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Medicine Aug 2018Anti-VEGF agents has been widely used in ocular diseases, but its safety for treating anterior segment disorders, the conclusions are controversial. (Meta-Analysis)
Meta-Analysis Review
Safety of antivascular endothelial growth factor administration in the ocular anterior segment in pterygium and neovascular glaucoma treatment: Systematic review and meta-analysis.
BACKGROUND
Anti-VEGF agents has been widely used in ocular diseases, but its safety for treating anterior segment disorders, the conclusions are controversial.
METHODS
Several major databases, including CENTRAL, MEDLINE, and EMBASE, were searched. Safety data from 18 randomized controlled trials (RCTs) were used to compare anti-VEGF treatment in the ocular anterior segment in pterygium and neovascular glaucoma treatment with placebo/sham treatment for eye diseases. A meta-analysis for adverse events was performed.
RESULTS
Eighteen RCT studies with 955 eyes were included in the meta-analysis. Significant difference in conjunctival disorders (OR: 1.62; 95% CI, 1.01-2.59; P = .05) was noted among the included studies, but not in ocular intolerance (odds ratio [OR]: 0.75; 95% CI, 0.34-1.62; P = .46), corneal disorders (OR: 0.71; 95% CI, 0.37-1.37; P = .31), or the subgroup analysis of conjunctival disorders.
CONCLUSIONS
The administration of anti-VEGF agents in the ocular anterior segment for patients with pterygium and glaucoma was tolerable in tolerance and cornea, but was the risk factor of conjunctival disorders. The healing of corneal epithelium may be delayed in patients with primary corneal epithelial defects after anti-VEGF application. However, due to the limited evidence, further research should be performed on the safety of anti-VEGF administration in patients with different corneal disorders.
Topics: Administration, Ophthalmic; Aged; Angiogenesis Inhibitors; Bevacizumab; Female; Glaucoma, Neovascular; Humans; Male; Middle Aged; Pterygium; Treatment Outcome
PubMed: 30142821
DOI: 10.1097/MD.0000000000011960 -
BioMed Research International 2022The neutrophil to lymphocyte ratio (NLR) reflects a dynamic relationship between the innate (neutrophils) and adaptive (lymphocytes) cellular immune response. This... (Meta-Analysis)
Meta-Analysis Review
The neutrophil to lymphocyte ratio (NLR) reflects a dynamic relationship between the innate (neutrophils) and adaptive (lymphocytes) cellular immune response. This systematic review and meta-analysis was conducted to critically evaluate the literature regarding the use of the NLR as a reliable means to detect several ocular disorders. Our study was registered with the PROSPERO (ID: CRD42022314850). Three databases, including PubMed, Embase, Scopus, and the Web of Science, were searched on September 9, 2022, with no restrictions on the article's language. Finally, 32 articles were recognized as eligible for our meta-analysis. We found that patients with eye diseases had significantly elevated levels of NLR in comparison to healthy controls (SMD =0.53, 95% CI =0.35-0.71, < 0.001). In subgroup analysis, patients with keratoconus (SMD =0.69; 95% CI =0.33-1.05, < 0.001), glaucoma (SMD =0.56, 95% CI =0.25-0.87, < 0.001), pterygium (SMD =0.14; 95% CI =0.01-0.26, < 0.001), and idiopathic epiretinal membrane (SMD =0.14; 95% CI =0.01-0.26, < 0.001) had higher levels of NLR compared to healthy controls. However, NLR levels of patients with dry eye disease were similar to healthy controls (SMD =0.32, 95% CI = -0.49-1.13, = 0.435). It can be said that NLR is a valuable marker of systemic inflammation, which is significantly increased in many eye disorders, suggesting that inflammation plays a key role in the pathophysiology of these diseases.
Topics: Humans; Neutrophils; Lymphocytes; Biomarkers; Eye Diseases; Inflammation; Lymphocyte Count
PubMed: 36281463
DOI: 10.1155/2022/5744008 -
American Journal of Ophthalmology Oct 2017To summarize key findings from a systematic review of the effectiveness and risks of conjunctival autograft (CAG) compared with amniotic membrane transplant (AMT) for... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
To summarize key findings from a systematic review of the effectiveness and risks of conjunctival autograft (CAG) compared with amniotic membrane transplant (AMT) for pterygium.
DESIGN
Cochrane systematic review.
METHODS
We included only randomized controlled trials (RCTs) in which CAG and AMT had been compared for primary or recurrent pterygia. The primary outcome was recurrence of pterygium ≥1 mm onto the cornea by 3 and 6 months post surgery. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis.
RESULTS
Twenty RCTs with 1866 participants (1947 eyes) were included. Pterygium recurrence 6 months after surgery ranged from 3.3% to 16.7% in the CAG group and 6.4% to 42.3% in the AMT group based on data from 1021 eyes in 10 RCTs. Estimated risk ratios from meta-analysis indicated that CAG-treated eyes had a 47% lower risk of recurrence 6 months after surgery compared with the AMT group (RR, 0.53, 95% confidence interval [CI], 0.33-0.85). For 96 eyes with recurrent pterygium, the risk of recurrence 6 months after CAG was reduced by 55% compared with AMT (risk ratio [RR], 0.45, 95% CI, 0.21-0.99). Three-month recurrence rates were similar for CAG and AMT based on data from 538 eyes (6 RCTs).
CONCLUSIONS
CAG was more effective than AMT to prevent pterygium recurrence by 6 months post surgery, especially in recurrent pterygia. CAG-treated eyes had half the recurrence rates of AMT-treated eyes. Future RCTs should assess changes in patient-reported outcomes (symptoms, cosmesis) and visual acuity, and evaluate effects of surgical variations.
Topics: Amnion; Autografts; Conjunctiva; Humans; Pterygium; Randomized Controlled Trials as Topic; Recurrence; Transplantation, Autologous; Treatment Outcome; Visual Acuity
PubMed: 28734814
DOI: 10.1016/j.ajo.2017.07.004 -
International Journal of Ophthalmology 2017To evaluate the clinical effect of bevacizumab in pterygium treatment.
AIM
To evaluate the clinical effect of bevacizumab in pterygium treatment.
METHODS
A systematic review and quantitative Meta-analysis was performed. PubMed, EMBASE, Web of Science and Cochrane database were searched for eligible literatures published in English until June 2016. The endpoint was recurrence rate and pooled risk ratio (RR) was calculated.
RESULTS
Nine eligible studies were included and Meta-analysis results showed no significantly difference in patients treated with bevacizumab in short term follow-up [3mo: RR=0.70 (0.34, 1.45); 6mo: RR=0.55 (0.23, 1.32)] compared with control groups. No significant effects were observed in favor of bevacizumab in subgroup analyses: patients with subconjunctival injection of bevacizumab [3mo: RR=0.95 (0.70, 1.29); 6mo: RR=0.83 (0.55, 1.28)], primary pterygium [3mo: RR=0.59 (0.23, 1.54; 6mo: RR=0.59 (0.23, 1.53)], simple pterygium excision [3mo: 0.32 (0.05, 2.04), =0.23; 6mo: 0.27 (0.05, 1.53)] and excision with conjunctival autograft [3mo: 1.51 (0.25, 9.15); 6mo: 1.11 (0.06, 21.69)].
CONCLUSION
In this Meta-analysis, we did not found the significant effect of bevacizumab in pterygium treatment, at least in short term follow-up (3mo and 6mo).
PubMed: 28730117
DOI: 10.18240/ijo.2017.07.17 -
International Journal of Environmental... Dec 2017Pterygium is a chronic eye disease: among its recognized risk factors there is long-term exposure to ultraviolet (UV) radiation. The Sun is the main source of UV... (Review)
Review
Pterygium is a chronic eye disease: among its recognized risk factors there is long-term exposure to ultraviolet (UV) radiation. The Sun is the main source of UV exposure: according to the World Health Organization, the Population Attributable Fraction of pterygium due to solar radiation (SR) is 42-74%. Outdoor work can deeply influence the eye exposure to solar UV rays, but, despite this, pterygium is currently not adequately considered as a possible occupational disease in this working category, at least in Europe. For this reason, we performed a systematic review of the scientific literature published in the last ten years (2008-2017) considering the role of outdoor work as a risk factor for pterygium, in order to give new support for the prevention of this UV related disease in workers. We identified 29 relevant papers. Our results show that pterygium prevalence highly increased with latitude and mean annual UV index, and outdoor work is one of the most relevant risk factors, as well as age and male sex, both in high risk and in moderate risk World areas considering the environmental UV levels. Accordingly, pterygium occurring in outdoor workers should be considered an occupational disease. Moreover, our findings clearly support the need of further research on more effective prevention of the occupational risk related to long-term solar radiation exposure of the eye.
Topics: Europe; Female; Humans; Male; Occupational Exposure; Pterygium; Risk Assessment; Risk Factors; Sunlight; Ultraviolet Rays
PubMed: 29278403
DOI: 10.3390/ijerph15010037 -
Current Pharmaceutical Design 2018The study aimed to perform a systematic review and meta-analysis of randomized controlled trials comparing the efficacy and complications of autologous blood versus... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The study aimed to perform a systematic review and meta-analysis of randomized controlled trials comparing the efficacy and complications of autologous blood versus using fibrin glue and surgical sutures for conjunctival autograft fixation in primary pterygium surgery.
DESIGN
Systematic review with quantitative meta-analysis.
METHODS
Four authentic databases have been searched using relevant keywords. Eligible studies were obtained, and their data were extracted into an online form. Analysis was done using Review Manager for windows. Dichotomous outcomes were reported as risk ratio, while continuous data were reported as mean difference.
RESULTS
Seven studies were included in the analysis. Most of the included studies were of moderate quality according to Cochrane Risk of Bias assessment tool. There was no difference between the three techniques in recurrence rates (Risk Ratio (RR) 0.80, 95% CI [0.45 to 1.44], p= 0.46). Graft retraction and displacement were more profound in the autologous blood group vs fibrin glue and suture groups (RR 3.22, 95% CI [1.48 to7.02], p= 0.003) and (RR 5.27, 95% CI [2.24 to 12.38], p> 0.001) respectively. In terms of operative time, fibrin glue took shorter while suturing took longer time compared to blood coagulum (Mean Difference (MD) =1.57, 95% CI [0.90, 2.25], p> 0.00001) and (MD -20.47, 95% CI [-38.05 to -2.88], p =0.02).
CONCLUSION
Autologous blood for conjunctival autograft fixation in primary pterygium surgery was associated with lower graft stability than fibrin glue or sutures. However, it did not account for higher recurrence rates than the fibrin glue or sutures. Patient satisfaction and postoperative symptoms are relatively better in the blood coagulum group than the other techniques. The overall quality of evidence is low. Further well designed randomized controlled trials are still needed.
Topics: Autografts; Conjunctiva; Humans; Pterygium; Randomized Controlled Trials as Topic
PubMed: 30277146
DOI: 10.2174/1381612824666181001161352 -
The Cochrane Database of Systematic... Dec 2016Pterygium, a growth of the conjunctiva over the cornea, is a progressive disease leading in advanced stages to visual impairment, restriction of ocular motility, chronic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pterygium, a growth of the conjunctiva over the cornea, is a progressive disease leading in advanced stages to visual impairment, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence can be a problem. Currently the best surgical option in terms of recurrence is conjunctival autograft. To date the most common surgical methods of attaching conjunctival autografts to the sclera are through suturing or fibrin glue. Each method presents its own advantages and disadvantages. Sutures require considerable skill from the surgeon and can be associated with a prolonged operation time, postoperative discomfort and suture-related complications, whereas fibrin glue may give a decreased operation time, improve postoperative comfort and avoid suture-related problems.
OBJECTIVES
To assess the effectiveness of fibrin glue compared to sutures in conjunctival autografting for the surgical treatment of pterygium.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2016), Embase (January 1980 to October 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 14 October 2016.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) in any setting where fibrin glue was compared with sutures to treat people with pterygium.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the search results, assessed trial quality, and extracted data using standard methodological procedures expected by Cochrane. Our primary outcome was recurrence of pterygium defined as any re-growth of tissue from the area of excision across the limbus onto the cornea. The secondary outcomes were surgical time and complication rate. We graded the certainty of the evidence using GRADE.
MAIN RESULTS
We included 14 RCTs conducted in Brazil, China, Egypt, India, Malaysia, New Zealand, Philippines, Saudi Arabia, Sweden and Turkey. The trials were published between 2004 and 2016, and were assessed as a mixture of unclear and low risk of bias with three studies at high risk of attrition bias. Only adults were enrolled in these studies.Using fibrin glue for the conjunctival autograft may result in less recurrence of pterygium compared with using sutures (risk ratio (RR) 0.47, 95% CI 0.27 to 0.82, 762 eyes, 12 RCTs; low-certainty evidence). If pterygium recurs after approximately 10 in every 100 surgeries with sutures, then using fibrin glue may result in approximately 5 fewer cases of recurrence in every 100 surgeries (95% CI 2 fewer to 7 fewer cases). Using fibrin glue may lead to more complications compared with sutures (RR 1.92; 95% CI 1.22 to 3.02, 11 RCTs, 673 eyes, low-certainty evidence). The most common complications reported were: graft dehiscence, graft retraction and granuloma. On average using fibrin glue may mean that surgery is quicker compared with suturing (mean difference (MD) -17.01 minutes 95% CI -20.56 to -13.46), 9 RCTs, 614 eyes, low-certainty evidence).
AUTHORS' CONCLUSIONS
The meta-analyses, conducted on people with pterygium in a hospital or outpatient setting, show fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. There was low-certainty evidence to suggest a higher proportion of complications in the fibrin glue group.
Topics: Autografts; Conjunctiva; Fibrin Tissue Adhesive; Humans; Pterygium; Randomized Controlled Trials as Topic; Recurrence; Secondary Prevention; Sutures; Tissue Adhesives; Transplantation, Autologous
PubMed: 27911983
DOI: 10.1002/14651858.CD011308.pub2 -
JAMA Ophthalmology Dec 2022Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country...
IMPORTANCE
Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed.
OBJECTIVE
To describe the key outcomes of the PECI development.
EVIDENCE REVIEW
A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review.
FINDINGS
Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI.
CONCLUSIONS AND RELEVANCE
This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.
Topics: Humans; Universal Health Insurance; World Health Organization; Health Promotion
PubMed: 36394836
DOI: 10.1001/jamaophthalmol.2022.4716 -
BMJ Open Dec 2017
PubMed: 29275352
DOI: 10.1136/bmjopen-2013-003787corr1 -
BMJ Open Ophthalmology Apr 2024Pterygium is a common ocular surface disorder that requires surgical intervention for treatment. Conjunctival autografts are preferred over simple excision due to lower... (Meta-Analysis)
Meta-Analysis
Modified sutureless and glue-free method versus conventional sutures for conjunctival autograft fixation in primary pterygium surgery: a systematic review and meta-analysis.
BACKGROUND
Pterygium is a common ocular surface disorder that requires surgical intervention for treatment. Conjunctival autografts are preferred over simple excision due to lower recurrence rates. This systematic review and meta-analysis compared the modified sutureless glue-free (MSGF) method with conventional sutures (CS) for conjunctival autograft fixation in primary pterygium surgery.
METHODS
A comprehensive search was conducted in MEDLINE, Embase, CENTRAL, Google Scholar and ClinicalTrials.gov for randomised controlled trials (RCTs) comparing MSGF and CS conjunctival autografts. Outcome measures included operation time, recurrence and postoperative complications. Standardised mean difference (SMD) and risk ratio (RR) were used for continuous and dichotomous outcomes, respectively.
RESULTS
11 RCTs involving 833 participants were included. The analysis revealed that MSGF had a significantly shorter operation time compared with CS (SMD -3.704, 95% CI -5.122 to -2.287, p<0.001). CS was associated with a higher risk of foreign body sensation (RR 0.22, 95% CI 0.06 to 0.74, p=0.01). MSGF was associated with a higher risk of graft dehiscence (RR 9.01, 95% CI 2.74 to 29.68, p=0.000) and graft retraction (RR 2.37, 95% CI 1.17 to 4.77, p=0.02). No significant differences were found in recurrence, graft haemorrhage, granuloma, Dellen and conjunctival oedema.
CONCLUSION
Using the MSGF technique in conjunctival autograft fixation for pterygium surgery reduces operation time by relying solely on the patient's blood for fixation. However, it increases the risk of graft dehiscence and retraction. However, CS is linked to a higher likelihood of experiencing foreign body sensations. Understanding the learning curve and surgeon familiarity with novel techniques is crucial for optimising patient care and surgical outcomes, while individualised decision-making is necessary considering the advantages and disadvantages of each approach. Further research is warranted to minimise complications and optimise surgical outcomes.
Topics: Humans; Pterygium; Autografts; Fibrin Tissue Adhesive; Recurrence; Conjunctiva; Sutures; Foreign Bodies
PubMed: 38565231
DOI: 10.1136/bmjophth-2023-001621