-
Clinical Ophthalmology (Auckland, N.Z.) 2024Cataract surgery is one of the most frequently performed eye surgeries worldwide, and among several techniques, phacoemulsification has become the standard of care due... (Review)
Review
BACKGROUND
Cataract surgery is one of the most frequently performed eye surgeries worldwide, and among several techniques, phacoemulsification has become the standard of care due to its safety and efficiency. We evaluated the advantages and disadvantages of two phacoemulsification techniques: phaco-chop and divide-and-conquer.
METHODS
PubMed, Cochrane, Embase, and Web of Science databases were queried for randomized controlled trial (RCT), prospective and retrospective studies that compared the phaco-chop technique over the divide-and-conquer technique and reported the outcomes of (1) Endothelial cell count change (ECC); (2) Ultrasound time (UST); (3) Cumulated dissipated energy (CDE); (4) Surgery time; and (5) Phacoemulsification time (PT). Heterogeneity was examined with I statistics. A random-effects model was used for outcomes with high heterogeneity.
RESULTS
Nine final studies, (6 prospective RCTs and 3 observational), comprising 837 patients undergoing phacoemulsification. 435 (51.9%) underwent the phaco-chop technique, and 405 (48.1%) underwent divide-and-conquer. Overall, the phaco-chop technique was associated with several advantages: a significant difference in ECC change postoperatively (Mean Difference [MD] -221.67 Cell/mm; 95% Confidence Interval [CI] -401.68 to -41.66; p < 0.02; I2=73%); a shorter UST (MD -51.16 sec; 95% CI -99.4 to -2.79; p = 0.04; I2=98%); reduced CDE (MD -8.68 units; 95% CI -12.76 to -4.60; p < 0.01; I2=84%); a lower PT (MD -55.09 sec; 95% CI -99.29 to -12.90; = 0.01; I2=100). There were no significant differences in surgery time (MD -3.86 min; 95% CI -9.55 to 1.83; p = 0.18; I2=99%).
CONCLUSION
The phaco-chop technique proved to cause fewer hazards to the corneal endothelium, with less delivered intraocular ultrasound energy when compared to the divide-and-conquer technique.
PubMed: 38827775
DOI: 10.2147/OPTH.S463525 -
Journal of Cataract and Refractive... May 2024Rotational stability is key for optimizing postoperative visual outcomes as even a small degree of rotation of a toric intraocular lens (IOL) from its target axis can...
Rotational stability is key for optimizing postoperative visual outcomes as even a small degree of rotation of a toric intraocular lens (IOL) from its target axis can result in a significant reduction of astigmatic correction. This systematic review and meta-analysis evaluated the rotational stability of toric IOLs of different lens models and haptic designs. All published studies and clinical trials that investigate postoperative rotation of toric IOLs were searched and evaluated. Quality of studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS) scale. A single-arm meta-analysis was performed in R4.3.1 software with subgroup analysis performed based on lens model and haptic design. Fifty-one published studies of 4863 eyes were included in the meta-analysis. The pooled mean absolute rotation of all toric IOLs was 2.36° (95% CI: 2.08-2.64). Postoperative rotation is dependent on many aspects of lens material and design. Modern commercially available toric IOLs exhibit exceptional rotational stability.
PubMed: 38768060
DOI: 10.1097/j.jcrs.0000000000001486 -
World Journal of Gastrointestinal... Apr 2024The quality-adjusted life year (QALY) is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments...
BACKGROUND
The quality-adjusted life year (QALY) is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures. Surgical waiting lists (SWLs) represent a pressing problem in public healthcare. The QALY measure has rarely been used in the context of surgery. It would be interesting to know how many QALYs are lost by patients on SWLs.
AIM
To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature.
METHODS
The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. An unlimited search was carried out in PubMed, updated on January 19, 2024. Data on the following variables were investigated and analyzed: Specialty, country of study, procedure under study, scale used to measure QALYs, the use of a theoretical or real-life model, objectives of the study and items measured, the economic value assigned to the QALY in the country in question, and the results and conclusions published.
RESULTS
Forty-eight articles were selected for the study. No data were found regarding QALYs lost on SWLs. The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery, with 15 articles each. The country in which the most studies of QALYs were carried out was the United States ( = 21), followed by the United Kingdom ( = 9) and Canada ( = 7). The most studied procedure was organ transplantation ( = 39), including 15 kidney, 14 liver, 5 heart, 4 lung, and 1 intestinal. Arthroplasty ( = 4), cataract surgery ( = 2), bariatric surgery ( = 1), mosaicplasty ( = 1), and septoplasty ( = 1) completed the surgical interventions included. Thirty-nine of the models used were theoretical (the most frequently applied being the Markov model, = 34), and nine were real-life. The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions, but in 32 articles the survey was not specified. The willingness-to-pay per QALY gained ranged from $100000 in the United States to €20000 in Spain.
CONCLUSION
The relationship between QALYs and SWLs has only rarely been studied in the literature. The rate of QALYs lost on SWLs has not been determined. Future research is warranted to address this issue.
PubMed: 38690041
DOI: 10.4240/wjgs.v16.i4.1155 -
American Journal of Ophthalmology Apr 2024
PubMed: 38685524
DOI: 10.1016/j.ajo.2024.02.040 -
American Journal of Ophthalmology Apr 2024To assess the incidence of secondary glaucoma in children following congenital cataract surgery. (Review)
Review
PURPOSE
To assess the incidence of secondary glaucoma in children following congenital cataract surgery.
DESIGN
Systematic review and meta-analysis.
METHODS
The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception through March 16, 2023. Studies reporting congenital cataract surgery and glaucoma were enrolled. The quality of the selected studies was assessed using the Newcastle Ottawa Scale, and data analysis was executed utilizing R software.
RESULTS
A total of 36 published studies with 3151 patients (4717 eyes) were included in the analysis. The incidence rate of glaucoma following congenital cataract surgery was 6.6% (95% CI: 3.9%, 9.9%). The incidence of secondary glaucoma in the primary intraocular lens (IOL) implantation group (3.3% [95% CI: 1.5%, 5.8%]) and the secondary IOL implantation group (3.5% [95% CI: 0%, 11.4%]) were lower compared to the aphakia group (13.5% [95% CI: 7.7%, 20.6%]). The incidence rate among children with congenital cataracts from Asia (6.9% [95% CI: 4.1%, 10.4%]) was higher than that in European children (0.9% [95% CI: 0%, 3.0%]; P < .01). A correlation was identified between the age at cataract surgery and the incidence of secondary glaucoma (P = .02).
CONCLUSIONS
This meta-analysis found that the incidence of secondary glaucoma following congenital cataract surgery is approximately 6.6%. Children with IOL implantation exhibit a lower incidence of secondary glaucoma, with a lower incidence noted in European children compared to their Asian counterparts. The age at cataract surgery is an important risk factor to consider.
PubMed: 38679355
DOI: 10.1016/j.ajo.2024.04.021 -
American Journal of Ophthalmology Apr 2024
PubMed: 38663503
DOI: 10.1016/j.ajo.2024.04.012 -
Arquivos Brasileiros de Oftalmologia 2024Visual impairment and blindness caused by cataracts are major public health problems. Several factors are associated with an increased risk of age-related cataracts,... (Meta-Analysis)
Meta-Analysis
PURPOSE
Visual impairment and blindness caused by cataracts are major public health problems. Several factors are associated with an increased risk of age-related cataracts, such as age, smoking, alcohol consumption, and ultraviolet radiation. This meta-analysis aimed to assess the association between body mass index and age-related cataracts.
METHODS
Studies on weight and age-related cataracts published from January 2011 to July 2020 were reviewed by searching PubMed, Medline, and Web of Science databases. The random-effects and fixed-effects models were used for the meta-analysis, and the results were reported as odd ratios.
RESULTS
A total of nine studies were included in the meta-analysis. No correlation was found between underweight and nuclear cataracts (OR=1.31, 95% CI [-0.50 to 3.12], p=0.156). The results of the random-effects model showed that overweight was significantly associated with age-related cataracts and reduced the risk of age-related cataracts (OR=0.91, 95% CI [0.80-1.02], p<0.0001; I2=62.3%, p<0.0001). Significant correlations were found between overweight and cortical, nuclear, and posterior subcapsular cataracts (OR=0.95, 95% CI [0.66-1.24], p<0.0001; OR=0.92, 95% CI (0.76-1.08), p<0.0001; OR=0.87, 95% CI [0.38-1.02], p<0.0001). Significant correlations were found between obesity and cortical, nuclear, and posterior subcapsular cataracts (OR=1.00, 95% CI [0.82-1.17], p<0.0001; OR=1.07, 95% CI [0.92-1.22], p<0.0001; OR=1.14, 95% CI [0.91-1.37], p<0.0001).
CONCLUSION
This finding suggested a significant correlation between body mass index and age-related cataracts, with overweight and obesity reducing or increasing the risk of age-related cataracts, respectively.
Topics: Humans; Age Factors; Body Mass Index; Cataract; Obesity; Overweight; Risk Factors
PubMed: 38656018
DOI: 10.5935/0004-2749.2021-0382 -
Taiwan Journal of Ophthalmology 2024Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable... (Review)
Review
Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable alternative to penetrating keratoplasty (PK). This systematic review explores the intricacies of DALK, comparing its preoperative, intraoperative, and postoperative considerations with PK. Extensive literature searches revealed a wealth of data regarding DALK's advantages and challenges, with an emphasis on graft survival, visual outcomes, and complications. In the preoperative phase, DALK showcases its versatility, catering to a wide spectrum of patients, including those with KC and ocular surface disorders. Intraoperatively, it offers innovative techniques to address emphysema, bubble formation, and Descemet's membrane perforation, all while maintaining a strong focus on patient-centered outcomes. Postoperatively, DALK's lower rejection rates and decreased complications underscore its potential superiority over PK, although unique challenges such as graft failure from nonimmunologic factors demand vigilant management. This comprehensive review not only serves as a valuable resource for ophthalmic surgeons but also sheds light on the evolving landscape of corneal transplantation, highlighting DALK's role as a transformative force in the field.
PubMed: 38654987
DOI: 10.4103/tjo.TJO-D-23-00175 -
Survey of Ophthalmology 2024We assessed risk factors for complications associated with resident-performed cataract surgery. Using the Preferred Reporting Items for Systematic reviews and... (Review)
Review
We assessed risk factors for complications associated with resident-performed cataract surgery. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched 4databases in September, 2023. We included peer-reviewed, full-text, English-language articles assessing risk factors for complications in resident performed cataract surgery. We excluded studies describing cataract surgeries performed by fellows, combined surgeries, and studies with insufficient information. Our initial search yielded 6244 articles; 15 articles were included after title/abstract and full-text review. Patient-related risk factors included older age, hypertension, prior vitrectomy, zonular pathology, pseudoexfoliation, poor preoperative visual acuity, small pupils, and selected types of cataracts. Surgeon-related risk factors included resident postgraduate year and surgeon right-handedness. Other risk factors included absence of supervision, long phacoemulsification time, and phacoemulsification with high power and torsion. The quality of the studies was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation; most studies graded as moderate, primarily due to risk of bias. When assigning cases to residents, graduate medical educators should consider general and resident-specific risk factors to facilitate teaching and preserve patient safety.
Topics: Humans; Internship and Residency; Risk Factors; Ophthalmology; Clinical Competence; Postoperative Complications; Cataract Extraction; Education, Medical, Graduate; Intraoperative Complications
PubMed: 38648911
DOI: 10.1016/j.survophthal.2024.04.002 -
Indian Journal of Ophthalmology May 2024Age is an important risk factor for both glaucoma and cataract. As global life expectancy continues to rise, the prevalence of concomitant open-angle glaucoma (OAG) and... (Comparative Study)
Comparative Study
Age is an important risk factor for both glaucoma and cataract. As global life expectancy continues to rise, the prevalence of concomitant open-angle glaucoma (OAG) and cataracts is increasing. Currently, there is a lack of definitive consensus on the optimal management approach for such individuals. Conventionally, trabeculectomy (Trab) in combination with phacoemulsification is the preferred method. Recent developments in microinvasive glaucoma surgery (MIGS), which offer similar results with fewer complications, provide a new possible approach to this condition. This study aimed to assess the current knowledge of combination surgery in patients with cataract and OAG to provide a comprehensive understanding and help its implementation in clinical settings. A comprehensive systematic search was conducted in May 2021 on five databases (MEDLINE, Embase, SCOPUS, Proquest, EBSCO, and Cochrane Library). The results were filtered for English and human studies but not publication year. All studies published up to May 2021 were reviewed. Newcastle-Ottawa Scale and PEDro scale were used to screen studies for risk of bias where appropriate. Four studies satisfied the inclusion criteria and were subsequently added in this review. Study designs consisted of one RCT and three descriptive studies. Appropriate assessment tools were used; these studies demonstrated moderate to good quality. Postoperative mean IOP, IOP reduction, and qualified success rates were comparable in the Phaco-MIGS (Phaco-endoscopic cyclophotocoagulation (ECP), Phaco-ab interno trabeculectomy (AIT)) and Phaco-Trab group. Severe complication was reported only in the latter. Phaco-MIGS (in particular, trabectome) shows excellent promise as an option for individuals with OAG and concomitant cataract; further research through RCT is required to validate these findings.
Topics: Humans; Glaucoma, Open-Angle; Trabeculectomy; Cataract; Intraocular Pressure; Visual Acuity
PubMed: 38648451
DOI: 10.4103/IJO.IJO_1322_23