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Microorganisms Mar 2022Beta-lactamase (BL) production is a major public health problem. Although not the most frequent AmpC type, AmpC-BL is increasingly isolated, especially plasmid AmpC-BL...
Beta-lactamase (BL) production is a major public health problem. Although not the most frequent AmpC type, AmpC-BL is increasingly isolated, especially plasmid AmpC-BL (pAmpC-BL). The objective of this study was to review information published to date on pAmpC-BL in and and on the epidemiology and detection methods used by clinical microbiology laboratories, by performing a systematic review using the MEDLINE PubMed database. The predictive capacity of a screening method to detect AmpC-BL using disks with cloxacillin (CLX) was also evaluated by studying 102 clinical isolates grown in CHROMID ESBL medium with the addition of cefepime (FEP), cefoxitin (FOX), ertapenem (ETP), CLX, and oxacillin with CLX. The review, which included 149 publications, suggests that certain risk factors (prolonged hospitalization and previous use of cephalosporins) are associated with infections by pAmpC-BL-producing microorganisms. The worldwide prevalence has increased over the past 10 years, with a positivity rate ranging between 0.1 and 40%, although AmpC was only detected when sought in a targeted manner. CMY-2 type has been the most prevalent pAmpC-BL-producing microorganism. The most frequently used phenotypic method has been the double-disk synergy test (using CLX disks or phenyl-boronic acid and cefotaxime [CTX] and ceftazidime) and the disk method combined with these inhibitors. In regard to screening methods, a 1-µg oxacillin disk with CLX showed 88.9% sensitivity, 100% specificity, 100% positive predictive value (PPV), 98.9% negative predictive value (NPV), and 98.9% validity index (VI). This predictive capacity is reduced with the addition of extended-spectrum beta-lactamases, showing 62.5% sensitivity, 100% specificity, 100% PPV, 93.5% NPV, and 94.1% VI. In conclusion, there has been a worldwide increase in the number of isolates with pAmpC-BL, especially in Asia, with CMY-2 being the most frequently detected pAmpC-BL-producing type of microorganism. Reduction in its spread requires routine screening with a combination of phenotypic methods (with AmpC inhibitors) and genotypic methods (multiplex PCR). In conclusion, the proposed screening technique is an easy-to-apply and inexpensive test for the detection of AmpC-producing isolates in the routine screening of multidrug-resistant microorganisms.
PubMed: 35336186
DOI: 10.3390/microorganisms10030611 -
Journal of Healthcare Engineering 2022Facet tropism is recognized as the difference in the positioning of the facet joints in association with each other in the sagittal plane. This guides to an imbalanced... (Meta-Analysis)
Meta-Analysis
Facet tropism is recognized as the difference in the positioning of the facet joints in association with each other in the sagittal plane. This guides to an imbalanced biomechanical force over the facet joints and the intervertebral disc during rotation and other physiological activities. A systematic review and meta-analysis of Web of Science, EMBASE, PubMed, Cochrane Library, SCOPUS, and CINHAL from 2004 to 2021 to recognize the related research studies was performed. The data for meta-analysis were obtained from multiple studies to get the combined effect of the facet tropism on the lumbar disc herniation (LDH) and the degenerative lumbar spondylolisthesis (LDS). 117 articles were incorporated in the systematic review, where 41 studies were selected for meta-analysis, out of which 7 studies were found eligible as per the inclusion criteria. When degenerative lumbar spondylolisthesis was compared with the normal group, 95% CI was observed at 1.94 (1.59, 2.28). There was a comparison of disc herniation with the normal group in L4/L5, with a 95% CI of 0.60 (0.05, 1.14). The L5/S1 disc herniation was compared with the normal group and was found to be 0.21 (-0.48, 0.90). Therefore, it was observed that facet tropism is related to lumbar disc herniation and degenerative lumbar spondylolisthesis. Our meta-analysis demonstrated a unique link between the facet tropism and the lumbar disk degeneration along with degenerative lumbar spondylolisthesis.
Topics: Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Magnetic Resonance Imaging; Spondylolisthesis; Zygapophyseal Joint
PubMed: 35242295
DOI: 10.1155/2022/2486745 -
BMC Ophthalmology Feb 2022β-Zone parapapillary atrophy (β-PPA) is a common sign in patients with open-angle glaucoma (OAG). Some studies have suggested that β-PPA can aid in the diagnosis of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
β-Zone parapapillary atrophy (β-PPA) is a common sign in patients with open-angle glaucoma (OAG). Some studies have suggested that β-PPA can aid in the diagnosis of OAG. We performed a systematic review and meta-analysis of the prevalence and diagnostic ability of β-PPA in OAG.
METHODS
We performed a literature search in PubMed, Web of Science, Embase and Google Scholar from inception to 1st November, 2021. Both hospital-based and population-based studies that reported details of β-PPA in OAG were included.
RESULTS
We screened 1404 articles from these databases and ultimately included 24 articles in our meta-analysis. The prevalence of β-PPA in OAG was 0.73 (95% CI 0.67 to 0.78). The results of subgroup analysis by country revealed prevalence rates of 0.83 (95% CI 0.78 to 0.88) in Japan, 0.85 (95% CI 0.64 to 0.97) in Korea, 0.64 (95% CI 0.55 to 0.73) in the USA, 0.61 (95% CI 0.58 to 0.63) in Germany and 0.57 (95% CI 0.39 to 0.74) in China. Fundus photography, Heidelberg retina tomography (HRT), Heidelberg retina angiography (HRA) + indocyanine green angiography (ICGA), Spectral domain optical coherence tomography (SD-OCT)and Swept source optical coherence tomography(SS-OCT) values were 0.65 (95% CI 0.58 to 0.71), 0.70 (95% CI 0.50 to 0.86), 0.78 (95% CI 0.61 to 0.91), 0.77 (95% CI 0.65 to 0.88) and 0.99(95% CI 0.87 to 1.00) respectively. The sensitivity and specificity of β-PPA as a diagnostic marker were 0.78 (95% CI 0.68 to 0.85) and 0.63 (95% CI 0.51 to 0.73), respectively.
CONCLUSIONS
β-PPA is a potential diagnostic marker for OAG. However, a more detailed understanding of β-PPA characteristics is needed to improve the ability to predict OAG.
Topics: Atrophy; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Optic Atrophy; Optic Disk; Prevalence; Tomography, Optical Coherence
PubMed: 35151269
DOI: 10.1186/s12886-022-02282-5 -
Annals of Palliative Medicine Dec 2021Tongfu traditional Chinese medicine (TCM) preparation is a common alternative therapy for clinical treatment of patients with septic gastrointestinal dysfunction. In... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Tongfu traditional Chinese medicine (TCM) preparation is a common alternative therapy for clinical treatment of patients with septic gastrointestinal dysfunction. In recent years, a number of randomized controlled trials (RCTs) have been conducted to verify the effectiveness of Tongfu TCM preparation in the treatment of sepsis gastrointestinal dysfunction, but all of them have been small sample studies, and the research conclusions have been controversial. Here, this study conducted a meta-analysis on the clinical efficacy of the treatment of septic gastrointestinal dysfunction with TCM preparation, to produce a more objective and comprehensive systematic review to guide clinical application.
BACKGROUND
To evaluate the efficacy and safety of Tongfu traditional Chinese medicine (TCM) preparation in the treatment of patients with septic gastrointestinal dysfunction.
METHODS
Randomized controlled trials (RCTs) of Tongfu TCM preparation in the treatment of septic gastrointestinal dysfunction published before February 2021 were searched for in the Chinese databases China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Biomedical Literature Disk (CBMdisc), and Chongqing VIP (CQVIP), and English databases PubMed, Web of Science, EBSCO, and The Cochrane Library. Meta-analysis was performed using RevMan 5.3 software, and funnel plots were drawn to evaluate the bias of literatures.
RESULTS
A total of 22 RCTs involving 1,558 patients were included. There were 772 patients in the control group and 786 in the trial group. Meta-analysis results showed that: gastrointestinal dysfunction score [mean difference (MD) =-0.50, 95% confidence interval (CI): -0.61 to -0.38], Acute Physiology and Chronic Health Evaluation II (APACHE II) score (MD =-3.30, 95% CI: -3.73 to -2.86), and mortality (MD =0.34, 95% CI: 0.25-0.47) in the experimental group were significantly lower than those in the control group, and the difference was statistically significant (P<0.001). The funnel plot results showed that there was little possibility of publication bias.
DISCUSSION
Tongfu TCM preparation can effectively improve the gastrointestinal function of patients with sepsis gastrointestinal dysfunction, prevent the deterioration of the disease, and reduce the mortality; however, more evidence is required to substantiate these findings.
Topics: China; Humans; Medicine, Chinese Traditional; Sepsis; Treatment Outcome
PubMed: 35016408
DOI: 10.21037/apm-21-2461 -
Medicine Dec 2021Aim of this study was to systematically review the prevailing treatment methods for lumbar spondylolysis.
BACKGROUND:
Aim of this study was to systematically review the prevailing treatment methods for lumbar spondylolysis.
METHODS:
Manuscripts published between 1951 and 2020 were searched by using PubMed, Medline, Scopus, Springer, Web of Science databases. The study protocol was registered with PROSPERO (CRD42020218651). The inclusion criteria for all articles of prevailing treatment methods for spondylolysis were: 1. English language; 2. at least 1 relevant treatment method for spondylolysis; 3. Randomized controlled trial (RCT), systematic review, comparative study, cross-sectional, cohort, and/or case control study. 4. pre-diagnosed cases of spondylolysis whereas article was excluded if. 5. any spinal deformity. 6. any neurological condition. Standards have been independently applied by using 2 reviewers and another author resolved disagreements.
RESULTS:
Data extraction screened 12 full-length articles. Description, treatment, outcome, and findings were individually extracted and cross-referenced.
DISCUSSION:
Current review has suggested that the noninvasive treatment method specifically low intensity pulsed ultrasound, electro acupuncture and pulsed electromagnetic filed is effective for bone union while operative treatment specifically pedicle screw fixation +/- interbody fusion depending the extent of disk degeneration and craniocaudal foraminal stenosis is effective for minimizing pain and functional disability in patients with spondylolysis. This review concluded that the noninvasive treatment method specifically low intensity pulsed ultrasound is effective for bone union.
REVIEW REGISTRATION:
PROSPERO (CRD42020218651).
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Spondylolysis
PubMed: 34941130
DOI: 10.1097/MD.0000000000028319 -
Global Spine Journal Sep 2022Systematic review and meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
Cervical spine endoscopic discectomy and decompression have gained popularity in the last decade. This review aimed to shed light on the current outcomes of cervical spine endoscopic procedures for degenerative disc disease (DDD) and to calculate a pooled estimate of various outcome measures.
METHODS
We retrieved articles published in English related to endoscopic cervical spine procedures from 3 central databases from inception until September 2020. A subgroup analysis based on the anterior versus the posterior approach was performed.
RESULTS
Thirty-one articles fulfilled the eligibility criteria and included 1,410 patients. A successful outcome was observed in 91.3% (88.6-93.4%, = 0.000). This percentage was lower for the anterior approach (89.6% [85.8-92.5%], = 0.000) than for the posterior approach (94.2% [90.4-96.5%], = 0.000). A higher percentage of poor outcomes was reported for the anterior approach (5.7% [3.2-10.1%], = 0.000 vs. 2.3% [1-5.5%], = 0.000 for the posterior approach). The overall complication rate was 7.2% (5.2-9.8%, = 0.000). There was a slightly higher complication rate for the anterior approach (7.9% [4.5-13.3%], = 0.000) than for the posterior approach (6.7% [4.4-10%], = 0.000). The revision rate was 4.2% (2.6-6.8%, = 0.000); and 4.2% (1.8-9.7%, = 0.000) for the anterior approach and 4.00% (2.2-7.4%, = 0.000) for the posterior approach.
CONCLUSIONS
There is a higher success rate and lower complication rate with the posterior approach than with the anterior approach. However, high-quality randomized controlled trials are vital to evaluate the efficacy of these procedures.
PubMed: 34402323
DOI: 10.1177/21925682211037270 -
Antimicrobial Resistance and Infection... Jun 2021Vancomycin‑resistant Staphylococcus aureus (VRSA) is a serious public health challenging concern worldwide. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vancomycin‑resistant Staphylococcus aureus (VRSA) is a serious public health challenging concern worldwide.
OBJECTIVES
Therefore, the objective of present study of 62 published studies was to evaluate the prevalence of VRSA based on different years, areas, isolate source, antimicrobial susceptibility testing, and the genetic determinants.
METHODS
We searched the relevant articles that focused on the prevalence rates of VRSA in PubMed, Scopus, Embase, and Web of Science from 2000 to 2019. Statistical analyses were conducted using STATA software (version 14.0).
RESULTS
The prevalence of VRSA was 2% before 2006, 5% in 2006-2014, and 7% in 2015-2020 that showed a 3.5-fold increase in the frequency of VRSA between before 2006 and 2020 years. The prevalence of VRSA was 5% in Asia, 1% in Europe, 4% in America, 3% in South America, and 16% in Africa. The frequencies of VRSA isolated from clinical, non-clinical, and mixed samples were 6%, 7%, and 14%, respectively. The prevalence of VRSA was 12% using disk diffusion agar method, 7% using MIC-base methods, and 4% using mixed-methods. The prevalence of vanA, vanB, and vanC1 positive were 71%, 26%, and 4% among VRSA strains. The most prevalent genotype was staphylococcal cassette chromosomemec (SCCmec) II, which accounted for 57% of VRSA. The most prevalent staphylococcal protein A (spa) types were t002, t030, and t037.
CONCLUSION
The prevalence of VRSA has been increasing in recent years particularly in Africa/Asia than Europe/America. The most prevalent of genetic determinants associated with VRSA were vanA and SCCmec II. This study clarifies that the rigorous monitoring of definite antibiotic policy, regular surveillance/control of nosocomial-associated infections and intensive surveillance of vancomycin-resistance are required for preventing emergence and further spreading of VRSA.
Topics: Africa; Asia; Europe; Humans; Methicillin-Resistant Staphylococcus aureus; North America; Prevalence; South America; Staphylococcal Infections; Vancomycin-Resistant Staphylococcus aureus
PubMed: 34193295
DOI: 10.1186/s13756-021-00967-y -
Acta Ophthalmologica Mar 2022To evaluate microvascular alterations with optical coherence tomography angiography (OCTA) in eyes with non-arteritic anterior ischaemic optic neuropathy (NAION) and the... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate microvascular alterations with optical coherence tomography angiography (OCTA) in eyes with non-arteritic anterior ischaemic optic neuropathy (NAION) and the unaffected fellow eyes.
DESIGN
Systematic review and meta-analysis.
METHODS
A comprehensive literature search was conducted in the PubMed and Embase databases through 6 September 2020, to identify the studies on NAION and the unaffected fellow eyes using OCTA. Eligible studies and data of interest were extracted and analysed by RevMan Software v. 5.4 and Stata Software v.14.0. The weighted mean differences and 95% confidence intervals were used to assess the strength of the association.
RESULTS
Seventeen observational comparative studies, including 379 eyes with NAION, 175 unaffected contralateral eyes and 470 eyes of healthy controls, were identified. Compared to those of the healthy controls, the perfusion density (PD) of radial peripapillary capillary (RPC) and peripapillary superficial capillary plexus (ppSCP) of NAION were significantly lower. Moreover, the PD of the macular SCP (mSCP) in NAION was significantly reduced in the whole image, superior quadrant and temporal quadrant, while the macular deep capillary plexus (mDCP) showed a decreasing PD only within the whole image. Between unaffected fellow eyes and healthy eyes, significant differences of PD were demonstrated in the whole image and some peripapillary regions of the RPC and ppSCP.
CONCLUSION
Our results suggested that compared to those of healthy controls, the eyes affected by NAION and unaffected fellow eyes demonstrated significant microvascular impairments in different regions. Between acute and non-acute NAION, macular OCTA parameters showed different characteristic patterns.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Observational Studies as Topic; Optic Disk; Optic Neuropathy, Ischemic; Retinal Vessels; Tomography, Optical Coherence
PubMed: 34155823
DOI: 10.1111/aos.14930 -
International Journal of Microbiology 2021Antimicrobial resistance especially caused by extended-spectrum -lactamase-producing (ESBL-PE) has become a global public health concern. Globally, these isolates have... (Review)
Review
BACKGROUND
Antimicrobial resistance especially caused by extended-spectrum -lactamase-producing (ESBL-PE) has become a global public health concern. Globally, these isolates have remained the most important causes of several infections and associated mortality. Their rapid spread in Ethiopia is associated with a lack of regular surveillance and antibiotic stewardship programs. Isolates of ESBL-PE from different regions of Ethiopia were searched exhaustively. However, published data regarding the pooled estimate of ESBL-PE are not conducted in Ethiopia. For this reason, we systematically reviewed laboratory-based studies to summarize the overall pooled prevalence of the isolates recovered from various human specimens.
METHODS
An exhaustive literature search was carried out using the major electronic databases including PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, Google Scholar, Cochrane Library, Scopus, and Wiley Online Library to identify potentially relevant studies without date restriction. Original articles which address the research question were identified, screened, and included using the PRISMA follow diagram. Data extraction form was prepared in Microsoft Excel, and data quality was assessed by using 9-point Joanna Briggs Institute critical appraisal tools. Then, data were exported to STATA 16.0 software for analyses of pooled estimation of outcome measures. Estimation of outcome measures at 95% confidence interval was performed using Der-Simonian-Laird's random-effects model. Finally, results were presented via text, figures, and tables.
RESULTS
A comprehensive electronic database literature search has yielded a total of 86 articles. Among the total, 68 original articles were excluded after the review process. A total of 18 studies with 1191 bacterial isolates recovered from 7919 various clinical samples sizes were included for systematic review and meta-analysis. In this study, the pooled prevalence of ESBL-PE was 18% (95% CI: 9-26). Nine out of the total (50%) reviewed articles were studied using the combination disk test. Likewise, and . (50% both) were the predominant isolates of ESBL-PE in addition to other isolates such as spp. and spp.
CONCLUSION
This meta-analysis has shown a low pooled estimate of ESBL-PE in Ethiopia.
PubMed: 33859697
DOI: 10.1155/2021/6669778 -
The Cochrane Database of Systematic... Mar 2021In at least a third of primary angle closure cases, appositional angle closure persists after laser peripheral iridotomy, and further intervention may be considered....
BACKGROUND
In at least a third of primary angle closure cases, appositional angle closure persists after laser peripheral iridotomy, and further intervention may be considered. Laser peripheral iridoplasty (LPIp) can be used in treating chronic angle closure when angle closure persists after laser peripheral iridotomy. Previous reviews have found insufficient data to determine its clinical effectiveness, compared to other interventions. This is an update of a Cochrane Review first published in 2008 and updated in 2012. It examines all studies to date to establish whether LPIp shows any effectiveness over other available treatment options.
OBJECTIVES
To assess the effectiveness of laser peripheral iridoplasty in the treatment of people with chronic angle closure, when compared to laser peripheral iridotomy, medical therapy or no further treatment.
SEARCH METHODS
We searched various electronic databases. The date of the search was 20 December 2020.
SELECTION CRITERIA
We included only randomised controlled trials (RCTs) assessing the use of LPIp in cases of suspected primary angle closure (PACS), confirmed primary angle closure (PAC), or primary chronic angle-closure glaucoma (PACG). We applied no restrictions with respect to gender, age or ethnicity of participants. Trials evaluating LPIp for acute attacks of angle closure were not eligible.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Two authors independently assessed studies for risk of bias using Cochrane's 'risk of bias' tool. We collected adverse effects information from the trials.
MAIN RESULTS
We included four RCTs involving 252 participants (276 eyes). In total, three different methods of intervention were used and 15 outcomes reported, with different time points. We used narrative synthesis to describe the majority of the findings, as meta-analysis was only possible for a limited number of outcomes due to the variation in study design and outcomes assessed. Study Characteristics Participants were adults recruited from outpatient settings in the UK, Singapore, China and Korea with either PACS, PAC or PACG. All studies compared argon LPIp (as either a primary or secondary procedure) to an alternative intervention or no further treatment. Three studies were of parallel group design, and one within-person, randomised by eye. All studies showed elements of high risk of bias. Due to the nature of the intervention assessed, a lack of masking of both participants and assessors was noted in all trials. Findings Laser peripheral iridoplasty with iridotomy versus iridotomy alone as a primary procedure Two RCTs assessed the use of argon LPIp as a primary procedure with peripheral iridotomy, compared with peripheral iridotomy alone. However, neither study reported data for the primary outcome, disease progression. Argon LPIp showed no evidence of effect on: final mean intraocular pressure (IOP) at 3 months and 12 months (mean difference (MD) 0.39 mmHg, 95% confidence interval (CI) -1.07 to 1.85; I = 38%; 2 studies, 174 participants; low-certainty evidence); further surgical or laser intervention at 12 months (risk ratio (RR) 1.21, 95% CI 0.66 to 2.21; 1 study, 126 participants; low-certainty evidence); or mean number of additional medications required at 12 months (MD 0.10, 95% CI -0.34 to 0.54; 1 study, 126 participants; low-certainty evidence). Complications were assessed at 3 to 12 months (2 studies, 206 participants; low-certainty evidence) and found to be mild and uncommon, with comparable levels between groups. The only severe complication encountered was one case of malignant glaucoma in one study's argon LPIp group. Quality of life measures were not assessed. In the other study, investigators found that argon LPIp showed no evidence of effect on final mean anterior segment optical coherence tomography (AS-OCT) measurements, including anterior chamber depth (MD 0.00 mm, 95% CI -0.10 to 0.10; 24 participants, 48 eyes; very low-certainty evidence). Laser peripheral iridoplasty as a secondary procedure versus no treatment One RCT assessed the use of argon LPIp as a secondary procedure compared with no further treatment in 22 participants over three months. Disease progression, additional medications required, complications, further surgical or laser intervention, and quality of life outcomes were not assessed. There was only very low-certainty evidence regarding final maximum IOP value (MD -1.81 mmHg, 95% CI -3.11 to -0.51; very low-certainty evidence), with no evidence of effect on final minimum IOP values (MD -0.31 mmHg, 95% CI -1.93 to 1.31; very low-certainty evidence). The evidence is very uncertain about the effect of argon LPIp on AS-OCT parameters. The trial did not report AS-OCT measurements for the control group. Laser peripheral iridoplasty as a secondary procedure versus medication One RCT assessed the use of argon LPIp as a secondary procedure compared with travoprost 0.004% in 80 participants over 12 months. The primary outcome of disease progression was reported for this method: argon LPIp showed no evidence of effect on mean final cup/disk ratio (MD -0.03, 95% CI -0.11 to 0.05; low-certainty evidence). Argon LPIp showed no evidence of effect for: mean change in IOP (MD -1.20 mmHg, 95% CI -2.87 to 0.47; low-certainty evidence) or mean number of additional medications (MD 0.42, 95% CI 0.23 to 0.61; low-certainty evidence). Further surgical intervention was required by one participant in the intervention group alone, with none in the control group (low-certainty evidence). No serious adverse events were reported, with mild complications consisting of two cases of 'post-laser IOP spike' in the argon LPIp group. Quality of life measures were not assessed. The evidence is very uncertain about the effect of argon LPIp on AS-OCT parameters. The trial did not report AS-OCT measurements for the control group. Adverse events Availability of data were limited for adverse effects. Similar rates were observed in control and intervention groups, where reported. Serious adverse events were rare.
AUTHORS' CONCLUSIONS
After reviewing the outcomes of four RCTs, argon LPIp as an intervention may be no more clinically effective than comparators in the management of people with chronic angle closure. Despite a potential positive impact on anterior chamber morphology, its use in clinical practice in treating people with chronic angle closure is not supported by the results of trials published to date. Given these results, further research into LPIp is unlikely to be worthwhile.
Topics: Adult; Bias; Chronic Disease; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Laser Therapy; Lasers, Gas; Randomized Controlled Trials as Topic
PubMed: 33755197
DOI: 10.1002/14651858.CD006746.pub4