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Cancers May 2022Cervical dysplasia is a common precancerous lesion affecting 1% to 2% of women worldwide. Significant progress in the diagnosis and treatment of cervical dysplasia have... (Review)
Review
Cervical dysplasia is a common precancerous lesion affecting 1% to 2% of women worldwide. Significant progress in the diagnosis and treatment of cervical dysplasia have been made in the last decade. We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify controlled clinical trials reporting on the efficacy and safety of diagnostic and therapeutic interventions for cervical dysplasia. Data were analyzed according to PRISMA guidelines. In total, 33 studies reporting on 5935 women were identified. We recommend intravenous or intracervical lidocaine for pain reduction during colposcopically-directed cervical biopsies but not topical lidocaine, music, or video colposcopy. Monsel’s solution might be used to control bleeding after cervical biopsies. The acetic acid test should be scored 1 min after the application of acetic acid and should be followed by Lugol’s iodine test for an optimal yield of LSIL/HSIL. LEEP/LLETZ remains the standard and techniques such as SWETZ, C-LETZ, and TCBEE are not superior. LEEP/LLETZ should be performed under local anesthesia and with direct colposcopic vision. Cryotherapy and thermoablation might be used in women with LSIL, especially in women with HIV infection, but LEEP/LLETZ remains the standard for HSIL. Topical imiquimod remains an experimental procedure. In conclusion, significant progress has been made in the last decade regarding both diagnostic interventions as well as therapeutic interventions for women with cervical dysplasia. Based on >30 controlled clinical trials, we were able to formulate specific and evidence-based recommendations.
PubMed: 35681649
DOI: 10.3390/cancers14112670 -
Clinical Neurology and Neurosurgery Jun 2023Atypical symptoms of stroke, such as non-specific visual symptoms, are a challenging aspect of acute stroke diagnostics. Among patients evaluated for stroke in the... (Review)
Review
OBJECTIVE
Atypical symptoms of stroke, such as non-specific visual symptoms, are a challenging aspect of acute stroke diagnostics. Among patients evaluated for stroke in the Emergency Department, 2-28% present with stroke chameleons, and 30-43% with stroke mimics. We aimed to identify the type of visual symptoms present in typical strokes, stroke mimics, and stroke chameleons.
PATIENTS AND METHODS
By use of Preferred Reporting Items for Systematic Reviews and Meta-Analysis we searched PubMed and Embase for studies with reports of acute visual symptoms in typical strokes vs mimics or chameleons (PROSPERO protocol, ID CRD42022364749). Risk of bias was assessed by The Critical Appraisal Skills Program.
RESULTS
Thirteen papers were included, comprising data from 9248 patients evaluated for stroke. Compared to mimics, visual symptoms in stroke presented more frequently as hemianopia (28.2% vs 4.8%, 7,4% vs 2.3%, 22% vs 0%), visual loss (11.6% vs 1.8%), visual field defect (11.6% vs 4%, 24% vs 2%, 19% vs 1.7%), eye movement disorder (19.4% vs 6.4%), eye deviation (9.6% vs 0.9%), gaze palsy (32.1% vs 8.6%), oculomotor disturbance (37% vs 0%), and visual inattention (17.5% vs 4%). Compared to strokes, mimics more often presented "non-systematized visual trouble" (10% vs 3%) and blurred vision (22% vs 5%), whereas "visual disturbance" was reported more often in stroke chameleons than in typical strokes (10% vs 3%).
CONCLUSION
Detailed reports of visual symptoms were lacking in most studies, however blurred vision and "non-systematized visual trouble" were more frequent in mimics, "visual disturbance" in stroke chameleons, and negative visual symptoms such as visual field defects in typical strokes. A more systematic and detailed approach to visual symptoms may facilitate acute stroke recognition in patients with visual symptoms.
Topics: Humans; Stroke; Vision Disorders; Visual Field Tests; Blindness; Diagnosis, Differential
PubMed: 37163931
DOI: 10.1016/j.clineuro.2023.107749 -
Physiology & Behavior Oct 2022Lutein and zeaxanthin-xanthophyll carotenoids with antioxidant and anti-inflammatory characteristics-are present in the retina and the brain. High concentrations of... (Review)
Review
Lutein and zeaxanthin-xanthophyll carotenoids with antioxidant and anti-inflammatory characteristics-are present in the retina and the brain. High concentrations of these carotenoids have been positively related to cognitive performance. Therefore, this systematic review analyses the relationship between macular pigment density and cognitive functions. Most relevant databases were scoured for studies on healthy people relating cognitive functions to macular pigment optical density (MPOD). There were no age, sex, or race limitations. PROSPERO registration: CRD42021254833. Nineteen studies were included, seven randomized controlled trials (RCT) and eleven observational studies. The general aim of the studies was to examine the association between carotenoids (lutein, meso‑zeaxanthin and zeaxanthin) and cognitive function. Most observational studies correlates MPOD levels with cognitive function or brain activity. Besides, RCTs compared the cognitive function and/or brain activity after increasing lutein and zeaxanthin intake though dietary supplementation or avocado consumption. Dietary lutein and zeaxanthin intake increased MPOD in six of the seven clinical trials and significantly improved most of the cognitive functions studied. A wide variety of test and methodologies for measuring cognitive functions were observed. Memory, processing speed, attention and reasoning were the cognitive function significantly related to MPOD levels in adults. Brain activity also was related to MPOD, but the results were inconsistent. Only four of the eleven observational studies were based on young people and all studies showed a significant relationship between MPOD and cognitive functions. This systematic review showed a direct relationship among cognitive functions, macular pigment and the intake of lutein and zeaxanthin.
Topics: Adolescent; Adult; Cognition; Dietary Supplements; Humans; Lutein; Macular Pigment; Zeaxanthins
PubMed: 35752349
DOI: 10.1016/j.physbeh.2022.113891 -
Survey of Ophthalmology 2023We estimated the proportion of children with stereopsis following surgery in congenital and developmental cataracts by systematic review and meta-analysis and also... (Meta-Analysis)
Meta-Analysis Review
We estimated the proportion of children with stereopsis following surgery in congenital and developmental cataracts by systematic review and meta-analysis and also considered the factors influencing stereopsis, such as intervention age and presence of strabismus. Stereopsis is directly related to quality of life, and investigating its levels following cataract surgery in children may help decide the right time to intervene, particularly in the context of brain plasticity. We conducted a systematic literature search using Scopus, PubMed, and Web of Science and found 25 case series, 3 cohorts, and 3 clinical trial studies from 1/1/1995 to 31/12/2020. Study-specific proportions of stereopsis from 923 children were pooled using a random-effects model, and stratified analyses were conducted based on intervention age and pre-existing strabismus as a confounder. We appraised the risk of bias using tools published by National Institutes of Health and evaluated publication bias with funnel plots and the Egger test. The pooled proportions of stereopsis based on 8 unilateral and 6 bilateral congenital cataract studies were 0.37 (95% CIs: [0.24, 0.53]) and 0.45 (95% CIs: [0.24,0.68]) when patients with preexisting strabismus were excluded as a confounder. When the intervention age was ≤6 months, proportions in unilateral congenital cataract group significantly increased to 0.52 (95% CIs: [0.37, 0.66]; P = 0.49) compared to 0.26 (95% CIs: [0.14, 0.44]; P = 0.16) otherwise. A similar increase in proportions was found when intervention age ≤4 months. In both unilateral and bilateral congenital cataract groups, proportions increased significantly when the confounder was excluded. Overall, proportions in bilateral congenital cataracts were significantly greater than unilateral cases (irrespective of confounder). Eight unilateral and 5 bilateral developmental cataract studies resulted in pooled proportions of 0.62 (95% CIs: [0.27, 0.88] and 0.82 (95% CIs: [0.4, 0.97]), respectively. Although proportions for bilateral developmental cataracts were greater than unilateral cataracts (irrespective of confounder), results were not statistically significant. Finally, proportions in unilateral developmental cataracts were significantly greater than unilateral congenital cataracts (Z = 7.413, P = 6.173694e-14). We conclude that surgical intervention within first 4-6 months can significantly affect postoperative outcomes in unilateral congenital cataracts. Analysis of existing data does not show a significant effect of intervention age on stereopsis outcomes for developmental cataracts.
Topics: Child; Humans; Infant; Quality of Life; Visual Acuity; Cataract Extraction; Depth Perception; Cataract; Strabismus; Retrospective Studies; Follow-Up Studies
PubMed: 35988744
DOI: 10.1016/j.survophthal.2022.08.009 -
The Cochrane Database of Systematic... Feb 2020Neovascular glaucoma (NVG) is a potentially blinding, secondary glaucoma. It is caused by the formation of abnormal new blood vessels, which prevent normal drainage of... (Review)
Review
BACKGROUND
Neovascular glaucoma (NVG) is a potentially blinding, secondary glaucoma. It is caused by the formation of abnormal new blood vessels, which prevent normal drainage of aqueous from the anterior segment of the eye. Anti-vascular endothelial growth factor (anti-VEGF) medications are specific inhibitors of the primary mediators of neovascularization. Studies have reported the effectiveness of anti-VEGF medications for the control of intraocular pressure (IOP) in NVG.
OBJECTIVES
To assess the effectiveness of intraocular anti-VEGF medications, alone or with one or more type of conventional therapy, compared with no anti-VEGF medications for the treatment of NVG.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register); MEDLINE; Embase; PubMed; and LILACS to 22 March 2019; metaRegister of Controlled Trials to 13 August 2013; and two additional trial registers to 22 March 2019. We did not use any date or language restrictions in the electronic search for trials.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of people treated with anti-VEGF medications for NVG.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the search results for trials, extracted data, and assessed risk of bias, and the certainty of the evidence. We resolved discrepancies through discussion.
MAIN RESULTS
We included four RCTs (263 participants) and identified one ongoing RCT. Each trial was conducted in a different country: China, Brazil, Egypt, and Japan. We assessed the trials to have an unclear risk of bias for most domains due to insufficient information. Two trials compared intravitreal bevacizumab combined with Ahmed valve implantation and panretinal photocoagulation (PRP) with Ahmed valve implantation and PRP. We did not combine these two trials due to substantial clinical and statistical heterogeneity. One trial randomised participants to receive an injection of either an intravitreal anti-VEGF medication or placebo at the first visit, followed by non-randomised treatment according to clinical findings after one week. The last trial randomised participants to PRP with and without ranibizumab, but details of the study were unavailable for further analysis. Two trials that examined IOP showed inconsistent results. One found inconclusive results for mean IOP between participants who received anti-VEGF medications and those who did not, at one month (mean difference [MD] -1.60 mmHg, 95% confidence interval [CI] -4.98 to 1.78; 40 participants), and at one year (MD 1.40 mmHg, 95% CI -4.04 to 6.84; 30 participants). Sixty-five percent of the participants with anti-VEGF medications achieved IOP ≤ 21 mmHg, versus 60% without anti-VEGF medications. In another trial, those who received anti-VEGF medications were more likely to reduce their IOP than those who did not receive them, at one month (MD -6.50 mmHg, 95% CI -7.93 to -5.07; 40 participants), and at one year (MD -12.00 mmHg, 95% CI -16.79 to -7.21; 40 participants). Ninety-five percent of the participants with anti-VEGF medications achieved IOP ≤ 21 mmHg, versus 50% without anti-VEGF medications. The certainty of a body of evidence was low for this outcome due to limitations in the design and inconsistency of results between studies. Post-operative complications included anterior chamber bleeding (3 eyes) and conjunctival hemorrhage (2 participants) in the anti-VEGF medications group, and retinal detachment and phthisis bulbi (1 participant each) in the control group. The certainty of evidence is low due to imprecision of results and indirectness of evidence. No trial reported the proportion of participants with improvement in visual acuity, proportion of participants with complete regression of new iris vessels, or the proportion of participants with relief of pain and resolution of redness at four- to six-week, or one-year follow-up.
AUTHORS' CONCLUSIONS
Currently available evidence is uncertain regarding the long-term effectiveness of anti-VEGF medications, such as intravitreal ranibizumab or bevacizumab or aflibercept, as an adjunct to conventional treatment in lowering IOP in NVG. More research is needed to investigate the long-term effect of these medications compared with, or in addition to, conventional surgical or medical treatment in lowering IOP in NVG.
Topics: Endothelial Growth Factors; Glaucoma, Neovascular; Humans; Intraocular Pressure; Randomized Controlled Trials as Topic; Vascular Endothelial Growth Factor A; Visual Acuity
PubMed: 32027392
DOI: 10.1002/14651858.CD007920.pub3 -
Neurology(R) Neuroimmunology &... May 2024Susac syndrome (SuS) is an orphan microangiopathic disease characterized by a triad of encephalopathy, visual disturbances due to branch retinal artery occlusions, and... (Review)
Review
Susac syndrome (SuS) is an orphan microangiopathic disease characterized by a triad of encephalopathy, visual disturbances due to branch retinal artery occlusions, and sensorineuronal hearing loss. Our previous systematic review on all cases of SuS reported until 2012 allowed for a better understanding of clinical presentation and diagnostic findings. Based on these data, we suggested diagnostic criteria in 2016 to allow early diagnosis and treatment of SuS. In view of the accumulation of new SuS cases reported in the last 10 years and improved diagnostic tools, we here aimed at updating the demographic and clinical features of SuS and to review the updated ancillary tests being used for SuS diagnosis. Therefore, based on the 2016 criteria, we systematically collected and evaluated data on SuS published from January 2013 to March 2022.
Topics: Humans; Susac Syndrome; Magnetic Resonance Imaging; Brain Diseases; Vision Disorders; Diagnosis, Differential
PubMed: 38364193
DOI: 10.1212/NXI.0000000000200209 -
The Cochrane Database of Systematic... May 2021Age-related macular degeneration (AMD) is one of the leading causes of blindness in high-income countries. The majority of cases of AMD are of the non-exudative type.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Age-related macular degeneration (AMD) is one of the leading causes of blindness in high-income countries. The majority of cases of AMD are of the non-exudative type. Experts have proposed photobiomodulation (PBM) therapy as a non-invasive procedure to restore mitochondrial function, upregulate cytoprotective factors and prevent apoptotic cell death in retinal tissue affected by AMD.
OBJECTIVES
To assess the effectiveness and safety of PBM compared to standard care, no treatment or sham treatment for people with non-exudative AMD.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 5, 2020), Ovid MEDLINE, Embase, ISRCTN, ClinicalTrials.gov and the WHO ICTRP to 11 May 2020 with no language restrictions.
SELECTION CRITERIA
The review included randomised controlled trials (RCTs) on participants receiving any type of PBM therapy for non-exudative AMD compared to standard care, sham treatment or no treatment.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. We considered the following outcome measures at 12 months: best-corrected visual acuity (BCVA) ; contrast sensitivity; near vision; low luminance density score; reading speed; vision-related quality of life score; and adverse events such as progression of AMD and conversion to exudative AMD. We graded the certainty of the evidence using GRADE.
MAIN RESULTS
We included two published RCTs from single centres in the UK and Canada, which recruited 60 participants (60 eyes) and 30 participants (46 eyes) respectively. Participants in these trials were people with non-exudative AMD with Age-Related Eye Disease Study (AREDS) categories 2 to 4. One study compared single wavelength PBM with no treatment. This study was at risk of performance bias because the study was not masked, and there was attrition bias. One study compared multi-wavelength PBM with sham treatment and conflicts of interest were reported by study investigators. We also identified three eligible ongoing RCTs from searching the clinical trials database. When comparing PBM with sham treatment or no treatment for non-exudative AMD, there was no evidence of any meaningful clinical difference in BCVA at 12 months (mean difference (MD) 0.02 logMAR, 95% confidence interval (CI) -0.02 to 0.05; 2 RCTs, 90 eyes; low-certainty evidence). One study comparing multi-wavelength PBM with sham treatment showed an improvement in contrast sensitivity at Level E (18 cycles/degree) at 12 months (MD 0.29 LogCS, 95% CI 0.23 to 0.35; 1 RCT, 46 eyes; low-certainty evidence). Visual function and health-related quality of life scores were comparable between single wavelength PBM and no treatment groups at 12 months (VFQ-48 score MD 0.43, 95% CI -0.17 to 1.03; P = 0.16; 1 RCT, 47 eyes; low-certainty evidence). When comparing PBM with sham treatment or no treatment for non-exudative AMD, there was no evidence of any meaningful clinical difference in conversion to exudative AMD (risk ratio (RR) 0.97, 95% CI 0.17 to 5.44; 2 RCTs, 96 eyes; very low-certainty evidence) at 12 months. There was inconclusive evidence that single wavelength PBM prevents the progression of AMD (RR 0.79, 95% CI 0.41 to 1.53; P = 0.48; 1 RCT, 50 eyes; low-certainty evidence). Disease progression was defined as the development of advanced AMD or significant increase in drusen volume. No included study reported near vision, low luminance vision or reading speed outcomes.
AUTHORS' CONCLUSIONS
Currently there remains uncertainty whether PBM treatment is beneficial in slowing progression of non-exudative macular degeneration. There is a need for further well-designed controlled trials assessing dosimetry, powered for both effectiveness and safety outcomes. Consideration should be given to the adoption of agreed clinical outcome measures and patient-based outcome measures for AMD.
Topics: Bias; Confidence Intervals; Contrast Sensitivity; Disease Progression; Humans; Low-Level Light Therapy; Macular Degeneration; Outcome Assessment, Health Care; Placebos; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome; Visual Acuity
PubMed: 34097768
DOI: 10.1002/14651858.CD013029.pub2 -
Graefe's Archive For Clinical and... Oct 2020Intravitreal injection of VEGF inhibitors has become the standard of care for different macular diseases within the last years resulting in improved visual outcomes.... (Review)
Review
PURPOSE
Intravitreal injection of VEGF inhibitors has become the standard of care for different macular diseases within the last years resulting in improved visual outcomes. Under real-life conditions, however, the necessity for frequent retreatments and reexaminations poses a burden for patients and treatment centers. Non-adherence and non-persistence to intravitreal treatment may lead to inferior clinical outcomes, and knowledge of contributing factors is crucial to improve adherence. This systematic review analyzes current literature for potential factors involved in non-adherence and non-persistence.
METHODS
A systematic search was conducted in PubMed and Embase including three different aspects of intravitreal injection therapy: (1) diseases with intravitreal injections as treatment, (2) intravitreal injection, and (3) aspects of therapy adherence or therapy persistence. Data from identified quantitative studies were further extracted and grouped according to WHO criteria (condition, socio-economy, therapy, patient, and health system). The methodological quality of identified studies was graded. Identified qualitative studies (i.e., interviews) were descriptively analyzed and their findings narratively reported.
RESULTS
Twenty-four publications were included. In 16 of those publications, a quantitative data analysis was conducted, analyzing factors associated with non-adherence. Worse visual acuity at baseline and unfavorable development of visual acuity, higher age, and greater distance to the treatment center were associated with non-adherence, while there was inconsistent evidence for an association of comorbidity. In qualitative studies, high follow-up/treatment burden, fear and anxiety, disappointed patient expectations, and lack of motivation to continue treatment were reported as reasons for non-persistence.
CONCLUSIONS
Knowledge of potential barriers in IVT treatment may improve adherence and potentially clinical results. Improvements can be achieved particularly in the healthcare complex (organizational improvements) and the "patient" complex by establishing realistic expectations. Recurrent education of the patient may be necessary.
Topics: Angiogenesis Inhibitors; Humans; Intravitreal Injections; Ranibizumab; Vascular Endothelial Growth Factor A; Visual Acuity
PubMed: 32572607
DOI: 10.1007/s00417-020-04798-2 -
Acta Ophthalmologica Nov 2023The aim of the study was to provide an overview on the relation between vision and generic health-related quality of life (HRQoL) in general populations worldwide. We... (Review)
Review
The aim of the study was to provide an overview on the relation between vision and generic health-related quality of life (HRQoL) in general populations worldwide. We conducted a systematic review to identify articles that have evaluated the relation of binocularly measured distance visual acuity (VA) and HRQoL in adults at population level around the world. Used search terms were related to visual acuity, vision loss, visual impairment and HRQoL. We identified 780 articles, of which 12 satisfied the eligibility criteria. The studies were conducted in the USA, Europe, Asia and Australia. Generic HRQoL was measured using EQ-5D, 15D, SF-36, SF-12 and/or WHOQoL. Nine studies reported a trend between decreasing VA and deteriorating HRQoL of at least some degree. Vision loss was mostly associated with dimensions related to physical health and capability, including self-care, mobility and usual activities. Mental dimensions - vitality and social functioning in particular - were also affected, although the results were inconsistent. Six studies compared the impact of different medical conditions on HRQoL, all of which reported that the impact of visual impairment was equal or stronger compared with other major medical conditions. In conclusion, generic HRQoL instruments are sensitive to detect the relation between vision and HRQoL, as they cover dimensions influenced by vision. Declining vision is associated with reduced functioning, which leads to dependence and isolation - both major factors in an individual's well-being. This phenomenon showed surprising similarity around the world and therefore emphasises the global burden of vision loss at both individual and societal level and encourages its prevention and treatment.
Topics: Adult; Humans; Quality of Life; Vision, Ocular; Vision Disorders; Vision, Low; Visual Acuity; Surveys and Questionnaires
PubMed: 37032474
DOI: 10.1111/aos.15676 -
American Journal of Ophthalmology Jan 2023To compare the efficacy and safety of ultrathin Descemet stripping (automated) endothelial keratoplasty (UT-DS(A)EK) versus Descemet membrane endothelial keratoplasty... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To compare the efficacy and safety of ultrathin Descemet stripping (automated) endothelial keratoplasty (UT-DS(A)EK) versus Descemet membrane endothelial keratoplasty (DMEK) for the treatment of Fuchs endothelial dystrophy (FED) and bullous keratopathy (BK).
DESIGN
Systematic review and meta-analysis.
METHODS
Literature containing DMEK and UT-DSAEK were searched in the Cochrane Database of Systematic Reviews, PubMed, EMBASE, LILACS, and through manual reference searching. Studies were included that measured the outcome of interventions-including best corrected visual acuity (BCVA), endothelial cell density (ECD), and postoperative complications, especially graft detachment with the need of re-bubbling, graft rejection, graft failure, and postoperative elevated intraocular pressure (IOP)-in patients with FED and BK. Included outcomes were pooled as standardized mean differences (SMD) or risk ratios (RR) using random effects models. Inter-study heterogeneity was assessed using the Q-test and I statistic.
RESULTS
Seven (of 163) studies met all the inclusion and exclusion criteria. Meta-analysis showed a significantly better BCVA 12 months postoperatively, but an increased re-bubbling rate in eyes after DMEK compared with eyes after UT-DS(A)EK (BCVA: SMD = 0.50 [95% CI 0.27-0.74] and re-bubbling rate: RR = 0.33 [95% CI 0.16-0.67]). All other parameters did not differ significantly between both interventions, although estimates were imprecise (graft failure: RR = 0.65 [95% CI 0.18-2.30], graft rejection: RR = 1.40 [95% CI 0.27-7.30], and postoperative intraocular pressure elevation: RR = 1.14 [95% CI 0.60-2.18]). Postoperative SMDs of ECD could not be evaluated due to significant heterogeneity between studies.
CONCLUSIONS
Although the improvement in BCVA was higher after UT-DS(A)EK than after conventional DS(A)EK, the BCVA after DMEK was still superior. The complication rates were comparable for both procedures, except for the higher rate of re-bubbling after DMEK.
Topics: Humans; Cell Count; Corneal Edema; Descemet Membrane; Descemet Stripping Endothelial Keratoplasty; Endothelium, Corneal; Fuchs' Endothelial Dystrophy; Retrospective Studies; Visual Acuity
PubMed: 36220351
DOI: 10.1016/j.ajo.2022.09.013