Refractive surgical approaches to keratoconus: A systematic review and network meta-analysis.

Autor: Niazi S; Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran., Doroodgar F; Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: f-doroodgar@farabi.tums.ac.ir., Hashemi Nazari S; Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Rahimi Y; Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran., Alió Del Barrio JL; Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain., Gatzioufas Z; University Eye Hospital Basel, Basel, Switzerland., Findl O; Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140 Vienna, Austria., Vinciguerra P; Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Italy., Vinciguerra R; Humanitas San Pio X Hospital, Milan, Italy., Moshirfar M; John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA., Ambrósio R Jr; Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil; Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil; BrAIN: Brazilian Artificial Intelligence Networking in Medicine, Rio de Janeiro, Maceió, Brazil; Department of Ophthalmology, Federal University the state of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil; Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil., Alio JL; Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
Jazyk: angličtina
Zdroj: Survey of ophthalmology [Surv Ophthalmol] 2024 Sep-Oct; Vol. 69 (5), pp. 779-788. Date of Electronic Publication: 2024 May 06.
DOI: 10.1016/j.survophthal.2024.04.008
Abstrakt: Advancements in diagnostic methods and surgical techniques for keratoconus (KC) have increased non-invasive treatment options. Successful surgical planning for KC involves a combination of clinical science, empirical evidence, and surgical expertise. Assessment of disease progression is crucial, and halting the progression should be the focus if it is progressive. While surgeons used to rely on experience alone to decide the surgical method, comparing the network of primary factors, such as visual acuity, across studies can help them choose the most appropriate treatments for each patient and achieve optimal outcomes. Meticulous tabulation methods facilitate interpretation, highlighting the importance of selecting the correct surgical and rehabilitation approach based on each patient's condition and stage of the disease. We detail the outcomes of a comprehensive network meta-analysis comparing the effectiveness of various combined therapeutic refractive treatments for KC at identical stages of the disease, spanning 4 distinct follow-up intervals. Additionally, the comprehensive analysis suggests that for corneas with optimal best corrected visual acuity (BCVA) preoperatively (classified as regular), combining phakic intraocular lenses with intracorneal ring segments (ICRS) and corneal cross-linking (CXL) could offer the best therapeutic approach provided the disease stage does not exceed stage 3. For irregular corneas, although initial follow-ups show a significant difference in BCVA with surface ablation, longer-term follow-ups recommend combining surface ablation with ICRS and CXL, especially at higher stages.
Competing Interests: Declaration of Competing Interest On behalf of all authors and as the corresponding author, I hereby declare that there has been no conflicting interests of any type, at any time during the conduction of this project.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: