Comparison of Three Intraocular Lens Implantation Procedures for Aphakic Eyes With Insufficient Capsular Support: A Network Meta-analysis
| Autor: | Xi Li, Shuang Ni, Guan-Lu Liang, Shuyi Li, Wen Xu, Jing Wu, Qian-Yin Zheng |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Eye Hemorrhage Visual acuity genetic structures medicine.medical_treatment Network Meta-Analysis Operative Time Lens Capsule Crystalline Visual Acuity Glaucoma Iris Intraocular lens Aphakia Postcataract Lower risk Macular Edema 03 medical and health sciences 0302 clinical medicine Postoperative Complications Lens Implantation Intraocular Ophthalmology medicine Humans 030212 general & internal medicine Contraindication Lenses Intraocular Intraocular hemorrhage business.industry Corneal Endothelial Cell Loss medicine.disease eye diseases Confidence interval Relative risk 030221 ophthalmology & optometry medicine.symptom business Sclera |
| Zdroj: | American journal of ophthalmology. 192 |
| ISSN: | 1879-1891 |
| Popis: | Purpose To compare the clinical outcomes and main complications of transscleral-fixated (TSF), intrascleral-fixated (ISF), and iris-fixated (IF) intraocular lenses (IOLs). Design Systematic review and network meta-analysis. Methods The authors searched PubMed, EMBASE, and the Cochrane Library for relevant articles up to April 2017 with no language restrictions, and related studies meeting the eligibility criteria were included. A Bayesian framework was applied to compare the visual outcomes and complications of these 3 approaches. Results A total of 14 studies with 845 eyes were included in the present report. There was no significant difference between any pair of surgical approaches in best-corrected visual acuity (BCVA) and in final BCVA achieving 20/40 or better (Snellen). ISF presented a lower risk of cystoid macular edema (CME) compared with TSF (risk ratio [RR], 0.45; 95% confidence interval [CI], [0.18, 1.0]). IF showed superiorities in less intraocular hemorrhage (IOH) than ISF (RR, 0.078; 95% CI [0.0095, 0.38]), as well as TSF (RR, 0.26; 95% CI, [0.09, 0.72]). IF had a lower risk of glaucoma escalation; the difference was slightly higher than the conventional level of significance (RR, 0.41; 95% CI, [0.16, 1.04]). Moreover, the surgical time in IF was shorter than TSF (standard mean difference [SMD], −2.98; 95% CI, [−4.32, −1.64]) and ISF (SMD, −2.60; 95% CI, [−3.71, −1.49]). However, IF was associated with a significantly higher risk of endothelial cell density (ECD) impairment (SMD, −0.54; 95% CI, [−1.02, −0.05]) and significantly greater postoperative corneal endothelial cell loss rate (ECLR, %) (SMD, 0.35; 95% CI, [0.08, 0.63]) compared with TSF. Conclusions Postoperative visual outcomes were comparable among TSF, ISF, and IF for eyes with insufficient capsular support. However, the risk of some complications differed among approaches. IF showed its superiorities in lower risk of IOH and glaucoma escalation as well as shorter surgical time, while IF was at a disadvantage in greater endothelial cell impairment. Since some patients might have a clear contraindication to one of the surgical approaches, the decision of surgical approach eventually depends on surgeon experience and the presenting pathology. |
| Databáze: | OpenAIRE |
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