• 四川大學華西醫(yī)院眼科,成都,610041;

目的 　評價白內障摘除聯合人工晶狀體術后植入硅膠(silicone)與聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)人工晶狀體對晶狀體后囊混濁(posterior capsule opacification, PCO)影響的差異.
方法 　計算機檢索MEDLINE(1966～2003)、EMBASE(1980～2003)、Cochrane圖書館臨床對照試驗資料庫(2003年第1期)和中國生物醫(yī)學文獻光盤數據庫(1979～2003),收集有關比較PMMA和Silicone兩種材料的人工晶狀體植入對PCO形成影響的隨機對照試驗(RCT),由兩位研究者獨立進行質量評價、資料提取,并進行交叉核對.采用RevMan 4.2進行Meta分析.
結果 　共納入9篇RCT,672只眼.老年性白內障亞組的Meta分析結果顯示,在PCO程度[SMD合并=-0.92, 95%CI (-1.19,-0.64)]和Nd:YAG激光后囊切開率[OR合并=0.35, 95%CI (0.22,0.57)]方面,Silicone組明顯低于PMMA組,其差異有統(tǒng)計學意義;在術后視力方面,其差異無統(tǒng)計學意義[OR合并=1.22, 95%CI (0.43,3.50)].葡萄膜炎并發(fā)白內障亞組的Meta分析結果顯示,在術后視力方面,PMMA組較Silicone組為好,其差異有統(tǒng)計學意義[OR合并=0.38, 95%CI (0.15,0.91)];在PCO程度[SMD=0.23, 95%CI (-0.59, 1.05)]和Nd:YAG激光后囊切開率[OR合并=1.82, 95%CI (0.47,6.95)]方面,其差異無統(tǒng)計學意義.
結論 　現有資料表明,在降低PCO方面,老年性白內障患者選用Silicone優(yōu)于PMMA;由于納入研究少,葡萄膜炎并發(fā)白內障患者選用何種材料人工晶狀體較好,尚不能得出肯定結論.

引用本文： 李 妮,劉 誼,張軍軍,周 勇. 硅膠和聚甲基丙烯酸甲酯人工晶狀體對晶狀體后囊混濁影響的系統(tǒng)評價. 中國循證醫(yī)學雜志, 2005, 05(2): 125-129. doi: 復制

1. Ridley H. Intraocular Acrylic Lenses[J]. Trans Ophthalmol Soc UK, 1951;71: 617-621.
2. Schaumberg DA, Dana MR, Christen WG, Glynn RJ. A systematic overview of the incidence of posterior capsule opacification[J]. Ophthalmology, 1998;105(7): 1 213-1 221.
3. Jadad AR, Moore RA, Carroll D. Assessing the quality of reports of randomized clinical trials: is blinding necessary[J]? Controlled Clinical Trials, 1996;17: 1-12.
4. Olson RJ, Crandall AS. Silicone versus polymethylmethacrylate intraocular lenses with regard to capsular opacification[J]. Ophthalmic Surg Lasers, 1998;29(1): 55-58.
5. Ursell PG, Spalton DJ, Pande MV, Hollick EJ, Barman S, Boyce J, Tilling K. Relationship between intraocular lens biomaterials and posterior capsule opacification[J]. J Cataract Refract Surg, 1998;24(3): 352-360.
6. Hayashi H, Hayashi K, Nakao F, Hayashi F. Quantitative comparison of intraocular lens implantation[J]. Arch Ophthalmol, 1998;116(12): 1 579- 1 582.
7. Hollick EJ, Spalton DJ, Ursell PG, Pande MV, Barman SA, Boyce JF, Tilling K. The effect of polymethylmethacrylate, silicone, and polyacrylic intraocular lenses on posterior capsular opacification 3 years after cataract surgery[J]. Ophthalmology, 1999;106(1): 49-55.
8. Wang MC, Woung LC. Digital retroilluminated photography to analyze posterior capsule opacification in eyes with intraocular lenses[J]. J Cataract Refract Surg, 2000;26(1): 56-61.
9. Hollick EJ, Spalton DJ, Ursell PG, Meacock WR, Barman SA, Boyce JF. Posterior capsular opacification with hydrogel, polymethylmethacrylate, and silicone intraocular lenses: two-year results of a randomized prospective trial[J]. Am J Ophthalmol, 2000;129(5): 577-584.
10. Hayashi K, Hayashi H, Nakao F, Hayashi F. Changes in posterior capsule opacification after poly (methyl methacrylate), silicone, and acrylic intraocular lens implantation[J]. J Cataract Refract Surg, 2001;27(6): 817-824.
11. Alio JL, Chipont E, BenEzra D, Fakhry MA. International Ocular Inflammation Society, Study Group of Uveitic Cataract Surgery. Comparative performance of intraocular lenses in eyes with cataract and uveitis[J]. J Cataract Refract Surg, 2002;28(12): 2 096-2 108.
12. Papaliodis GN, Nguyen QD, Samson CM, Foster CS. Intraocular lens tolerance in surgery for cataracta complicata: assessment of four implant materials[J]. Semin Ophthalmol, 2002;17(3-4): 120-123.
  1. 1. Ridley H. Intraocular Acrylic Lenses[J]. Trans Ophthalmol Soc UK, 1951;71: 617-621.
  2. 2. Schaumberg DA, Dana MR, Christen WG, Glynn RJ. A systematic overview of the incidence of posterior capsule opacification[J]. Ophthalmology, 1998;105(7): 1 213-1 221.
  3. 3. Jadad AR, Moore RA, Carroll D. Assessing the quality of reports of randomized clinical trials: is blinding necessary[J]? Controlled Clinical Trials, 1996;17: 1-12.
  4. 4. Olson RJ, Crandall AS. Silicone versus polymethylmethacrylate intraocular lenses with regard to capsular opacification[J]. Ophthalmic Surg Lasers, 1998;29(1): 55-58.
  5. 5. Ursell PG, Spalton DJ, Pande MV, Hollick EJ, Barman S, Boyce J, Tilling K. Relationship between intraocular lens biomaterials and posterior capsule opacification[J]. J Cataract Refract Surg, 1998;24(3): 352-360.
  6. 6. Hayashi H, Hayashi K, Nakao F, Hayashi F. Quantitative comparison of intraocular lens implantation[J]. Arch Ophthalmol, 1998;116(12): 1 579- 1 582.
  7. 7. Hollick EJ, Spalton DJ, Ursell PG, Pande MV, Barman SA, Boyce JF, Tilling K. The effect of polymethylmethacrylate, silicone, and polyacrylic intraocular lenses on posterior capsular opacification 3 years after cataract surgery[J]. Ophthalmology, 1999;106(1): 49-55.
  8. 8. Wang MC, Woung LC. Digital retroilluminated photography to analyze posterior capsule opacification in eyes with intraocular lenses[J]. J Cataract Refract Surg, 2000;26(1): 56-61.
  9. 9. Hollick EJ, Spalton DJ, Ursell PG, Meacock WR, Barman SA, Boyce JF. Posterior capsular opacification with hydrogel, polymethylmethacrylate, and silicone intraocular lenses: two-year results of a randomized prospective trial[J]. Am J Ophthalmol, 2000;129(5): 577-584.
  10. 10. Hayashi K, Hayashi H, Nakao F, Hayashi F. Changes in posterior capsule opacification after poly (methyl methacrylate), silicone, and acrylic intraocular lens implantation[J]. J Cataract Refract Surg, 2001;27(6): 817-824.
  11. 11. Alio JL, Chipont E, BenEzra D, Fakhry MA. International Ocular Inflammation Society, Study Group of Uveitic Cataract Surgery. Comparative performance of intraocular lenses in eyes with cataract and uveitis[J]. J Cataract Refract Surg, 2002;28(12): 2 096-2 108.
  12. 12. Papaliodis GN, Nguyen QD, Samson CM, Foster CS. Intraocular lens tolerance in surgery for cataracta complicata: assessment of four implant materials[J]. Semin Ophthalmol, 2002;17(3-4): 120-123.