, 9: 1393-1400. DOI: 10.2147/DDDT.S80983.
5.	Rubsamen PE, Cousins SW. Therapeutic effect of periocular corticosteroids in experimental proliferative vitreoretinopathy[J]. Retina, 1997, 17(1): 44-50. DOI: 10.1097/00006982-199701000-00009.
6.	Sharma T, Gopal L, Reddy RK, et al. Primary vitrectomy for combined rhegmatogenous retinal detachment and choroidal detachment with or without oral corticosteroids: a pilot study[J]. Retina, 2005, 25(2): 152-157. DOI: 10.1097/00006982-200502000-00006.
7.	Denwattana A, Prakhunhungsit S, Thoongsuwan S, et al. Surgical outcomes of preoperative steroid for rhegmatogenous retinal detachment with associated choroidal detachment[J]. Eye (Lond), 2018, 32(3): 602-607. DOI: 10.1038/eye.2017.262.
8.	Wu JH, Zhang R, He JW, et al. Preoperative steroid use in rhegmatogenous retinal detachment associated with choroidal detachment after 23-gauge vitrectomy[J/OL]. J Ophthalmol, 2020, 2020: 6707239[2020-05-02]. https://pubmed.ncbi.nlm.nih.gov/32454991/. DOI: 10.1155/2020/6707239.
9.	于亞杰, 鄭鵬飛, 劉武. 玻璃體切除術前應用糖皮質激素治療脈絡膜脫離型視網膜脫離的效果分析[J]. 眼科, 2018, 27(3): 215-218. DOI: 10.13281/j.cnki.issn.1004-4469.2018.03.012.Yu YJ, Zheng PF, Liu W. Efficacy of preoperative glucocorticoid application on vitrectomy for primary rhegmatogenous retinal detachment with choroidal detachment[J]. Ophthalmol CHN, 2018, 27(3): 215-218. DOI: 10.13281/j.cnki.issn.1004-4469.2018.03.012.
10.	吳淑鳳, 李玉濤, 劉淑偉, 等. 伴脈絡膜脫離的黃斑裂孔性視網膜脫離術前皮質類固醇激素的治療作用研究[J]. 中國實用眼科雜志, 2009, 27(2): 137-139. DOI: 10.3760/cma.j.issn.1006-4443.2009.02.016.Wu SF, Li YT, Liu SW, et al. The efficacy of corticosteroid administration prior to vitrectomy for macular rhegmatogenous retinal detachment with choroidal detachment[J]. Chin J Pract Ophthalmol, 2009, 27(2): 137-139. DOI: 10.3760/cma.j.issn.1006-4443.2009.02.016.
11.	朱劍鋒, 許迅, 張皙. 合并脈絡膜脫離的孔源性視網膜脫離患者的手術療效分析[J]. 中華眼科雜志, 2002, 38(3): 135-139. DOI: 10.3760/j:issn:0412-4081.2002.03.003.Zhu JF, Xu X, Zhang X. Surgical therapeutic results of rhegmatogenous retinal detachment associated with choriodal detachment[J]. Chin J Ophthalmol, 2002, 38(3): 135-139. DOI: 10.3760/j:issn:0412-4081.2002.03.003.
12.	Wei Y, Zhou RL, Wang XB, et al. The effect of single periocular injection of methylprednisolone and drainage of suprachoroidal fluid in the treatment of rhegmatogenous retinal detachment combined with choroidal detachment[J]. Eye (Lond), 2019, 33(9): 1387-1392. DOI: 10.1038/s41433-019-0420-4.
13.	桂君民, 王一. 伴脈絡膜脫離的原發性孔源性視網膜脫離術前局部和全身應用皮質類固醇激素效果比較[J]. 第三軍醫大學學報, 2007, 29(11): 1105-1107. DOI: 10.3321/j.issn:1000-5404.2007.11.034.Gui JM, Wang Y. Comparison of ocular intensive and systemic corticosteroid administration prior to vitrectomy for primary rhegmatogenous retinal detachment with choroidal detachment[J]. Journal of Army Medical University, 2007, 29(11): 1105-1107. DOI: 10.3321/j.issn:1000-5404.2007.11.034.
14.	王旭. 曲安奈德在脈絡膜脫離型視網膜脫離手術治療中的效果研究[J]. 中國醫藥指南, 2012, 10(4): 139-140. DOI: 10.15912/j.cnki.gocm.2012.04.221.Wang X. Effect of triamcinolone in the surgical treatment of retinal detachment with choroidal detachment[J]. Guide of China Medicine, 2012, 10(4): 139-140. DOI: 10.15912/j.cnki.gocm.2012.04.221.
15.	劉建鵬, 梅波, 熱西提?沙買提, 等. 后Tenon囊下注射曲安奈德與靜脈滴注地塞米松聯合玻璃體切除治療RD/CD[J]. 國際眼科雜志, 2019, 19(5): 757-761. DOI: 10.3980/j.issn.1672-5123.2019.5.11.Liu JP, Mei B, Rexiti SMT, et al. Clinical effect of RD/CD treatment by posterior subcapsular Tenon injection triamcinolone acetonide and intravenous drip of dexamethasone combined vitrectomy[J]. Int Eye Sci, 2019, 19(5): 757-761. DOI: 10.3980/j.issn.1672-5123.2019.5.11.
16.	Shen LJ, Mao JB, Sun SM, et al. Perioperative pharmacological management of choroidal detachment associated with rhegmatogenous retinal detachment[J]. Acta Ophthalmol, 2016, 94(4): 391-396. DOI: 10.1111/aos.12694.
17.	韓林峰, 柯根杰, 顧永昊, 等. 甲強龍聯合地塞米松交替球周注射治療脈絡膜脫離型視網膜脫離[J]. 眼科新進展, 2015, 35(10): 935-938. DOI: 10.13389/j.cnki.rao.2015.0255.Han LF, Ke GJ, Gu YH, et al. Alternating peribulbar injection of methylprednisolone and dexamethasone for combined choroidal detachment and retinal detachment[J]. Rec Adv Ophthalmol, 2015, 35(10): 935-938. DOI: 10.13389/j.cnki.rao.2015.0255.
18.	Wei Y, Wang NL, Chen FH, et al. Vitrectomy combined with periocular/intravitreal injection of steroids for rhegmatogenous retinal detachment associated with choroidal detachment[J]. Retina, 2014, 34(1): 136-141. DOI: 10.1097/IAE.0b013e3182923463.
19.	Alibet Y, Levytska G, Umanets N, et al. Ciliary body thickness changes after preoperative anti-inflammatory treatment in rhegmatogenous retinal detachment complicated by choroidal detachment[J]. Graefe's Arch Clin Exp Ophthalmol, 2017, 255(8): 1503-1508. DOI: 10.1007/s00417-017-3673-2.
20.	段安麗, 王景昭, 王寧利. 曲安奈德玻璃體腔注射治療脈絡膜脫離型視網膜脫離的初步研究[J]. 中華眼科雜志, 2005, 41(7): 606-609. DOI: 10.3760/j:issn:0412-4081.2005.07.008.Duan AL, Wang JZ, Wang NL. The polit study of intravitreal injection of triamcinolone acetonide for treatment of retinal detachment with choroidal detachment[J]. Chin J Ophthalmol, 2005, 41(7): 606-609. DOI: 10.3760/j:issn:0412-4081.2005.07.008.
21.	Phulke S, Kaushik S, Kaur S, et al. Steroid-induced glaucoma: an avoidable irreversible blindness[J]. J Curr Glaucoma Pract, 2017, 11(2): 67-72. DOI: 10.5005/jp-journals-l0028-1226.
22.	Yang YH, Kuo HH, Hsu WC, et al. Ocular hypertension and severe intraocular pressure elevation after posterior subtenon injection of triamcinolone acetonide for various diseases[J]. Int J Ophthalmol, 2020, 13(6): 946-951. DOI: 10.18240/ijo.2020.06.14.
23.	Maeda Y, Ishikawa H, Nishikawa H, et al. Intraocular pressure elevation after subtenon triamcinolone acetonide injection; multicentre retrospective cohort study in Japan[J/OL]. PLoS One, 2019, 14(12): e0226118[2019-12-05]. https://pubmed.ncbi.nlm.nih.gov/31805140/. DOI: 10.1371/journal.pone.0226118.

1. Seelenfreund MH, Kraushar MF, Schepens CL, et al. Choroidal detachment associated with primary retinal detachment[J]. Arch Ophthalmol, 1974, 91(4): 254-258. DOI: 10.1001/archopht.1974.03900060264003.
2. Yu YJ, An M, Mo B, et al. Risk factors for choroidal detachment following rhegmatogenous retinal detachment in a Chinese population[J]. BMC Ophthalmol, 2016, 16: 140. DOI: 10.1186/s12886-016-0319-9.
3. Adelman RA, Parnes AJ, Sipperley JO, et al. Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2[J]. Ophthalmology, 2013, 120(9): 1809-1813. DOI: 10.1016/j.ophtha.2013.01.056.
4. Shi H, Guo T, Liu PC, et al. Steroids as an adjunct for reducing the incidence of proliferative vitreoretinopathy after rhegmatogenous retinal detachment surgery: a systematic review and meta-analysis[J]. Drug Des Devel Ther, 2015, 9: 1393-1400. DOI: 10.2147/DDDT.S80983.
5. Rubsamen PE, Cousins SW. Therapeutic effect of periocular corticosteroids in experimental proliferative vitreoretinopathy[J]. Retina, 1997, 17(1): 44-50. DOI: 10.1097/00006982-199701000-00009.
6. Sharma T, Gopal L, Reddy RK, et al. Primary vitrectomy for combined rhegmatogenous retinal detachment and choroidal detachment with or without oral corticosteroids: a pilot study[J]. Retina, 2005, 25(2): 152-157. DOI: 10.1097/00006982-200502000-00006.
7. Denwattana A, Prakhunhungsit S, Thoongsuwan S, et al. Surgical outcomes of preoperative steroid for rhegmatogenous retinal detachment with associated choroidal detachment[J]. Eye (Lond), 2018, 32(3): 602-607. DOI: 10.1038/eye.2017.262.
8. Wu JH, Zhang R, He JW, et al. Preoperative steroid use in rhegmatogenous retinal detachment associated with choroidal detachment after 23-gauge vitrectomy[J/OL]. J Ophthalmol, 2020, 2020: 6707239[2020-05-02]. https://pubmed.ncbi.nlm.nih.gov/32454991/. DOI: 10.1155/2020/6707239.
9. 于亞杰, 鄭鵬飛, 劉武. 玻璃體切除術前應用糖皮質激素治療脈絡膜脫離型視網膜脫離的效果分析[J]. 眼科, 2018, 27(3): 215-218. DOI: 10.13281/j.cnki.issn.1004-4469.2018.03.012.Yu YJ, Zheng PF, Liu W. Efficacy of preoperative glucocorticoid application on vitrectomy for primary rhegmatogenous retinal detachment with choroidal detachment[J]. Ophthalmol CHN, 2018, 27(3): 215-218. DOI: 10.13281/j.cnki.issn.1004-4469.2018.03.012.
10. 吳淑鳳, 李玉濤, 劉淑偉, 等. 伴脈絡膜脫離的黃斑裂孔性視網膜脫離術前皮質類固醇激素的治療作用研究[J]. 中國實用眼科雜志, 2009, 27(2): 137-139. DOI: 10.3760/cma.j.issn.1006-4443.2009.02.016.Wu SF, Li YT, Liu SW, et al. The efficacy of corticosteroid administration prior to vitrectomy for macular rhegmatogenous retinal detachment with choroidal detachment[J]. Chin J Pract Ophthalmol, 2009, 27(2): 137-139. DOI: 10.3760/cma.j.issn.1006-4443.2009.02.016.
11. 朱劍鋒, 許迅, 張皙. 合并脈絡膜脫離的孔源性視網膜脫離患者的手術療效分析[J]. 中華眼科雜志, 2002, 38(3): 135-139. DOI: 10.3760/j:issn:0412-4081.2002.03.003.Zhu JF, Xu X, Zhang X. Surgical therapeutic results of rhegmatogenous retinal detachment associated with choriodal detachment[J]. Chin J Ophthalmol, 2002, 38(3): 135-139. DOI: 10.3760/j:issn:0412-4081.2002.03.003.
12. Wei Y, Zhou RL, Wang XB, et al. The effect of single periocular injection of methylprednisolone and drainage of suprachoroidal fluid in the treatment of rhegmatogenous retinal detachment combined with choroidal detachment[J]. Eye (Lond), 2019, 33(9): 1387-1392. DOI: 10.1038/s41433-019-0420-4.
13. 桂君民, 王一. 伴脈絡膜脫離的原發性孔源性視網膜脫離術前局部和全身應用皮質類固醇激素效果比較[J]. 第三軍醫大學學報, 2007, 29(11): 1105-1107. DOI: 10.3321/j.issn:1000-5404.2007.11.034.Gui JM, Wang Y. Comparison of ocular intensive and systemic corticosteroid administration prior to vitrectomy for primary rhegmatogenous retinal detachment with choroidal detachment[J]. Journal of Army Medical University, 2007, 29(11): 1105-1107. DOI: 10.3321/j.issn:1000-5404.2007.11.034.
14. 王旭. 曲安奈德在脈絡膜脫離型視網膜脫離手術治療中的效果研究[J]. 中國醫藥指南, 2012, 10(4): 139-140. DOI: 10.15912/j.cnki.gocm.2012.04.221.Wang X. Effect of triamcinolone in the surgical treatment of retinal detachment with choroidal detachment[J]. Guide of China Medicine, 2012, 10(4): 139-140. DOI: 10.15912/j.cnki.gocm.2012.04.221.
15. 劉建鵬, 梅波, 熱西提?沙買提, 等. 后Tenon囊下注射曲安奈德與靜脈滴注地塞米松聯合玻璃體切除治療RD/CD[J]. 國際眼科雜志, 2019, 19(5): 757-761. DOI: 10.3980/j.issn.1672-5123.2019.5.11.Liu JP, Mei B, Rexiti SMT, et al. Clinical effect of RD/CD treatment by posterior subcapsular Tenon injection triamcinolone acetonide and intravenous drip of dexamethasone combined vitrectomy[J]. Int Eye Sci, 2019, 19(5): 757-761. DOI: 10.3980/j.issn.1672-5123.2019.5.11.
16. Shen LJ, Mao JB, Sun SM, et al. Perioperative pharmacological management of choroidal detachment associated with rhegmatogenous retinal detachment[J]. Acta Ophthalmol, 2016, 94(4): 391-396. DOI: 10.1111/aos.12694.
17. 韓林峰, 柯根杰, 顧永昊, 等. 甲強龍聯合地塞米松交替球周注射治療脈絡膜脫離型視網膜脫離[J]. 眼科新進展, 2015, 35(10): 935-938. DOI: 10.13389/j.cnki.rao.2015.0255.Han LF, Ke GJ, Gu YH, et al. Alternating peribulbar injection of methylprednisolone and dexamethasone for combined choroidal detachment and retinal detachment[J]. Rec Adv Ophthalmol, 2015, 35(10): 935-938. DOI: 10.13389/j.cnki.rao.2015.0255.
18. Wei Y, Wang NL, Chen FH, et al. Vitrectomy combined with periocular/intravitreal injection of steroids for rhegmatogenous retinal detachment associated with choroidal detachment[J]. Retina, 2014, 34(1): 136-141. DOI: 10.1097/IAE.0b013e3182923463.
19. Alibet Y, Levytska G, Umanets N, et al. Ciliary body thickness changes after preoperative anti-inflammatory treatment in rhegmatogenous retinal detachment complicated by choroidal detachment[J]. Graefe's Arch Clin Exp Ophthalmol, 2017, 255(8): 1503-1508. DOI: 10.1007/s00417-017-3673-2.
20. 段安麗, 王景昭, 王寧利. 曲安奈德玻璃體腔注射治療脈絡膜脫離型視網膜脫離的初步研究[J]. 中華眼科雜志, 2005, 41(7): 606-609. DOI: 10.3760/j:issn:0412-4081.2005.07.008.Duan AL, Wang JZ, Wang NL. The polit study of intravitreal injection of triamcinolone acetonide for treatment of retinal detachment with choroidal detachment[J]. Chin J Ophthalmol, 2005, 41(7): 606-609. DOI: 10.3760/j:issn:0412-4081.2005.07.008.
21. Phulke S, Kaushik S, Kaur S, et al. Steroid-induced glaucoma: an avoidable irreversible blindness[J]. J Curr Glaucoma Pract, 2017, 11(2): 67-72. DOI: 10.5005/jp-journals-l0028-1226.
22. Yang YH, Kuo HH, Hsu WC, et al. Ocular hypertension and severe intraocular pressure elevation after posterior subtenon injection of triamcinolone acetonide for various diseases[J]. Int J Ophthalmol, 2020, 13(6): 946-951. DOI: 10.18240/ijo.2020.06.14.
23. Maeda Y, Ishikawa H, Nishikawa H, et al. Intraocular pressure elevation after subtenon triamcinolone acetonide injection; multicentre retrospective cohort study in Japan[J/OL]. PLoS One, 2019, 14(12): e0226118[2019-12-05]. https://pubmed.ncbi.nlm.nih.gov/31805140/. DOI: 10.1371/journal.pone.0226118.

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Preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment: a network meta-analysis

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