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European Journal of Ophthalmology May 2023Monofocal intraocular lenses (IOLs) used in cataract surgery are designed to improve visual acuity (VA). The available evidence of new monofocal IOLs" functional... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Monofocal intraocular lenses (IOLs) used in cataract surgery are designed to improve visual acuity (VA). The available evidence of new monofocal IOLs" functional benefits is limited. The aim of this meta-analysis was to analyze the improvement in VA using Tecnis Eyhance monofocal IOLs compared to standard monofocal IOLs Tecnis ZCB00.
METHODS
MEDLINE, Web of Science and Scopus were searched for studies assessing improvement in intermediate VA using Tecnis Eyhance IOLs versus Tecnis ZCB00 IOLs. Studies evaluating post-operative VA in patients who underwent cataract surgery were selected. This meta-analysis followed PRISMA guidelines and was registered in PROSPERO. The Cochrane Risk of Bias Tool 2.0. was used to assess the methodological quality of the included studies, risk of selection bias and comparability of cohorts and outcomes.
RESULTS
The search resulted in 1153 articles. Five studies met the inclusion criteria and were included in the meta-analysis. A total of 604 eyes were evaluated, of which 309 received Tecnis Eyhance IOLs and 295 were implanted with Tecnis ZCB00 IOLs. Mean binocular distant-corrected intermediate VA with Tecnis Eyhance IOLs at 2 weeks-1 month showed a significant difference of -0,21 logMAR, p < 0.001; and mean binocular distance-corrected intermediate VA with Tecnis Eyhance IOLs at 6 months showed a significant difference of -0,11 logMAR, p < 0.001.
CONCLUSION
Near VA could not be assessed in this meta-analysis as it was measured in very few studies. Preliminary pooled evidence indicates that intermediate VA improved with Tecnis Eyhance IOLs. Further studies evaluating near VA and with longer follow-up are still necessary.
Topics: Humans; Prosthesis Design; Lenses, Intraocular; Vision, Ocular; Cataract Extraction; Cataract; Phacoemulsification; Patient Satisfaction
PubMed: 36124373
DOI: 10.1177/11206721221127075 -
International Ophthalmology Feb 2023To compare the visual, refractive, and anatomical outcomes and incidence of complications between combined pars plana vitrectomy and phacoemulsification... (Meta-Analysis)
Meta-Analysis Review
Pars plana vitrectomy combined with phacoemulsification versus pars plana vitrectomy only for treatment of phakic rhegmatogenous retinal detachment: a systematic review and meta-analysis.
PURPOSE
To compare the visual, refractive, and anatomical outcomes and incidence of complications between combined pars plana vitrectomy and phacoemulsification (phacovitrectomy) versus pars plana vitrectomy (PPV-only) in phakic eyes with rhegmatogenous retinal detachment (RRD).
METHODS
Two independent reviewers searched MEDLINE, Cochrane Central, and Web of Science to identify relevant articles. Prospective or retrospective studies comparing PPV-only and phacovitrectomy for RRD were included. Recruited studies provided information about at least anatomical success or refractive outcomes. Meta-analysis was performed for single surgery success rate, final best-corrected visual acuity (BCVA), postoperative complications, mean predicted refractive error, and mean absolute predicted refractive error.
RESULTS
Seven studies (788 eyes) were selected, including two clinical trials and five retrospective comparative case series. The single surgery success rate was similar in PPV-only and phacovitrectomy groups (risk ratio [RR] = 1.02; 95% confidence interval [CI] 0.95-1.10; P = 0.57). Mean final BCVA was significantly better in the PPV-only group than the phacovitrectomy group (MD = 0.06; 95% CI 0.00-0.12; P = 0.04). The risk of epiretinal membrane formation was significantly higher in eyes that underwent phacovitrectomy than PPV-only (RR = 2.85; 0.95% CI 1.5-5.41; P = 0.001). Phacovitrectomy group showed a more myopic final mean predicted refractive error than PPV-only group (MD = -0.31; 95% CI -0.55--0.07; P = 0.01).
CONCLUSION
There was no significant difference between the two groups regarding the anatomical outcome. Slightly better visual and refractive results were observed in the PPV-only group. However, the results should be interpreted with caution as the majority of included studies were low-quality retrospective studies.
Topics: Humans; Retinal Detachment; Scleral Buckling; Phacoemulsification; Vitrectomy; Retrospective Studies; Prospective Studies; Visual Acuity; Myopia; Treatment Outcome
PubMed: 35986229
DOI: 10.1007/s10792-022-02465-5 -
Etiology, pathogenesis, and management of acute intraocular lens opacification: a systematic review.International Journal of Ophthalmology 2022Millions of cataract surgeries with intraocular lens (IOL) implantation are performed worldwide. Although cataract surgery brings many benefits to the patients, the risk... (Review)
Review
Millions of cataract surgeries with intraocular lens (IOL) implantation are performed worldwide. Although cataract surgery brings many benefits to the patients, the risk of various complications is still a concern. One of the infrequent adverse events but potentially affecting on patients' visual acuity and contrast sensitivity is losing the transparency of IOL. IOL opacification may lead to IOL removal or exchange, which is unpleasant to both the patient and the surgeon. Several reports of acute IOL clouding are available in the literature describing various etiologies of this phenomenon, however, the exact mechanism remained unclear in some cases. Herein, we aimed to review the causes and outcomes of intraoperative and early postoperative IOL opacification.
PubMed: 35919328
DOI: 10.18240/ijo.2022.07.21 -
BMJ Open Jun 2022To compare the efficacy and safety of two Schlemm's canal-based microinvasive glaucoma surgery (MIGS) devices, the Hydrus Microstent and the iStent Trabecular Bypass... (Meta-Analysis)
Meta-Analysis
Comparison of Hydrus and iStent microinvasive glaucoma surgery implants in combination with phacoemulsification for treatment of open-angle glaucoma: systematic review and network meta-analysis.
OBJECTIVES
To compare the efficacy and safety of two Schlemm's canal-based microinvasive glaucoma surgery (MIGS) devices, the Hydrus Microstent and the iStent Trabecular Bypass combined with phacoemulsification for treatment of open-angle glaucoma.
DESIGN
Systematic review and network meta-analysis.
METHODS
Literature searches were conducted on PubMed, Web of Science, Cochrane Library and ClinicalTrials.gov to identify randomised controlled trials (RCTs) assessing the Hydrus or the iStent implantation combined with phacoemulsification for treatment of open-angle glaucoma until September 2020. Risk of bias was assessed using a six-item modified Jadad scale. Effects were estimated using the intraocular pressure (IOP) reduction (IOPR), the percentage of IOPR and the proportion of medication-free patients at follow-up end. Safety was estimated using the proportions of adverse events. The network meta-analysis was conducted within a Bayesian framework using the Markov Chain Monte Carlo method in ADDIS software.
RESULTS
Six prospective RCTs comprising 1397 patients were identified. Regarding the absolute value and the percentage of IOPR, the Hydrus and 2-iStent implantation combined with phacoemulsification were significantly more effective than phacoemulsification alone. Rank probability analysis revealed the Hydrus might be the best choice to lower IOP. There was no significant difference in the proportion of medication-free patients among groups. The Hydrus and 2-iStent implantation had a higher probability to achieve the medication-free status versus the 1-iStent implantation and phacoemulsification alone. Overall safety profiles were good for each device with the focal peripheral anterior synechiae more frequently reported in Hydrus eyes.
CONCLUSIONS
The Hydrus implantation may have a slight advantage over the 1-iStent or 2-iStent implantation in combination with phacoemulsification to treat open-angle glaucoma. Our findings might be of some uncertainty due to the limited included data. Further studies are needed to investigate whether our findings are robust, including high-quality RCTs to directly compare these MIGS devices.
Topics: Glaucoma Drainage Implants; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Network Meta-Analysis; Phacoemulsification; Stents
PubMed: 35705355
DOI: 10.1136/bmjopen-2021-051496 -
Survey of Ophthalmology 2022Intracameral phenylephrine is commonly used in ophthalmic surgery as an alternative or supplement to mydriatic eye drops; hence, the importance of an evidence-based... (Review)
Review
Intracameral phenylephrine is commonly used in ophthalmic surgery as an alternative or supplement to mydriatic eye drops; hence, the importance of an evidence-based understanding of its risk-benefit profile is vital. We performed a comprehensive search in the PubMed, Google Scholar, and Cochrane databases for published studies and case reports relating to the use of intracameral phenylephrine. Articles from 1958 to 2021 with the following keywords were used: "intracameral phenylephrine," "intracameral mydriatics," "phenylephrine," "pupil dilation," "complications." Intracameral phenylephrine was first used in 2003 as an alternative to topical mydriatics. Since then, it is being increasingly used with a variety of benefits, including rapid onset of mydriasis, and cost-effectiveness. There are various case reports, however, of ocular and systemic complications associated with intracameral phenylephrine such as generation of free radicals, toxic anterior segment syndrome, inconsistent pupillary dilation during surgery, and ventricular fibrillation. Alternatives to intracameral phenylephrine such as iris hooks, a Malyugin ring, intracameral epinephrine, and intracameral tropicamide were compared with intracameral phenylephrine. Intracameral phenylephrine appears to have a good safety profile.
Topics: Humans; Lidocaine; Mydriatics; Ophthalmic Solutions; Phacoemulsification; Phenylephrine; Pupil
PubMed: 35691387
DOI: 10.1016/j.survophthal.2022.06.002 -
European Journal of Ophthalmology Jan 2023To investigate differences in outcomes between active-fluidics and gravity-fluidics phacoemulsification systems. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate differences in outcomes between active-fluidics and gravity-fluidics phacoemulsification systems.
METHODS
We searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) published no later than December 1, 2021. The Cochrane Collaboration risk of bias tool was used for quality assessment. We presented the outcomes as standardized mean differences (SMDs) with 95% confidence intervals (CI). Sensitivity analysis was performed by removing studies that included ≥2 types of phacoemulsification tips.
RESULTS
We analyzed six RCTs that totally enrolled 884 patients. Patients undergoing lens extraction with active-fluidics systems exhibited lower cumulative dissipated energy (CDE), total aspiration time (TAT), and estimated fluid usage (EFU) compared with patients who did not (SMD [95% CI]: CDE, - 0.818 [ - 1.054 to - 0.582]; TAT, - 0.664 [ - 0.850 to - 0.479]; EFU, - 0.655 [ - 0.932 to - 0.378]). A sensitivity analysis revealed similar results for CDE, TAT, and EFU. For endothelial cell density (ECD) 1 week after surgery, ECD 1 month after surgery, and central corneal thickness (CCT) 1 week after surgery, outcomes of both systems were comparable (ECD at 1 week, 0.074 [ - 0.177 to 0.325]; ECD at 1 month, 0.069 [ - 0.167 to 0.305]; CCT 1 week after surgery, 0.077 [ - 0.173 to 0.328]). No severe adverse events in patients treated with either system were reported in the studies.
CONCLUSION
Active-fluidics systems are superior to gravity-fluidics systems with respect to CDE, TAT, and EFU; no differences in postoperative ECD and CCT were observed. Future studies are required to determine the reasons for heterogeneity and to detect rare adverse events.
Topics: Humans; Visual Acuity; Prospective Studies; Randomized Controlled Trials as Topic; Cataract Extraction; Phacoemulsification
PubMed: 35673714
DOI: 10.1177/11206721221107512 -
Seminars in Ophthalmology Aug 2022The purpose of this meta-analysis is to systematically compare the IOP-lowering effect of different microstents combined with phacoemulsification versus... (Meta-Analysis)
Meta-Analysis
Microstent Implantation with Phacoemulsification Versus Phacoemulsification Alone for Patients with Open Angle Glaucoma: A Systematic Review and Meta-Analysis of Randomised Clinical Trials.
PURPOSES
The purpose of this meta-analysis is to systematically compare the IOP-lowering effect of different microstents combined with phacoemulsification versus phacoemulsification for patients with OAG and cataract.
METHODS
This work was done through the data searched from PubMed, EMBASE, and the Cochrane Library. The Cochrane Handbook was also used to evaluate the quality of the included studies. In addition, this meta-analysis was performed using Revman 5.4 software.
RESULTS
A total of 8 randomized controlled trials (RCTs) were included. Compared with phacoemulsification alone, microstent implantation with phacoemulsification resulted in significant reduction in the postoperative IOP (MD = -1.66, 95%CI: [-2.25 to -1.06]). Patients with medication free and patients with beyond 20% IOP reduction were significantly increased in the microstent implantation with phacoemulsification group compared with phacoemulsification alone group (RR = 1.54, 95%CI: [1.34 to 1.77]; RR = 1.34, 95%CI: [1.24 to 1.45]).
CONCLUSION
Both microstent implantation with concurrent phacoemulsification and phacoemulsification alone result in a significant reduction in IOP. In terms of both reductions, microstent implantation with phacoemulsification significantly outperforms phacoemulsification alone.
Topics: Cataract; Cataract Extraction; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Phacoemulsification; Randomized Controlled Trials as Topic; Stents
PubMed: 35666616
DOI: 10.1080/08820538.2022.2086012 -
Annals of Palliative Medicine Apr 2022For patients with cataracts and retinopathy, phacoemulsification can improve the progress of the disease to a certain extent. However, the efficacy of... (Meta-Analysis)
Meta-Analysis
Efficacy and safety of phacoemulsification cataract surgery with prophylactic vitreous injection of bevacizumab in the treatment of retinopathy: a systematic review and meta-analysis.
BACKGROUND
For patients with cataracts and retinopathy, phacoemulsification can improve the progress of the disease to a certain extent. However, the efficacy of phacoemulsification alone is often not ideal, and may even aggravate the prognostic effects, such as macular edema and slow visual recovery. Thus, an increasing number of clinicians have explored comprehensive therapy involving phacoemulsification combined with drug therapy, which has led to some research progress. However, there is still great controversy about the combined treatment. In this study, we performed a literature meta-analysis to systematically evaluate the clinical efficacy and safety of prophylactic intravitreal injection of bevacizumab combined with phacoemulsification for the treatment of cataracts complicated with retinopathy.
METHODS
We searched the PubMed, Web of Science, Embase, and MEDLINE databases for English language papers related to these studies factors published between January 2001 and January 2021. The retrieved articles were screened and the quality of the included studies was evaluated. Meta-analysis was performed and RevMan5.3 was used to calculate the enhanced mean difference (MD).
RESULTS
Six articles were finally included in this meta-analysis, involving a total of 325 cases with cataracts and retinopathy. The results showed that the best-corrected visual acuity at 1 month [MD =-0.06; 95% confidence interval (CI): (-0.09, -0.03); P=0.0002] and 3 months [MD =-0.09; 95% CI: (-0.11, -0.07); P<0.00001] in the preventive vitreous injection bevacizumab intervention group were significantly better than those of the control group (P<0.1). However, the best-corrected visual acuity at 6 months [MD =-0.02; 95% CI: (-0.07, 0.03); P=0.39] was not significantly different between these two groups (P>0.05). In addition, the central macular thickness of the preventive vitreous injection bevacizumab intervention group at 1 month after treatment [MD =-37.07; 95% CI: (-45.87, -28.27); P<0.00001], 3 months [MD =-15.26; 95% CI: (-23.87, -6.66); P=0.0005], and 6 months [MD =-26.77; 95% CI: (-37.51, -16.04); P<0.00001] were significantly different to the control group (P<0.05).
DISCUSSION
The results of this study showed that prophylactic intravitreal injection of bevacizumab combined with phacoemulsification is a safe and effective treatment for patients with cataracts and retinopathy within 6 months after treatment.
Topics: Bevacizumab; Cataract; Diabetic Retinopathy; Humans; Phacoemulsification; Visual Acuity
PubMed: 35523750
DOI: 10.21037/apm-22-222 -
Eye (London, England) Apr 2023The XEN45 Gel Stent is a subconjunctival filtering device that has demonstrated promising efficacy. This meta-analysis quantitatively evaluates reported complications... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The XEN45 Gel Stent is a subconjunctival filtering device that has demonstrated promising efficacy. This meta-analysis quantitatively evaluates reported complications and interventions after XEN45 implantation in the treatment of open angle glaucoma (OAG).
METHODS
Pilot, cohort, observational studies, and randomised controlled trials that included at least ten patients undergoing ab interno or externo XEN45 surgery, with or without phacoemulsification were deemed eligible for inclusion. A meta-analysis of proportions with random-effect models was performed using the meta routine in R version 3.2.1. Outcomes included the rate of complications and post-operative interventions.
RESULTS
One hundred and fifty-two studies were identified on initial literature search and 33 were included in final analysis. Numerical hypotony was the most common post-operative complication, involving 20% of patients (95% CI: 10-31%). Post-operative gross hyphema occurred in 14% (95% CI: 7-22%) and transient intra-ocular pressure (IOP) spikes (>30 mmHg) in 13% (95% CI: 4-27%). Stent exposure occurred in 1% (95% CI: 0-2%). Stent migration occurred in 1% (95% CI: 0-3%). XEN45 revision and/or a second XEN45 implantation was performed in 5% of patients (95% CI: 3-7%). Stent relocation was performed in 3% (95% CI: 1-7%). A second glaucoma procedure was performed in 11% (95% CI: 8-15%). 26% underwent one (95% CI: 17-36%), 13% underwent two (95% CI: 5-24%) while 4% underwent three (95% CI: 2-6%) bleb needling procedures. 35% of patients (95% CI: 29-40%) required at least one needling. The average rate of needling per patient was 0.38 (95% CI: 0.20-0.59). However, there is a lack of high-quality data, with 8 of the 33 studies assessed to have a moderate to high risk of bias.
CONCLUSIONS
While literature suggests that XEN45 Gel Stent implantation is safe in the treatment of OAG, the overall current level of evidence is low and further studies are needed. More than a third of patients require at least one post-operative bleb needling procedure.
Topics: Humans; Glaucoma, Open-Angle; Blister; Treatment Outcome; Glaucoma; Intraocular Pressure; Glaucoma Drainage Implants; Stents; Retrospective Studies
PubMed: 35347294
DOI: 10.1038/s41433-022-02022-5 -
Computer Assisted Surgery (Abingdon,... Dec 2022To explore the effect of image-guided systems in phacoemulsification with intraocular lens (IOL) implantation. (Meta-Analysis)
Meta-Analysis
PURPOSE
To explore the effect of image-guided systems in phacoemulsification with intraocular lens (IOL) implantation.
METHODS
We searched Pubmed, Embase and China National Knowledge Infrastructure (inception to January 20, 2021). Two researchers extracted data and assessed paper quality independently. Uncorrected distance visual acuity (UDVA) before and after surgery, best corrected visual acuity (BCVA) before and after surgery, preoperative cylinder, postoperative residual refractive cylinder, postoperative corneal cylinder, IOL misalignment, and intraocular pressure (IOP) were compared.
RESULTS
We included 14 studies with 885 cataract eyes. All data were performed using Review Manager 5.3 (RevMan 5.3) (https://revman.cochrane.org/). Cases of all preoperative outcomes showed no significant difference between image-guided group and manual group. There was no significant difference in postoperative UDVA (Standard mean difference (SMD: -0.11, 95% CI: -0.32 to 0.11, = 59%, = 0.33)), BCVA (SMD: 0.03, 95% CI: -0.12 to 0.18, = 36%, = 0.72), corneal cylinder (Weighted mean difference WMD: 0.13, 95% CI: -0.06 to -0.32, = 0%, = 0.17), IOP (WMD: -0.37, 95% CI: -1.36 to -0.62, = 9%, = 0.46) between two groups. There was less residual refractive cylinder in image-guided group than in manual group (WMD: -0.20, 95% CI: -0.26 to -0.14, = 59%, <0.00001). It is more accurate in IOL alignment when combined with image-guided systems (WMD: -1.20, 95% CI: -1.43 to -0.96, = 14%, < 0.00001).
CONCLUSION
Image-guided systems can improve the effect in phacoemulsification with intraocular lens (IOL) implantation.
Topics: Astigmatism; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Phacoemulsification; Visual Acuity
PubMed: 35313122
DOI: 10.1080/24699322.2022.2047787