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The Cochrane Database of Systematic... Nov 2023Macular holes cause severe impairment of sight. With the aim of improving the outcome of surgery for macular holes, particularly larger macular holes (those measuring... (Review)
Review
BACKGROUND
Macular holes cause severe impairment of sight. With the aim of improving the outcome of surgery for macular holes, particularly larger macular holes (those measuring over 400 μm), a variable period of face-down positioning may be advised. This review is an update of a Cochrane Review published in 2011.
OBJECTIVES
To evaluate the effect of postoperative face-down positioning on the outcome of surgery for macular hole.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2022, Issue 5), which contains the Cochrane Eyes and Vision Trials Register, Ovid MEDLINE, Ovid Embase, the ISRCTN registry, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. There were no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 May 2022.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) in which postoperative face-down positioning was compared to no face-down positioning following surgery for macular holes. The primary outcome of interest was closure of the macular hole. Other outcomes of interest included visual outcomes, quality of life outcomes, and the occurrence of adverse events. Pairs of review authors independently selected studies for inclusion, extracted data, assessed risk of bias, and evaluated the certainty of evidence using GRADE.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. We analysed dichotomous data as risk ratios (RRs), and continuous data as mean differences (MDs), with 95% confidence intervals (CI). The unit of analysis was eyes.
MAIN RESULTS
We included eight studies allocating a total of 709 eyes (699 participants). There was heterogeneity in study design, including the control group treatment (from no positioning to strict maintenance of other 'face-forward' postures) and surgical procedures (with or without inner limiting membrane peeling, with or without cataract surgery). There were also different durations of positioning, with two studies using 3 days, two studies using 5 days, and three studies using 10 days of face-down positioning. Whilst the overall risk of bias was low, all included studies were judged to be at high or unclear risk of bias due to absence of assessment of adherence to the 'prescribed' intervention of face-down positioning or posturing. The primary outcome of successful anatomical hole closure at one to six months following surgery was reported in 95 of every 100 eyes of participants advised to position face-down for at least three days after surgery, and in 85 of every 100 eyes of participants not advised to position face-down (RR 1.05, 95% CI 0.99 to 1.12, 709 eyes, 8 studies, I² = 44%). Amongst the 327 eyes of participants with macular holes of at least 400 μm, hole closure was noted in 94 of every 100 eyes of participants advised to position face-down, and in 84 of every 100 eyes of participants not advised to position face-down (RR 1.08, 95% CI 0.93 to 1.26, 5 studies, I² = 62%). Amongst the 129 eyes of participants with macular holes of less than 400 μm, hole closure was noted in 100 of every 100 eyes of participants advised to position face-down, and in 96 of every 100 eyes of participants not advised to position face-down (RR 1.03, CI 0.97 to 1.11, 4 studies, I² = 0%). The certainty of the evidence was low, downgraded for imprecision (CIs including no effect) and study design limitations (with different durations of face-down posturing used in the absence of a dose-response gradient, and limitations in measuring the exposure). Meta-analysis of visual acuity data was challenging given the use of different definitions of postoperative visual outcome across studies. Three studies reported findings by gain in Early Treatment Diabetic Retinopathy Study (ETDRS) letters (MD 2.04, 95% CI -0.01 to 4.09, very low-certainty evidence). Meta-analyses of quality of life data were not possible because of inconsistency in outcome metrics across studies. One study reported no difference between groups in quality of life, as reported on a validated quality of life metric scale (the National Eye Institute Visual Function Questionnaire - 25 (NEI VFQ-25), between face-down positioning for five days and non-face-down positioning (median NEI VFQ-25 score was 89 (interquartile range (IQR) 76 to 94) in the face-down group versus 87 (IQR 73 to 93) in the non-face-down group (adjusted mean difference on a logistic scale 0.02, 95% CI -0.03 to 0.07, P = 0.41)). Two studies reported increased ease of positioning and less pain in non-face-down positioning groups on non-validated 0-to-10-point visual analogue scores. On an ease-of-positioning score running from 0 (very difficult) to 10 (very easy), there were consistent reports of the discomfort associated with face-down positioning: the median participant-reported ease-of-positioning score was 6 (IQR 4 to 8) in those undergoing 5 days of face-down positioning versus 9 (IQR 7 to 10) in the comparator group (P = 0.01). On a pain score with 0 being pain-free and 10 being in severe pain, mean pain score was 6.52 ± 2.48 in the face-down positioning group versus 2.53 ± 2.6 in the non-face-down positioning group. The adverse event of postoperative nerve compression occurred in less than 1 in every 100 (3 per 1000) participants advised to position face-down, and 0 in every 100 participants not advised to position face-down (699 participants, 8 studies, moderate-certainty evidence).
AUTHORS' CONCLUSIONS
We identified eight RCTs evaluating face-down positioning following surgery for macular hole. The included studies were not all directly comparable due to differences in the surgical techniques used and the durations of postoperative positioning advised. Low-certainty evidence suggests that face-down positioning may have little or no effect on macular hole closure after surgery. Face-down positioning is a low-risk intervention, with serious adverse events affecting fewer than 1 in 300 people. We suggest that any future trials focus on patients with larger macular holes, with interventions and outcome measures used in previous trials (i.e. with inner limiting membrane peeling, positioning durations of three to five days, and validated quality of life metrics) to allow future meta-analyses to determine any effect with greater precision and confidence.
Topics: Humans; Cataract Extraction; Diabetic Retinopathy; Pain; Retinal Perforations
PubMed: 37987517
DOI: 10.1002/14651858.CD008228.pub3 -
Graefe's Archive For Clinical and... Apr 2024Retained foreign objects (RFOs) can place patients undergoing cataract surgery at risk for significant vision-threatening complications. In this systematic review, we...
PURPOSE
Retained foreign objects (RFOs) can place patients undergoing cataract surgery at risk for significant vision-threatening complications. In this systematic review, we examine the characteristics, clinical outcomes, and management of RFOs originating from surgical instruments or the surgical field after routine cataract surgery.
METHODS
Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we searched five databases in June 2023. The inclusion criteria were peer-reviewed, full-text, English-language articles describing RFOs after routine cataract surgery. Studies that described non-routine cataract surgeries, patients with a history of ocular trauma, or organic RFOs were excluded. Two investigators independently extracted data and appraised the methodological quality of each study using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).
RESULTS
Twenty-eight studies were included in our qualitative synthesis describing metal, fiber, and plastic RFOs. Typically, the RFOs were detected during surgery or slit-lamp examination. Presentations of patients with metal or fiber RFOs varied, with some being asymptomatic. Patients with plastic RFOs were usually symptomatic, often with decreased visual acuity and/or anterior chamber inflammation. Metal RFOs may have originated from metal fatigue from prolonged instrument usage and contact between surgical instruments, fiber RFOs from surgical wipes and gauzes, and plastic RFOs from instrument wrapping and intraocular lens defects. Factors such as location, biocompatibility, and secondary intraocular inflammation influenced the decision to surgically remove RFOs. Following surgical removal, the signs and symptoms resolved in most patients with RFOs. The studies' GRADE ratings indicated limitations in risk of bias and imprecision.
CONCLUSION
The presentation and management of RFOs varied depending on the type of material. To prevent RFOs, clinicians should carefully inspect surgical instruments and packs and use fiber-free wipes, towels, and gauzes. Future studies should investigate the efficacy and cost-effectiveness of different RFO prevention strategies.
Topics: Humans; Cataract Extraction; Lenses, Intraocular; Foreign Bodies; Inflammation; Cataract
PubMed: 37962665
DOI: 10.1007/s00417-023-06286-9 -
Nutrients Oct 2023Cataract, defined as the opacification of the lens that prevents clear vision, is a leading cause of vision loss and impairment worldwide. Elderly people comprise the... (Review)
Review
Cataract, defined as the opacification of the lens that prevents clear vision, is a leading cause of vision loss and impairment worldwide. Elderly people comprise the highest proportion of those suffering from this eye disease. According to the National Institute of Health (NIH), the risk of developing aged-related cataract (ARC) increases with every decade of life, starting from the age of 40. Despite progress in surgical treatment methods, life-style modifications may be beneficial in prevention or slowing down the progression of ARC. This systematic review aims to summarize studies on the significance of specific nutritional patterns, dietary products, vitamins, minerals, and carotenoids intake in the onset or progression of ARC. In this context, the presented paper thoroughly analyzes 24 articles, following the PRISMA guidelines. The results indicate significant protective effects of various dietary patterns, including the Korean balanced diet, vegetarian diet, "dairy products and vegetables", "traditional", "antioxidant", and "omega-3" patterns. Additionally, the consumption of fruits, vegetables, legumes, nuts, skimmed yoghurt, fish, coffee, and vitamins has shown positive effects on cataract incidence. Therefore, further research seems to be essential to gain a better understanding of these associations and to create uniform dietary recommendations for both the vulnerable population and ARC patients.
Topics: Aged; Animals; Humans; Vitamins; Diet; Cataract; Antioxidants; Vitamin A; Vegetables; Vitamin K
PubMed: 37960238
DOI: 10.3390/nu15214585 -
Journal of Ophthalmology 2023Both systemic and inhaled corticosteroids may increase the risk of cataract in patients with both chronic obstructive pulmonary disease (COPD) and asthma. Our aim was to... (Review)
Review
PURPOSE
Both systemic and inhaled corticosteroids may increase the risk of cataract in patients with both chronic obstructive pulmonary disease (COPD) and asthma. Our aim was to assess the degree of association between cataract and corticosteroid exposure in patients with asthma and COPD.
METHODS
A systematic literature review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The odds ratio estimates were extracted from each article. A random effects model was applied for estimate pooling in separate meta-analyses according to study design. Meta-regression was performed to assess the dose-response relationship between corticosteroid exposure and the risk of cataract development.
RESULTS
A total of 19 studies met the criteria for inclusion in this review, of which 12 studies provided effect estimates for pooled analyses. All but one of the included observational studies reported a significant association between use of corticosteroids and cataract development in cohorts of asthma and/or COPD patients. Pooled analyses revealed on average a doubled risk of cataract in corticosteroid-exposed asthma and COPD patients. Studies have shown that daily high-dose inhaled corticosteroid (ICS) ≥ 1000 g is associated with a significant risk of developing cataract and by that predispose to subsequent cataract surgery, although one study showed that systemic corticosteroids increase cataract risk more than ICS.
CONCLUSION
ICS treatment in asthma and COPD patients is a risk factor for cataract development. Our results emphasize a previously underestimated potential long-term risk of treatment with ICS and underline the importance of targeting ICS treatment, and not least dosing, to improve the risk-benefit ratio of maintenance treatment in both asthma and COPD.
PubMed: 37899845
DOI: 10.1155/2023/8209978 -
Ophthalmologica. Journal International... 2024The safety and effectiveness of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling remains poorly understood for the treatment of epiretinal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The safety and effectiveness of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling remains poorly understood for the treatment of epiretinal membrane (ERM).
OBJECTIVES
Our study aims to compare the safety and effectiveness of PPV with and without ILM peeling for ERM.
METHODS
A systematic literature search was conducted on Ovid MEDLINE, Embase, Cochrane Library, and Google Scholar from January 2000 to January 2023 for comparative studies reporting visual and anatomical outcomes for patients with ERM that received PPV with or without ILM peeling. Primary outcomes included best-corrected visual acuity (BCVA) at last study observation and change in BCVA from baseline. Secondary outcomes included retinal thickness (RT) at last study observation, change in RT from baseline, risk of ERM recurrence, and adverse events. A random-effects meta-analysis was performed. Risk of bias of randomized controlled trials was assessed using the Risk of Bias 2 tool of observational studies using the Risk of Bias in Non-randomized Studies of Interventions-I tool. The certainty of evidence of outcomes was evaluated using Grading of Recommendations, Assessment, Development and Evaluation criteria.
RESULTS
Nineteen studies reporting on 1,291 eyes at baseline were included. PPV with and without ILM peel achieved a similar BCVA at last study observation (p = 0.68) and change in BCVA from baseline (p = 0.79). These findings remained consistent irrespective of whether simultaneous phacoemulsification was performed. PPV with ILM peel achieved a significantly lower incidence of ERM recurrence (risk ratio [RR] = 0.26, 95% CI = [0.13, 0.51], p < 0.0001) and additional surgery (RR = 0.17, 95% CI = [0.04, 0.74], p = 0.02) compared to PPV without ILM peel.
CONCLUSION
PPV with and without ILM peel achieved a similar BCVA at last study observation in ERM patients. Patients treated with PPV and ILM peel also had a reduced risk of ERM recurrence and lower reoperation risk. These conclusions are associated with a moderate certainty of evidence and potential for bias from multiple non-randomized studies.
Topics: Humans; Epiretinal Membrane; Vitrectomy; Basement Membrane; Retina; Cataract Extraction; Retrospective Studies; Tomography, Optical Coherence
PubMed: 37899043
DOI: 10.1159/000534851 -
American Journal of Ophthalmology Mar 2024Many studies have examined the ocular pulse amplitude (OPA) to better understand its physiology and clinical relevance, but the papers are scattered, not consistently... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Many studies have examined the ocular pulse amplitude (OPA) to better understand its physiology and clinical relevance, but the papers are scattered, not consistently indexed, and sometimes difficult to locate. We aimed to identify and summarize the relevant published evidence on OPA and, in a meta-analysis, outline specific differences of this parameter between healthy individual, primary open-angle glaucoma, normal-tension glaucoma, ocular hypertension, and cataract patients.
DESIGN
Systematic review and meta-analysis.
METHODS
A thorough literature search and data extraction were conducted by 2 reviewers independently. Reports on OPA measured by the dynamic contour tonometry in conjunction with different ocular and systemic diseases or potential influencing factors were included.
RESULTS
Of the 527 initially found reports, 97 met the inclusion criteria assessing 31 clinical conditions. A meta-analysis based on 6850 eyes and 106 study arms (68.8%) revealed differences in mean OPA values in millimeters of mercury between various entities. Among healthy eyes, the OPA was 2.58 mm Hg (95% CI: 2.45-2.71), whereas OPA values were higher in glaucoma (unspecified glaucoma 2.73 mm Hg, 95% CI: 2.38-3.08; normal-tension glaucoma 2.66 mm Hg, 95% CI: 2.36-2.97; and primary open-angle glaucoma 2.92 mm Hg, 95% CI: 2.75-3.08). Although ocular hypertension showed the highest OPA values (3.53 mm Hg, 95% CI: 3.05-4.01), the lowest values were found in cataract eyes (2.26 mm Hg, 95% CI: 1.57-2.94).
CONCLUSION
We found different OPA values characteristic of different clinical entities, with above-normal values in glaucoma and ocular hypertension and lower values in cataract patients. Our work is intended for clinicians and researchers who want to get a quick overview of the available evidence or who need statistical data on OPA distributions in individual diseases.
Topics: Humans; Intraocular Pressure; Glaucoma, Open-Angle; Healthy Volunteers; Blood Pressure; Glaucoma; Ocular Hypertension; Tonometry, Ocular; Low Tension Glaucoma; Cataract
PubMed: 37898282
DOI: 10.1016/j.ajo.2023.10.014 -
European Journal of Clinical... Feb 2024Cataract is the leading cause of blindness around the world. Previous investigations have assessed the relationship between cataract, cataract surgery and dementia risk,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cataract is the leading cause of blindness around the world. Previous investigations have assessed the relationship between cataract, cataract surgery and dementia risk, but their results remain controversial. Herein, we conducted a meta-analysis to evaluate the associations between cataract, cataract surgery and the risk of dementia.
METHODS
We systemically screened the literature from three electronic databases PubMed, EMBASE and CENTRAL until April 2023. The data were collected by two independent researchers. The hazard ratios (HRs) or odds ratios (ORs) from eligible studies with 95% confidence intervals (CIs) were adjusted into the risk ratios (RRs), which were pooled using the random-effects model.
RESULTS
A total of nine studies with 448,140 participants reported the associations between cataract or cataract surgery and the risk of dementia were included in this meta-analysis. The outcomes of our pooled analysis indicated that cataract was associated with an increased risk of all-cause dementia (RR = 1.24, 95% CI, 1.14-1.35, p < .00001), Alzheimer's disease (RR = 1.22, 95% CI, 1.10-1.35, p = .0002) and vascular dementia (RR = 1.29, 95% CI, 1.01-1.66, p = .04). Cataract surgery is associated with a reduction of the dementia risk (RR = 0.74, 95% CI, 0.67-0.81, p < .00001).
CONCLUSIONS
Current evidence from the existing studies supports that cataract is associated with an increased risk of dementia, and cataract surgery may be instrumental in reducing the risk of dementia in patients with cataract.
Topics: Humans; Alzheimer Disease; Cataract; Cataract Extraction
PubMed: 37874275
DOI: 10.1111/eci.14113 -
Graefe's Archive For Clinical and... May 2024To compare anterior capsule contraction (ACC) after cataract surgery with implantation of intraocular lens (IOLs) of different materials and designs. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To compare anterior capsule contraction (ACC) after cataract surgery with implantation of intraocular lens (IOLs) of different materials and designs.
METHODS
We searched three electronic databases for relevant studies published up to January 1, 2023. Five randomized controlled trails (RCTs) and three cohort studies involving 1,221 eyes were included in quantitative synthesis. We extracted data, assessed their quality independently, and calculated standard mean difference (SMD) using a random-effects model. Six RCTs and one retrospective cohort were included in information summary.
RESULTS
The contraction of the anterior capsule opening area in the hydrophilic group was larger than that of the hydrophobic group from one month to one year postoperatively (P < 0.001 and P < 0.001, respectively). Specifically, the hydrophilic group showed greater contraction of the anterior capsule opening area at one month postoperatively (Standardized mean difference [SMD] = -0.73, 95% confidence interval [CI] = -0.93 to -0.52), three months (SMD = -1.04, 95% CI = -1.32 to -0.75), six months (SMD = -0.99, 95% CI = -1.24 to -0.74) and one year (SMD = -1.33, 95% CI = -2.50 to -0.16). As of one year postoperatively, the anterior capsular opening area showed a trend of decreasing over time in both groups (P = 0.046 and P = 0.050, respectively). In information summary, three studies indicated no relationship between haptic design and ACC, while the other four studies reported that the number and shape of haptic would affect ACC.
CONCLUSION
This meta-analysis suggested that the postoperative ACC after the implantation of hydrophobic IOLs was less than that induced by hydrophilic IOLs. Haptic design may also affect the degree of ACC.
Topics: Humans; Lens Implantation, Intraocular; Haptic Technology; Lenses, Intraocular; Eye, Artificial; Cataract; Phacoemulsification; Postoperative Complications; Prosthesis Design
PubMed: 37831171
DOI: 10.1007/s00417-023-06230-x -
Clinical Ophthalmology (Auckland, N.Z.) 2023Recent advances in telemedicine have led to increased use of digital ophthalmoscopes (DO) in clinical settings. This review aims to assess commercially available DOs,... (Review)
Review
PURPOSE
Recent advances in telemedicine have led to increased use of digital ophthalmoscopes (DO) in clinical settings. This review aims to assess commercially available DOs, including smartphone (SP), desktop, and handheld ophthalmoscopes, and evaluate their applications.
METHODS
A literature review was performed by searching PubMed (pubmed.ncbi.nlm.nih.gov), Web of Science (webofknowledge.com), and Science Direct (sciencedirect.com). All English-language papers that resulted from the search terms "digital ophthalmoscope", "screening tool", "glaucoma screening", "diabetic retinopathy screening", "cataract screening", and "papilledema screening" were reviewed. Studies that contained randomized clinical trials with human participants between January 2010 and December 2020 were included. The Risk of Bias in Systematic Reviews (ROBIS) tool was used to assess the methodological quality of each included paper.
RESULTS
Of the 1307 studies identified, 35 met inclusion and exclusion criteria. The ROBIS tool determined that 29/35 studies (82.8%) had a low risk of bias, 3/35 (8.5%) had a moderate risk of bias, and 3/35 (8.5%) had a high risk of bias.
CONCLUSION
The continued adoption of DOs remains uncertain because of concerns about the image quality for non-mydriatic eyes and the confidence in data captured from the device. Likewise, there is a lack of guidelines for the use of DOs, which makes it difficult for providers to determine the best device for their practice and to ensure appropriate use. Even so, DOs continue to gain acceptance as technology and practice integration improve, especially in underserved areas with limited access to ophthalmologists.
PubMed: 37822326
DOI: 10.2147/OPTH.S423845 -
Eye & Contact Lens Nov 2023This study systematically reviewed the performance of bandage contact lenses (BCL) such as lotrafilcon A, lotrafilcon B, senofilcon A, balafilcon A, and comfilcon A as...
This study systematically reviewed the performance of bandage contact lenses (BCL) such as lotrafilcon A, lotrafilcon B, senofilcon A, balafilcon A, and comfilcon A as postoperative treatment in different ocular surgeries. A systematic search of English and Chinese databases (from inception to December 2021) was conducted for studies reporting the efficacy of BCLs after ocular surgeries. Postoperative symptoms, corneal healing, and visual outcomes were studied. Overall, 38 studies were identified. Bandage contact lens was applied as a postoperative aid in corneal refractive, cataract, and vitrectomy surgeries. Most studies were on photorefractive keratectomy. Reduced postoperative symptoms were observed within 4 hr to 3 days, whereas re-epithelization of the cornea and healing was complete within 3 to 7 days after ocular surgeries except for vitrectomy. In a vitrectomy, greater comfort and improved corneal epithelium were observed on the seventh day after surgery. An improvement in dry eye symptoms was observed at 7 days with considerable benefits observed after 1 month of cataract surgery. These findings indicate that BCLs are effective for improving postoperative symptoms and facilitation of early visual rehabilitation with a wear time of 8 hr to 7 days depending on the type of ocular surgery.
Topics: Humans; Ophthalmology; Bandages, Hydrocolloid; Contact Lenses, Hydrophilic; Photorefractive Keratectomy; Cataract
PubMed: 37816246
DOI: 10.1097/ICL.0000000000001021