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Acta Ophthalmologica Feb 2022Osteogenesis imperfecta (OI) is a rare inherited heterogeneous connective tissue disorder characterized by bone fragility, low bone mineral density, skeletal deformity...
PURPOSE
Osteogenesis imperfecta (OI) is a rare inherited heterogeneous connective tissue disorder characterized by bone fragility, low bone mineral density, skeletal deformity and blue sclera. The dominantly inherited forms of OI are predominantly caused by mutations in either the COL1A1 or COL1A2 gene. Collagen type I is one of the major structural proteins of the eyes and therefore is the eye theoretically prone to alterations in OI. The aim of this systematic review was to provide an overview of the known ocular problems reported in OI.
METHODS
A literature search (in PubMed, Embase and Scopus), which included articles from inception to August 2020, was performed in accordance with the PRISMA guidelines.
RESULTS
The results of this current review show that almost every component of the eye could be affected in OI. Decreased thickness of the cornea and sclera is an important factor causing eye problems in patients with OI such as blue sclera. Findings that stand out are ruptures, lacerations and other eye problems that occur after minor trauma, as well as complications from standard surgical procedures.
DISCUSSION
Alterations in collagen type I affect multiple structural components of the eye. It is recommended that OI patients wear protective glasses against accidental eye trauma. Furthermore, when surgery is required, it should be approached with caution. The prevalence of eye problems in different types of OI is still unknown. Additional research is required to obtain a better understanding of the ocular defects that may occur in OI patients and the underlying pathology.
Topics: Blindness; Collagen Type I; Eye Diseases; Humans; Mutation; Osteogenesis Imperfecta; Phenotype; Risk Factors
PubMed: 34009739
DOI: 10.1111/aos.14882 -
Asia-Pacific Journal of Ophthalmology... Jan 2021We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and...
PURPOSE
We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome.
DESIGN
Systematic review.
METHODS
We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes.
RESULTS
Our search yielded 217 papers. After removing duplicated and irrelevant reports, we included 57 articles involving 2624 eyes. The mean age at operation was 51.47 ± 25.62 years. Sutured SFIOL was most commonly reported in all subjects with Marfan syndrome and 92.87% of pediatric patients. The pooled intraoperative complication rate was 6.65%. Minor anterior chamber hemorrhage was the most common intraoperative (1.92%) and postoperative complication (13.93%). Optic capture was the top intraocular lens (IOL)-related complication (4.47%). The overall mean endothelial cell loss was 8.95% at 16.77 ± 11.04 months. Overall 11.99% of SFIOLs were decentred with a mean distance of 0.49 ± 0.40 mm and a mean degree of tilt by 4.11 ± 3.03°.
CONCLUSIONS
Glued SFIOL had the fewest IOL-related complications and the lowest endothelial cell loss. Sutured SFIOL carried the highest IOL-related complications, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.
Topics: Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Postoperative Complications; Retrospective Studies; Sclera; Suture Techniques; Visual Acuity
PubMed: 33481393
DOI: 10.1097/APO.0000000000000369 -
The Cochrane Database of Systematic... Aug 2020Primary congenital glaucoma (PCG) is an optic neuropathy with high intraocular pressure (IOP) that manifests within the first few years of a child's life and is not... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Primary congenital glaucoma (PCG) is an optic neuropathy with high intraocular pressure (IOP) that manifests within the first few years of a child's life and is not associated with other systemic or ocular abnormalities. PCG results in considerable morbidity even in high-income countries.
OBJECTIVES
To compare the effectiveness and safety of different surgical techniques for PCG.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2020, Issue 4); Ovid MEDLINE; Embase.com; PubMed; metaRegister of Controlled Trials (mRCT) (last searched 23 June 2014); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search. We last searched the electronic databases on 27 April 2020.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) and quasi-RCTs comparing different surgical interventions in children under five years of age with PCG.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodology.
MAIN RESULTS
We included 16 trials (13 RCTs and three quasi-RCTs) with 587 eyes in 446 children. Eleven (69%) trials were conducted in Egypt and the Middle East, three in India, and two in the USA. All included trials involved children younger than five years of age, with follow-up ranging from six to 80 months. The interventions compared varied across trials. Three trials (on 68 children) compared combined trabeculotomy and trabeculectomy (CTT) with trabeculotomy. Meta-analysis of these trials suggests there may be little to no evidence of a difference between groups in mean IOP (mean difference (MD) 0.27 mmHg, 95% confidence interval (CI) -0.74 to 1.29; 88 eyes; 2 studies) and surgical success (risk ratio (RR) 1.01, 95% CI 0.90 to 1.14; 102 eyes; 3 studies) at one year postoperatively. We assessed the certainty of evidence as very low for these outcomes, downgrading for risk of bias (-1) and imprecision (-2). Hyphema was the most common adverse outcome in both groups (no meta-analysis due to considerable heterogeneity; I = 83%). Two trials (on 39 children) compared viscotrabeculotomy to conventional trabeculotomy. Meta-analysis of 42 eyes suggests there is no evidence of between groups difference in mean IOP (MD -1.64, 95% CI -5.94 to 2.66) and surgical success (RR 1.11, 95% CI 0.70 to 1.78) at six months postoperatively. We assessed the certainty of evidence as very low, downgrading for risk of bias and imprecision due to small sample size. Hyphema was the most common adverse outcome (38% in viscotrabeculotomy and 28% in conventional trabeculotomy), with no evidence of difference difference (RR 1.33, 95% CI 0.63 to 2.83). Two trials (on 95 children) compared microcatheter-assisted 360-degree circumferential trabeculotomy to conventional trabeculotomy. Meta-analysis of two trials suggests that mean IOP may be lower in the microcatheter group at six months (MD -2.44, 95% CI -3.69 to -1.19; 100 eyes) and at 12 months (MD -1.77, 95% CI -2.92 to -0.63; 99 eyes); and surgical success was more likely to be achieved in the microcatheter group compared to the conventional trabeculotomy group (RR 1.59, 95% CI 1.14 to 2.21; 60 eyes; 1 trial at 6 months; RR 1.54, 95% CI 1.20 to 1.97; 99 eyes; 2 trials at 12 months). We assessed the certainty of evidence for these outcomes as moderate due to small sample size. Hyphema was the most common adverse outcome (40% in the microcatheter group and 17% in the conventional trabeculotomy group), with greater likelihood of occurring in the microcatheter group (RR 2.25, 95% CI 1.25 to 4.04); the evidence was of moderate certainty due to small sample size (-1). Of the nine remaining trials, no two trials compared the same two surgical interventions: one trial compared CTT versus CTT with sclerectomy; three trials compared various suturing techniques and adjuvant use including mitomycin C, collagen implant in CTT; one trial compared CTT versus Ahmed valve implant in previously failed surgeries; one trial compared CTT with trabeculectomy; one trial compared trabeculotomy to goniotomy; and two trials compared different types of goniotomy. No trials reported quality of life or economic data. Many of the included trials had limitations in study design, implementation, and reporting, therefore the reliability and applicability of the evidence remains unclear.
AUTHORS' CONCLUSIONS
The evidence suggests that there may be little to no evidence of difference between CTT and routine conventional trabeculotomy, or between viscotrabeculotomy and routine conventional trabeculotomy. A 360-degree circumferential trabeculotomy may show greater surgical success than conventional trabeculotomy. Considering the rarity of the disease, future research would benefit from a multicenter, possibly international trial, involving parents of children with PCG and with a follow-up of at least one year.
Topics: Child, Preschool; Glaucoma; Glaucoma Drainage Implants; Humans; Hyphema; Infant; Infant, Newborn; Intraocular Pressure; Mitomycin; Postoperative Complications; Randomized Controlled Trials as Topic; Sclera; Trabecular Meshwork; Trabeculectomy; Treatment Outcome
PubMed: 32816311
DOI: 10.1002/14651858.CD008213.pub3 -
PloS One 2020High myopia is a sight-threatening disease that causes axial length elongation and severe complications. Data on the benefits of posterior scleral reinforcement surgery... (Meta-Analysis)
Meta-Analysis
BACKGROUND
High myopia is a sight-threatening disease that causes axial length elongation and severe complications. Data on the benefits of posterior scleral reinforcement surgery in myopia control have been conflicting. The purpose of this study was to explore the treatment effect and complications of posterior scleral reinforcement in the treatment of myopia.
METHODS
Articles were retrieved for relevant studies from inception to July 24, 2019, by PubMed, EMBASE, and Ovid. Analyses were conducted to compare the treatment effects of controlling spherical equivalent refraction and axial length elongation. The weighted mean difference and Hedges' adjusted g were used to evaluate the treatment effects, with a random-effects model. Heterogeneity was quantified using I2 statistic and explored by subgroup analysis. Publication bias was addressed by funnel plots and Egger's test.
RESULTS
A total of 11 articles were included in this meta-analysis. On estimating the treatment effect, the mean differences of myopia progression and axial length changes between surgery and control groups were 0.41 diopters per year (95% CI 0.21 to 0.61; P < .001) and -0.17 mm per year (95% CI -0.22 to -0.11; P < .001). Subgroup analysis showed significant treatment effects of the single wide strip operation. Single-arm meta-analysis showed less annual axial elongation in children subgroup. These results were robust by sensitivity analysis. The incidence of some major complications in the operation group were significantly greater (5.8% vs 2.7% for myopic degeneration; 2.3% vs 1.6% for macular hemorrhage; 0.8% vs 0 for retinal detachment).
CONCLUSION
Posterior scleral reinforcement may be an effective surgery on controlling myopia progression by slowing both refraction and axial length change. However, frequent surgical complications should be considered. Further well-designed studies are needed to determine the long-term safety and efficacy.
Topics: Axial Length, Eye; Disease Progression; Female; Humans; Male; Myopia; Myopia, Degenerative; Ophthalmologic Surgical Procedures; Refraction, Ocular; Retinal Detachment; Sclera; Visual Acuity
PubMed: 32453804
DOI: 10.1371/journal.pone.0233564 -
Ophthalmic Research 2021Scleral and iris fixation of intraocular lenses (IOL) are useful in the treatment of surgical or traumatic aphakia, luxation, and subluxation of IOL if the patient does...
Scleral and iris fixation of intraocular lenses (IOL) are useful in the treatment of surgical or traumatic aphakia, luxation, and subluxation of IOL if the patient does not present appropriate capsular support. However, there is no consensus in the literature about which of these 2 methods is safer and better. The authors performed a literature review searching the main postoperative outcomes obtained with the use of each surgical method. Scleral and iris fixation of IOL are efficient in correction of the patients' visual acuity, even though each technique presents distinct complications which depend especially on the experience of the surgeon with the performed surgical method. It is important to understand that individuals submitted to scleral or iris fixation present previous preoperative complications in their eyes. Besides, both procedures are very complex, involving intense manipulation of the eye globe. The success rate of these surgical techniques is highly variable and has a close relation to the preoperative conditions of the patient's eye and the improvement of the surgeon's learning curve.
Topics: Humans; Iris; Lens Diseases; Lens Implantation, Intraocular; Lenses, Intraocular; Sclera; Suture Techniques; Visual Acuity
PubMed: 32163944
DOI: 10.1159/000507120 -
Ophthalmic Research 2020Myopia, especially high myopia, would cause damage in the choroid, retina and sclera, thereby leading to vision loss. Although refractive error correction can help... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Myopia, especially high myopia, would cause damage in the choroid, retina and sclera, thereby leading to vision loss. Although refractive error correction can help improve visual acuity, the pathology of myopia, a global issue, remains unclear and myopia progression, as well as concomitant fundus progression, remains uncontrolled. Under such circumstances, prevention of myopia is of great significance and thus should be prioritized.
OBJECTIVE
To explore whether outdoor time has positive significance for myopia prevention.
SEARCH METHODS
Databases of Pubmed, Science Direct, the Cochrane Library, the Chinese National Knowledge Infrastructure and the Wanfang Database were searched. The following terms or their combinations were used: myopia, prevention, control, random, randomized, randomization, intervention, outdoor. The full search strategy was shown in the Appendix below. The databases were last searched on -October 24, 2018.
SELECTION CRITERIA
Randomized controlled trials (RCTs) that participants accepted outdoor activity as an intervention measure for myopia prevention were included.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed the risk of bias for included studies. A fixed-effects model was applied, given that the heterogeneity among included studies was small.
MAIN RESULTS
Five RCTs with 3,014 subjects were included. Subjects' age ranged from 6 to 12 years, and the follow-up duration ranged from 9 to 36 months. Spherical equivalent error (SER) of the outdoor group was larger than that of the control group, and the pooled mean difference (MD) was 0.15 (95% CI 0.06-0.23) diopter (D). The change in SER of the outdoor group was smaller than that of the control group, with a pooled MD of 0.17 (95% CI 0.16-0.18) D. New myopia cases in the outdoor group were fewer than that of the control group, and the pooled risk ratio was 0.76 (95% CI 0.67-0.87). The change in axial length of the outdoor group was smaller than that of the control group, and the pooled MD was -0.03 (95% CI -0.03 to -0.03) mm. For all analyzed outcomes, there was no heterogeneity across included studies (I2 = 0%) and there was no publication bias either.
CONCLUSION
Outdoor time helps slow down the change of axial length and reduce the risk of myopia.
Topics: Humans; Myopia; Randomized Controlled Trials as Topic; Seasons; Time Factors; Visual Acuity
PubMed: 31430758
DOI: 10.1159/000501937