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Frontiers in Medicine 2022Phacoemulsification is an effective and widely performed technique in cataract surgery, but the comparative anatomical outcomes, including endothelial cell loss (ECL),...
BACKGROUND
Phacoemulsification is an effective and widely performed technique in cataract surgery, but the comparative anatomical outcomes, including endothelial cell loss (ECL), central corneal thickness (CCT), and central macular thickness (CMT), between high-flow and low-flow phacoemulsification cataract surgery remain unclear.
METHODS
This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Random-effects models were applied to measure pooled mean differences (MD) with 95% confidence intervals (CI) of anatomical outcomes between high-flow and low-flow phacoemulsification cataract surgery. We judged overall certainty of evidence (CoE) based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
RESULTS
We included six randomized controlled trials (RCTs) totaling 477 participants. The meta-analysis showed similar changes associated with these two surgery types in both ECL at postoperative days 2-14 (MD: -1.63%; 95% CI: -3.73 to 0.47%; CoE: very low), days 15-42 (MD: -0.65%; 95% CI -2.96 to 1.65%; CoE: very low) and day 43 to month 18 (MD: -0.35%; 95% CI: -1.48 to 0.78%; CoE: very low), and CCT at postoperative day 1 (MD: -16.37 μm; 95% CI: -56.91 to 24.17 μm; CoE: very low), days 2-14 (MD: -10.92 μm; 95% CI: -30.00 to 8.16 μm; CoE: very low) and days 15-42 (MD: -2.76 μm; 95% CI: -5.75 to 0.24 μm; CoE: low). By contrast, low-flow phacoemulsification showed less increase in CMT at postoperative days 15-42 (MD, -4.58 μm; 95% CI: -6.3 to -2.86 μm; CoE: low).
CONCLUSIONS
We found similar anatomical outcomes, except in CMT, for both high-flow and low-flow phacoemulsification cataract surgery. Future head-to-head RCTs on visual outcomes should confirm our findings.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier: CRD42022297036.
PubMed: 36250089
DOI: 10.3389/fmed.2022.1021941 -
PloS One 2022For primary angle-closure and angle-closure glaucoma, the fact that refractive error sometimes deviates from predictions after intraocular lens (IOL) implantation is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
For primary angle-closure and angle-closure glaucoma, the fact that refractive error sometimes deviates from predictions after intraocular lens (IOL) implantation is familiar to cataract surgeons. Since controversy remains in the accuracy of IOL power calculation formulas, both traditional and network meta-analysis on formula accuracy were conducted in patients with primary angle-closure conditions.
METHODS
A comprehensive literature search was conducted through Aug 2022, focusing on studies on intraocular lens power calculation in primary angle-closure (PAC) and primary angle-closure glaucoma (PACG). A systemic review and network meta-analysis was performed. Quality of studies were assessed. Primary outcomes were the mean absolute errors (MAE) and the percentages of eyes with a prediction error within ±0.50 diopiters (D) or ±1.00 D (% ±0.50/1.00 D) by different formulas.
RESULTS
Six retrospective studies involving 419 eyes and 8 formulas (Barrett Universal II, Kane, SRK/T, Hoffer Q, Haigis, Holladay I, RBF 3.0 and LSF) were included. SRK/T was used as a reference as it had been investigated in all the studies included. Direct comparison showed that none of the involved formula outperformed or was defeated by SRK/T significantly in terms of either MAE or % ±0.50/1.00 D (all P>0.05). Network comparison and ranking possibilities disclosed BUII, Kane, RBF 3.0 with statistically insignificant advantage. No significant publication bias was detected by network funnel plot.
CONCLUSIONS
No absolute advantage was disclosed among the formulas involved in this study for PAC/PACG eyes. Further carefully designed studies are warranted to evaluate IOL calculation formulae in this target population.
TRAIL REGISTRATION
Registration: PROSEPRO ID: CRD42022326541.
Topics: Biometry; Glaucoma, Angle-Closure; Humans; Lenses, Intraocular; Network Meta-Analysis; Optics and Photonics; Phacoemulsification; Refraction, Ocular; Retrospective Studies
PubMed: 36240196
DOI: 10.1371/journal.pone.0276286 -
Journal of Ophthalmology 2022This study aimed to systematically assess the effect of recombinant human epidermal growth factor (rhEGF) associated with conventional drugs on the score of dry eye...
Effect of Recombinant Human Epidermal Growth Factor Associated with Conventional Drug Therapy on the Dry Eye Symptom Score in Patients with Dry Eyes after Cataract Surgery: A Systematic Review and Meta-Analysis.
OBJECTIVE
This study aimed to systematically assess the effect of recombinant human epidermal growth factor (rhEGF) associated with conventional drugs on the score of dry eye symptoms in patients with dry eyes after cataract surgery.
METHODS
The online database was searched for the clinical controlled trials of rhEGF associated with conventional drugs in the therapy of dry eyes after cataract surgery. Until now, the retrieval timeframe is based on the establishment of the database. Separately, two researchers extracted the data. The bias risk of each included literature was assessed.
RESULTS
Eight clinical controlled studies were finally included, with 878 samples. The success rate of the study group was greatly higher, and the difference was statistically significant ( < 0.05). The fluorescein staining (FL) score of the research group after treatment was lower, and the difference was statistically significant ( < 0.05). Compared with the control group, the tear break up time (BUT) of the study group after treatment was notably prolonged. The dry eye symptom score of the research group after treatment was notably lower, and the difference was statistically significant ( < 0.05).
CONCLUSION
Sodium hyaluronate associated with rhEGF eye drops is successful to treat xerophthalmia after cataract operation. It successfully promotes corneal healing, promotes tear film stability, and increases basic tear secretion. This treatment scheme is worth popularizing and applying in clinics.
PubMed: 36237557
DOI: 10.1155/2022/5142851 -
Asia-Pacific Journal of Ophthalmology... Nov 2022The health care industry is an inherently resource-intense sector. Emerging technologies such as artificial intelligence (AI) are at the forefront of advancements in...
PURPOSE
The health care industry is an inherently resource-intense sector. Emerging technologies such as artificial intelligence (AI) are at the forefront of advancements in health care. The health economic implications of this technology have not been clearly established and represent a substantial barrier to adoption both in Australia and globally. This review aims to determine the health economic impact of implementing AI to ophthalmology in Australia.
METHODS
A systematic search of the databases PubMed/MEDLINE, EMBASE, and CENTRAL was conducted to March 2022, before data collection and risk of bias analysis in accordance with preferred reporting items for systematic ceviews and meta-analyses 2020 guidelines (PROSPERO number CRD42022325511). Included were full-text primary research articles analyzing a population of patients who have or are being evaluated for an ophthalmological diagnosis, using a health economic assessment system to assess the cost-effectiveness of AI.
RESULTS
Seven articles were identified for inclusion. Economic viability was defined as direct cost to the patient that is equal to or less than costs incurred with human clinician assessment. Despite the lack of Australia-specific data, foreign analyses overwhelmingly showed that AI is just as economically viable, if not more so, than traditional human screening programs while maintaining comparable clinical effectiveness. This evidence was largely in the setting of diabetic retinopathy screening.
CONCLUSIONS
Primary Australian research is needed to accurately analyze the health economic implications of implementing AI on a large scale. Further research is also required to analyze the economic feasibility of adoption of AI technology in other areas of ophthalmology, such as glaucoma and cataract screening.
Topics: Humans; Artificial Intelligence; Ophthalmology; Australia; Cost-Benefit Analysis; Treatment Outcome
PubMed: 36218837
DOI: 10.1097/APO.0000000000000565 -
Ophthalmology and Therapy Dec 2022This study aimed to determine the efficacy and safety of pars plana vitrectomy (PPV) as treatment for patients with primary symptomatic vitreous floaters.
INTRODUCTION
This study aimed to determine the efficacy and safety of pars plana vitrectomy (PPV) as treatment for patients with primary symptomatic vitreous floaters.
METHODS
We searched 12 databases for studies performing PPV for primary symptomatic vitreous floaters with at least 3 months follow-up. Two authors reviewed the studies and extracted data. Our main outcome of interest was patient satisfaction/reduction of symptoms/quality of life, but other measures of efficacy and safety were also extracted. Where possible, meta-analyses were performed to provide summary estimates.
RESULTS
We identified 18 eligible studies, which included 2077 eyes of 1789 patients. Studies reported that at least 90% of the patients were satisfied or had relief of symptoms. Best corrected visual acuity improved - 0.08 logMAR (95% CI - 0.10 to - 0.06 logMAR, P < 0.0001). Contrast sensitivity improved - 2.26% (95% CI - 3.26 to - 1.26%, P < 0.0001). After surgery, cataract occurred in 31.7% (95% CI 21.7-42.7%), retinal tears/breaks in 2.92% (95% CI 1.38-4.97%), vitreous hemorrhage in 1.97% (95% CI 0.83-3.54%), macular edema in 1.70% (95% CI 0.84-2.83%), retinal detachment in 1.54% (95% CI 0.62-2.82%), glaucoma in 1.04% (95% CI 0.53-1.73%), and endophthalmitis in 0.18% (95% CI 0.02-0.45%).
CONCLUSIONS
Postoperative patient satisfaction is high after PPV for primary symptomatic vitreous floaters. However, the patient should be carefully counselled as what to expect from the treatment and understand the risks associated with PPV.
PubMed: 36198880
DOI: 10.1007/s40123-022-00578-9 -
Reports of Practical Oncology and... 2022The extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) is the most common orbital and adnexal lymphomas. Radiotherapy is one of the... (Review)
Review
BACKGROUND
The extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) is the most common orbital and adnexal lymphomas. Radiotherapy is one of the most preferred treatment options for orbital lymphomas since they are localized and radiation sensitive. The objective of this study is to evaluate how radiation therapy affected the outcome of orbital MALT lymphoma.
MATERIALS AND METHODS
PRISMA guideline was used to conduct this systematic review of electronic databases (PubMed, EMBASE and Cochrane Library), then we assessed the quality of evidence of each paper.
RESULTS
Twenty-five studies were finally included. 94% studies were intended for definitive therapy and almost all of the studies used external radiation sources. The total doses given to the tumor bed ranged from 4 Gy to 55 Gy and were divided into three groups: ultra-low dose (4-6 Gy), standard-dose (24-30.6 Gy), and high-dose (> 30.6 Gy). 75-90% patients showed CR and local relapse was only reported at 3.5-5%. Higher 5-year PFS was reported in the patients group with lens shielding (90.1% 82.1%) and an increase in Meiboscore after RT courses. Toxicities, including dry eye and cataract, were reported in several patients. Acute toxicities subsided gradually over a few months with artificial tears. The risk of early cataract formation increases in patients who received > 30 Gy and lower in the IMRT group.
CONCLUSION
RT is a successful primary definitive therapy for low-grade orbital MALT lymphoma, with a high survival rate, low recurrence rate, and typically acceptable toxicity.
PubMed: 36196408
DOI: 10.5603/RPOR.a2022.0065 -
Journal of Current Ophthalmology 2022To conduct a systematic review and meta-analysis for estimating the prevalence of pediatric cataracts across Asia. (Review)
Review
PURPOSE
To conduct a systematic review and meta-analysis for estimating the prevalence of pediatric cataracts across Asia.
METHODS
A detailed literature search of PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar databases, from 1990 to July 2021, was performed to include all studies reporting the prevalence of cataracts among children. Two researchers performed the literature search and screening of articles independently, and a third researcher critically reviewed the overall search and screening process to ensure the consistency. The JBI Critical Appraisal Checklist for studies reporting prevalence data was used to assess the methodological quality of the included studies.
RESULTS
Of the 496 identified articles, 35 studies with a sample size of 1,168,814 from 12 Asian countries were included in this analysis. The estimated pooled prevalence of pediatric cataracts in Asian children is 3.78 (95% confidence interval: 2.54-5.26)/10,000 individuals with high heterogeneity (I = 89.5%). The pooled prevalence by each country per 10,000 was 0.60 in Indonesia, 0.92 in Bangladesh, 1.47 in Iran, 2.01 in Bhutan, 3.45 in Laos, 3.68 in China, 4.27 in Thailand, 4.47 in India, 5.33 in Malaysia, 5.42 in Nepal, 9.34 in Vietnam, and 10.86 in Cambodia.
CONCLUSIONS
This study utilizes existing literature to identify the prevalence of cataracts in Asian children. Moreover, it highlights the need for more epidemiological studies with large sample sizes from other countries in Asia to accurately estimate the burden of disease.
PubMed: 36147271
DOI: 10.4103/joco.joco_339_21 -
Diagnostics (Basel, Switzerland) Aug 2022The surgical time duration, the postoperative best-corrected visual acuity (BCVA), and the incidence rate of intraoperative complications, alongside the vision and... (Review)
Review
BACKGROUND
The surgical time duration, the postoperative best-corrected visual acuity (BCVA), and the incidence rate of intraoperative complications, alongside the vision and posturing parameters, were estimated by systematic review and meta-analysis to compare the three-dimensional (3D) heads-up visualization system (HUVS) and standard operating microscope (SOM) in cataract surgery.
METHODS
A literature search was conducted using PubMed, Embase, and Scopus on 26 June 2022. The weighted mean difference (WMD) was used to present postoperative BCVA and the mean surgical time duration, whereas the risk ratio (RR) was used to present the incidence rate of intraoperative complications. Publication bias was evaluated with Egger's test. The Cochrane Collaboration's Tool for randomized clinical trials, the methodological index for non-randomized, and the Newcastle-Ottawa Scale were used to assess the risk of bias. The research has been registered with the PROSPERO database (identifier, CRD42022339186).
RESULTS
In the meta-analysis of five studies with 1021 participants, the pooled weighted mean difference (WMD) of the postoperative BCVA showed no significant difference between patients who underwent HUVS versus SOM cataract surgery (WMD = -0.01, 95% confidence interval (CI): -0.01 -0.02). In the meta-analysis of nine studies with 5505 participants, the pooled WMD of mean surgical time duration revealed no significant difference between patients who underwent HUVS versus SOM cataract surgery (WMD = 0.17, 95% CI: -0.43-0.76). In the meta-analysis of nine studies with 8609 participants, the pooled risk RR associated with intraoperative complications was 1.00 (95% CI, 1.00-1.01).
CONCLUSIONS
3D HUVS and SOM provide comparable surgical time duration, postoperative BCVA, and incidence rate of intraoperative complications.
PubMed: 36140501
DOI: 10.3390/diagnostics12092100 -
JAMA Ophthalmology Nov 2022A bayesian network meta-analysis (NMA) can help compare the various types of multifocal and monofocal intraocular lenses (IOLs) used in clinical practice. (Meta-Analysis)
Meta-Analysis
Visual Outcomes and Optical Quality of Accommodative, Multifocal, Extended Depth-of-Focus, and Monofocal Intraocular Lenses in Presbyopia-Correcting Cataract Surgery: A Systematic Review and Bayesian Network Meta-analysis.
IMPORTANCE
A bayesian network meta-analysis (NMA) can help compare the various types of multifocal and monofocal intraocular lenses (IOLs) used in clinical practice.
OBJECTIVE
To compare outcomes of presbyopia-correcting IOLs frequently recommended in clinical practice through a bayesian NMA based on a systematic review.
DATA SOURCES
Medline (PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on May 15, 2021, from inception.
STUDY SELECTION
Based on the research question, randomized clinical trials assessing multifocal IOLs in patients who underwent bilateral cataract extraction were searched. Nonrandomized studies, studies in patients with unilateral or contralateral cataract extractions, duplicated studies, conference abstracts, and nonpeer-reviewed articles were excluded.
DATA EXTRACTION AND SYNTHESIS
Descriptive statistics and outcomes were extracted. The NMA was conducted to compare different types of IOLs. The mean differences for continuous variables, odds ratios for binary variables, 95% credible intervals (CrIs), and ranks of interventions were estimated.
MAIN OUTCOMES AND MEASURES
The outcomes examined included binocular visual acuities by distance and optical quality, including glare, halos, and spectacle independence.
RESULTS
This NMA included 27 studies comprising 2605 patients. For uncorrected near visual acuity, trifocal IOLs (mean difference, -0.32 [95% CrI, -0.46 to -0.19]) and old bifocal diffractive IOLs (mean difference, -0.33 [95% CrI, -0.50 to -0.14]) afforded better visual acuity than monofocal IOLs. Regarding uncorrected intermediate visual acuity, extended depth-of-focus IOLs provided better visual acuity than monofocal IOLs. However, there were no differences between extended depth-of-focus and trifocal diffractive IOLs in pairwise comparisons. For uncorrected distant visual acuity, all multifocal IOLs were comparable with monofocal IOLs. There were no statistical differences between multifocal and monofocal IOLs regarding contrast sensitivity, glare, or halos.
CONCLUSIONS AND RELEVANCE
For patients considering a multifocal IOL due to presbyopia, bilateral implantation of a trifocal IOL might be an optimal option for patients without compromising distant visual acuity.
Topics: Humans; Presbyopia; Network Meta-Analysis; Bayes Theorem; Lenses, Intraocular; Cataract Extraction; Contrast Sensitivity; Cataract
PubMed: 36136323
DOI: 10.1001/jamaophthalmol.2022.3667 -
International Journal of Ophthalmology 2022To compare the efficacy and safety of intravitreal aflibercept with dexamethasone implant in the treatment of macular edema (ME) associated with diabetic retinopathy...
Comparison of intravitreal aflibercept and dexamethasone implant in the treatment of macular edema associated with diabetic retinopathy or retinal vein occlusion: a Meta-analysis and systematic review.
AIM
To compare the efficacy and safety of intravitreal aflibercept with dexamethasone implant in the treatment of macular edema (ME) associated with diabetic retinopathy (DR) or retinal vein occlusion (RVO).
METHODS
A comprehensive search of studies comparing dexamethasone and aflibercept in patients with ME was conducted at PubMed, Embase, and Cochrane Central Register of Controlled Trials from the beginning of library to April 16, 2021. Extracting the data including best-corrected visual acuity (BCVA), central retinal thickness (CRT), number of injections and serious adverse events (SAEs) from the final qualified articles. RevMan 5.3 software was used for Meta-analysis of the included studies.
RESULTS
Totally 7 studies with 369 eyes were included. The causes of ME in the final screening study included RVO and DR. Compared with the aflibercept treatment group, the BCVA of the dexamethasone implant treatment group showed no significant difference in the follow-up for 3mo [mean difference (MD): -0.05, 95% confidence interval (CI): -0.11, 0.02; =0.17] and 12mo (MD: -0.01, 95%CI: -0.38, 0.37; =0.98), but it was slightly worse than the aflibercept group at 6mo (MD: 0.12, 95%CI: 0.03, 0.21; =0.008). In terms of CRT reduction, there was no significant difference between the two groups at 3mo (MD: -28.14, 95%CI: -79.95, 23.67; =0.29), 6mo (MD: 27.67, 95%CI: -84.89, 140.24; =0.63), and 12mo (MD: -59.00, 95%CI: -127.37, 9.37; =0.09). However, dexamethasone implant had fewer injections, but more adverse events such as elevated intraocular pressure (IOP) and cataract.
CONCLUSION
Intravitreal injection of aflibercept and dexamethasone implant can both effectively increase BCVA and reduce CRT. Compared with aflibercept, dexamethasone implant is not inferior in improving vision and reducing CRT in the initial treatment period (3mo) and long-term treatment period (12mo). Besides, it has fewer injections and more likely to cause elevated IOP and cataract.
PubMed: 36124196
DOI: 10.18240/ijo.2022.09.15