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Survey of Ophthalmology 2024In phakic patients Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) are frequently combined with... (Review)
Review
In phakic patients Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) are frequently combined with phacoemulsification and intraocular lens (IOL) implantation (triple procedure). This surgery might cause a refractive shift difficult to predict. Early DMEK and DSAEK results have shown a tendency toward a hyperopic shift. Myopic postoperative refraction is typically intended to correct this postoperative refractive defect and to bring all eyes as close to emmetropia as possible. We sought to understand the mechanism underlying the hyperopization and to identify predictive factors for poorer refractive outcomes, the most suitable target refraction and IOL calculation methods in patients undergoing combined cataract extraction and lamellar endothelial corneal transplantation (DSAEK or DMEK) for endothelial dysfunctions. Of the 407 articles analyzed, only 18 were included in the analysis. A myopic target between -0.50 D and -0.75 was the most common (up to -1.50 for DSAEK triple procedures), even though no optimum target was found. Hyperopic surprises appeared more frequently in corneas that were flatter in the center than in the periphery (oblate posterior profile). Among the numerous IOL calculation formulas, there was no apparent preference.
Topics: Humans; Refraction, Ocular; Descemet Stripping Endothelial Keratoplasty; Lens Implantation, Intraocular; Phacoemulsification; Visual Acuity
PubMed: 38309315
DOI: 10.1016/j.survophthal.2024.01.003 -
Journal of Cataract and Refractive... May 2024Corneal crosslinking (CXL) is used for treating keratoconus and post-laser in situ keratomileusis ectasia. However, refractive surgery is not usually performed with... (Meta-Analysis)
Meta-Analysis Comparative Study
Corneal crosslinking (CXL) is used for treating keratoconus and post-laser in situ keratomileusis ectasia. However, refractive surgery is not usually performed with prophylactic CXL. Therefore, we performed a meta-analysis comparing outcomes of refractive surgeries with vs without prophylactic CXL. We systematically searched databases for studies comparing refractive surgeries for myopic correction with vs without prophylactic corneal crosslinking. Review Manager 5.4.1 was used to perform statistical analysis. We included 2820 eyes from 28 studies. Compared with refractive surgery alone, surgery with prophylactic CXL resulted in decreased central corneal thickness, corrected distance visual acuity logMAR, and safety and efficacy indices. There were no significant differences in postoperative uncorrected distance visual acuity of 20/20 or better at ≥12 months and other visual outcomes among both groups. More randomized controlled trials with standard crosslinking protocols are needed to analyze the prophylactic use of crosslinking with refractive surgeries.
Topics: Humans; Cross-Linking Reagents; Photosensitizing Agents; Keratomileusis, Laser In Situ; Riboflavin; Collagen; Visual Acuity; Myopia; Photorefractive Keratectomy; Photochemotherapy; Lasers, Excimer; Corneal Stroma; Ultraviolet Rays; Keratoconus; Corneal Surgery, Laser; Refraction, Ocular
PubMed: 38288954
DOI: 10.1097/j.jcrs.0000000000001405 -
Cureus Dec 2023The coexistence of two globally leading causes of blindness, glaucoma and cataracts, is common. Combining trabeculectomy with cataract surgery is a common practice while... (Review)
Review
Efficacy and Safety of Manual Small-Incision Cataract Surgery With Trabeculectomy Versus Phacotrabeculectomy in Patients With Glaucoma and Cataract: A Systematic Review and Meta-Analysis.
The coexistence of two globally leading causes of blindness, glaucoma and cataracts, is common. Combining trabeculectomy with cataract surgery is a common practice while determining the preferred surgical management for patients is a complex consideration. Therefore, a systematic review and meta-analysis were conducted to compare the efficacy and safety of two surgical procedures, manual small-incision cataract surgery (MSICS) combined with trabeculectomy and . A comprehensive search was performed in PubMed, Science Direct, and Cochrane Library published up to March 2023. Articles not indexed in those databases were also searched. Pooled odds ratios (OR) and mean differences (MD) with corresponding 95% confidence interval (CI) were also retrieved to compare the outcomes estimating efficacy and safety. Biases in selected studies were assessed. A total of seven studies consisting of 352 eyes for MSICS with trabeculectomy and 348 eyes for were included. Postoperative intraocular pressure (IOP) was comparable between the two techniques (MD: -0.45; 95% CI: -1.07 to 0.16; p = 0.15). Postoperative best corrected visual acuity (BCVA) <6/12 (OR: 1.26; 95% CI: 0.62 to 2.53; p = 0.52), complete success (OR: 0.92; 95% CI: 0.51 to 1.67; p = 0.78), and postoperative complications (OR: 1.27; 95% CI: 0.75 to 2.15, p = 0.38) did not differ significantly. This meta-analysis indicated comparable efficacy and safety profile between MSICS with trabeculectomy and . Further high-quality studies are required to confirm these findings.
PubMed: 38264398
DOI: 10.7759/cureus.51025 -
PloS One 2024To evaluate the accuracy of 10 formulas for calculating intraocular lens (IOL) power in cataract eye with an axial length (AL) of more than 28.0 mm. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the accuracy of 10 formulas for calculating intraocular lens (IOL) power in cataract eye with an axial length (AL) of more than 28.0 mm.
METHODS
We searched scientific databases including PubMed, EMBASE, Web of Science and Cochrane Library for research published over the past 5 years, up to Sept 2023. The inclusion criteria were case series studies that compared different formulas (Barrett II, EVO, Kane, Hill-RBF, Haigis, Hoffer Q, Holladay 1, SRK/T, Holladay 1 w-k and SRK/T w-k), in patients with extremely long AL undergoing uncomplicated cataract surgery with IOL implantation. The mean difference (MD) of mean absolute error (MAE) and the odds ratio (OR) of both the percentage of eyes within ±0.50D of prediction error (PPE±0.50D) and the percentage of eyes within ±1.00D of prediction error (PPE±1.00D) among different formulas were pooled using meta-analysis.
RESULTS
A total of 11 studies, involving 1376 eyes, were included to evaluate the 10 formulas mentioned above. Among these formulas, Barrett II, EVO, Kane, and Hill-RBF demonstrated significantly lower MAE values compared to SRK/T. Furthermore, Kane and Hill-RBF had lower MAE values than EVO. Additionally, Barrett II and Kane yielded significantly lower MAE values than Haigis while Hill-RBF showed significantly lower MAE values than Holladay 1. Moreover, Hill-RBF showed the highest values for both PPE±0.50D and PPE±1.00D, followed by Kane. Both EVO and Kane had higher values of PPE±0.50D and PPE±1.00D compared to Haigis and SRK/T.
CONCLUSION
The Wang-Koch adjusted formulas and new-generation formulas have shown potential for higher accuracy in predicting IOL power for cataract patients with extremely long AL compared to traditional formulas. Based on the current limited clinical studies, Hill-RBF and Kane formulas seem to be a better choice for eyes with extremely long AL.
Topics: Humans; Eye; Cataract; Cataract Extraction; Databases, Factual; Lenses, Intraocular
PubMed: 38252627
DOI: 10.1371/journal.pone.0296771 -
Frontiers in Medicine 2023To investigate the effects of postoperative astigmatism on the visual outcomes following presbyopia-correcting surgery with multifocal intraocular lens implantation.
PURPOSE
To investigate the effects of postoperative astigmatism on the visual outcomes following presbyopia-correcting surgery with multifocal intraocular lens implantation.
METHODS
A comprehensive literature search was conducted using PubMed, Embase, and Web of Science for articles published until January 2023. Additionally, we included retrospective case series and prospective comparative studies. The combined mean difference (MD) with 95% confidence intervals (CI) and odds ratio (OR) with 95% CI were used to express continuous and categorical outcomes, respectively. All statistical analyses were performed using Review Manager (version 5.4.1).
RESULTS
We included nine eligible studies that analyzed 3,088 eyes. The proportion of eyes with useful postoperative visual acuity (logMAR ≤ 0.20) and residual astigmatism significantly differed with respect to the magnitude of astigmatism and presence/absence of blurred vision ( < 0.001 for both). Additionally, the mean uncorrected distance visual acuity (MD, 0.14; 95% CI, 0.06 to 0.21; = 0.0003) and uncorrected intermediate visual acuity (MD, 0.07; 95% CI, 0.00 to 0.13; = 0.04), but not the uncorrected near visual acuity (MD, 0.02; 95%CI-0.01 to 0.05; = 0.17), significantly differed according to the magnitude of astigmatism.
CONCLUSION
Astigmatism, even at low levels (≥ 0.5D), has a significant effect on visual outcomes, especially on UDVA and UIVA, following multifocal intraocular lens implantation. Accurate preoperative and postoperative evaluation of astigmatism is important.
PubMed: 38089878
DOI: 10.3389/fmed.2023.1214714 -
Journal of Clinical Medicine Nov 2023The purpose of the research project was to extensively review the efficacy and safety of a trehalose tear-substitute treatment in cases of dry eye disease (DED). A... (Review)
Review
The purpose of the research project was to extensively review the efficacy and safety of a trehalose tear-substitute treatment in cases of dry eye disease (DED). A systematic review that included only full-length randomized controlled studies (RCTs) reporting the effects of trehalose tear-substitute treatment in three databases, PubMed, Scopus and Web of Science, was performed according to the PRISMA statement. The search period included papers published before 8 August 2023. The Cochrane risk-of-bias tool was used to analyze the quality of the studies selected. A total of 10 RCTs were included in this systematic review. Trehalose tear-substitute treatments achieved a higher improvement than did control group interventions in all reported variables. The mean differences between both groups were in favor of trehalose, and were as follows: ocular surface disease index (OSDI) questionnaire score of -8.5 ± 7 points, tear film breakup time (TBUT) of 1.9 ± 1 s, tear film thickness (TFT) of 0.25 ± 0.1 μm, tear meniscus height (TMH) of 0.02 ± 0.02 mm, Schirmer test (ST) of 0.8 ± 1.4 mm, corneal fluorescein staining (CFS) of -0.7 ± 0.1 points and visual acuity (VA) of 0.3 ± 2.1 letters. No adverse events after trehalose tear-substitute treatments were reported. Trehalose tear substitutes are a safe and effective treatment for DED. Therefore, trehalose tear substitutes should be recommended for patients with dry eye disease. In addition, there is specific evidence to support its use in the preoperative cataract surgery period.
PubMed: 38068353
DOI: 10.3390/jcm12237301 -
Frontiers in Public Health 2023To systematically compare and rank the accuracy of AI-based intraocular lens (IOL) power calculation formulas and traditional IOL formulas in highly myopic eyes. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically compare and rank the accuracy of AI-based intraocular lens (IOL) power calculation formulas and traditional IOL formulas in highly myopic eyes.
METHODS
We screened PubMed, Web of Science, Embase, and Cochrane Library databases for studies published from inception to April 2023. The following outcome data were collected: mean absolute error (MAE), percentage of eyes with a refractive prediction error (PE) within ±0.25, ±0.50, and ±1.00 diopters (D), and median absolute error (MedAE). The network meta-analysis was conducted by R 4.3.0 and STATA 17.0.
RESULTS
Twelve studies involving 2,430 adult myopic eyes (with axial lengths >26.0 mm) that underwent uncomplicated cataract surgery with mono-focal IOL implantation were included. The network meta-analysis of 21 formulas showed that the top three AI-based formulas, as per the surface under the cumulative ranking curve (SUCRA) values, were XGBoost, Hill-RBF, and Kane. The three formulas had the lowest MedAE and were more accurate than traditional vergence formulas, such as SRK/T, Holladay 1, Holladay 2, Haigis, and Hoffer Q regarding MAE, percentage of eyes with PE within ±0.25, ±0.50, and ±1.00 D.
CONCLUSIONS
The top AI-based formulas for calculating IOL power in highly myopic eyes were XGBoost, Hill-RBF, and Kane. They were significantly more accurate than traditional vergence formulas and ranked better than formulas with Wang-Koch AL modifications or newer generations of formulas such as Barrett and Olsen.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022335969.
Topics: Adult; Humans; Refraction, Ocular; Lenses, Intraocular; Artificial Intelligence; Network Meta-Analysis; Retrospective Studies; Myopia; Refractive Errors
PubMed: 38026369
DOI: 10.3389/fpubh.2023.1279718 -
Bulletin of the World Health... Dec 2023To assess how the returns on investment from correcting refractive errors and cataracts in low- and middle-income countries compare with the returns from other global...
OBJECTIVE
To assess how the returns on investment from correcting refractive errors and cataracts in low- and middle-income countries compare with the returns from other global development interventions.
METHODS
We adopted two complementary approaches to estimate benefit-cost ratios from eye health investment. First, we systematically searched PubMed® and Web of Science™ on 14 August 2023 for studies conducted in low-and-middle-income countries, which have measured welfare impacts associated with correcting refractive errors and cataracts. Using benefit-cost analysis, we compared these impacts to costs. Second, we employed an economic modelling analysis to estimate benefit-cost ratios from eye health investments in India. We compared the returns from eye health to returns in other domains across global health and development.
FINDINGS
We identified 21 studies from 10 countries. Thirteen outcomes highlighted impacts from refractive error correction for school students. From the systematic review, we used 17 out of 33 outcomes for benefit-cost analyses, with the median benefit-cost ratio being 36. The economic modelling approach for India generated benefit-cost ratios ranging from 28 for vision centres to 42 for school eye screening, with an aggregate ratio of 31. Comparing our findings to the typical investment in global development shows that eye health investment returns six times more benefits (median benefit-cost ratio: 36 vs 6).
CONCLUSION
Eye health investments provide economic benefits with varying degrees based on the intervention type and location. Our findings underline the importance of incorporating eye health initiatives into broader development strategies for substantial societal returns.
Topics: Humans; Cost-Benefit Analysis; Investments; Cataract; Refractive Errors; India
PubMed: 38024247
DOI: 10.2471/BLT.23.289863 -
Ophthalmology May 2024Review of the efficacy and safety of standard versus soft topical steroid application after cataract surgery. (Meta-Analysis)
Meta-Analysis
TOPIC
Review of the efficacy and safety of standard versus soft topical steroid application after cataract surgery.
CLINICAL RELEVANCE
The control of postoperative inflammation is the mainstay of treatment after cataract surgery. However, no consensus exists regarding the postoperative steroid of choice. Basing the choice of topical postoperative steroidal treatment on high-quality data regarding both risks and benefits of various drugs would be advantageous for both patients and clinicians.
METHODS
A systematic search of the PubMed, Scopus, and Embase electronic databases for all peer-reviewed published randomized control trials that included clinical outcomes of topical steroidal treatment after uneventful cataract surgery was performed. Individual study data were extracted and evaluated in a weighted pooled analysis including grading of total anterior chamber (AC) inflammation, AC cells, AC flare, postoperative visual acuity (VA), intraocular pressure (IOP), and rate of adverse events (AEs).
RESULTS
Overall, 508 studies were found, of which 7 were eligible for the systematic review and ultimately were included for analysis, reporting on 593 patients from 5 countries. Age of included patients, when available, ranged between 3.7 and 73.4 years. Follow-up data were available for analysis at 1, 7, and 28 days after surgery. Except for a significantly lower grade of AC flare in the standard steroid group at day 7 (standardized mean difference, 0.26; 95% confidence interval, 0.05-0.47; I = 0%), inflammatory activity measurements displayed insignificant differences at every other follow-up (days 1 and 28 after surgery). Pooled analysis of IOP at each follow-up demonstrated a higher IOP at the 7-day visit in the standard steroid group, whereas IOP at other time points was comparable among the groups. Qualitative analysis of ocular AEs showed similarities among the groups.
DISCUSSION
The findings of this study suggest that for the average patient, both groups produce a comparable effect on both AC inflammation and postoperative IOP and VA.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Topics: Humans; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Cataract Extraction; Glaucoma; Steroids; Inflammation; Cataract
PubMed: 38007198
DOI: 10.1016/j.ophtha.2023.11.022 -
AANA Journal Dec 2023This systematic review was conducted to examine the value of the preoperative history and physical (H&P) examination and preoperative care prior to cataract extraction...
This systematic review was conducted to examine the value of the preoperative history and physical (H&P) examination and preoperative care prior to cataract extraction and the resulting outcomes of adverse events, patient experience, and cost. Four databases were searched using appropriate keywords from 2012 to 2022. Observational studies, randomized controlled trials, and quality improvement studies with data on the precataract H&P were included. Outcome measures were adverse events, cost, and patient experience. Of the 4,170 studies screened, 12 studies were included. Risk stratification of patients into a high-risk group with an H&P and a low-risk group without an H&P resulted in an increased incidence of minor adverse events in the low-risk group but did not increase the incidence of major adverse events or surgical adverse events. A short-term cost savings was reported, and patient experience was unchanged. In 2020, the Centers for Medicare and Medicaid Services removed the requirement for the precataract H&P within 30 days prior to ambulatory surgery, which has implications for surgery center policy. More research on the role of the preoperative H&P on patient experience, adverse events, cost, and outcomes should be conducted, given the methodological heterogeneity of this review.
Topics: Aged; United States; Humans; Medicare; Cataract Extraction; Cost Savings; Physical Examination; Cataract
PubMed: 37987726
DOI: No ID Found