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Immediate Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis.

Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J - J Ophthalmol (2015)

Bottom Line: The quality of evidence was rated as low to very low.In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence.Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Rigshospitalet-Glostrup, 2600 Glostrup, Denmark ; Danish Health and Medicines Authority, 2300 Copenhagen S, Denmark.

ABSTRACT
The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery on two different dates. The quality of evidence was rated as low to very low. None of the studies reported the prevalence of postoperative anisometropia. In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence. Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.

No MeSH data available.


Related in: MedlinePlus

Forest plot of any intra- or postoperative complication (including sensation of dry eyes). M-H: Mantel-Haenszel. CI: confidence interval.
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fig1: Forest plot of any intra- or postoperative complication (including sensation of dry eyes). M-H: Mantel-Haenszel. CI: confidence interval.

Mentions: Two of the included RCTs provided information on the number of complications (peri- and postoperative) in the two groups randomized to ISBCS or surgery on different days [24, 25]. The third study provided information on the total rate of complications for the two groups combined but not for each group separately (6/96 = a complication rate of 6.3%, including high intraocular pressure < 30 mmHg on the first postoperative day in 2 eyes and one with a corneal edema; at 2 months postoperatively 1 eye had iritis and at 4 months one eye had a vitreous detachment and 2 eyes (1 patient) had beginnings of posterior capsule opacification) [23]. The reported prevalence of postoperative complications was markedly different in the remaining two studies [24, 25], appearing to reflect different opinions in what was considered a postoperative complication; for example, only one of the studies included sutures in wound, first day postoperative pressure rise > 30 mmHg, or signs of posterior capsule fibrosis in the list of complications. Looking at any complication (intra- or postoperatively within the first month) the two studies [24, 25] reported a complication rate of 23% and 6%, respectively. The reported complications were capsule tears (n = 17), vitreous loss (n = 5), iridectomy or sphincterotomy (n = 7), sutures in wound (n = 34), intraocular pressure > 30 mmHg on the first postoperative day (n = 67), wound leak (n = 2), IOL decentration or deplacement (n = 6), and corneal edema (n = 31) and after one month IOL decentration (n = 2), corneal edema (n = 13), anterior chamber flare (n = 7), capsular fibrosis (n = 36), and macular edema (n = 3) in one study [25] and iris prolapse (n = 2), posterior capsule tear (n = 1), corneal edema on first postoperative day (n = 13), capsule opacification (n = 1) and foreign body sensation (n = 1), and dry eyes (n = 80) in the other study [24]. There was a tendency towards lower number of complications in the groups randomized to ISBCS (RR (95% CI) 0.76 (0.55, 1.07), p = 0.12, see Figure 1). Due to the large inconsistency in number of reported complications and the fact that the outcome assessors in the included RCTs were not blinded to patient randomization, the quality of the evidence was rated as very low; see Table 4 for a summary of the evidence and quality of the evidence assessment.


Immediate Sequential Bilateral Cataract Surgery: A Systematic Review and Meta-Analysis.

Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J - J Ophthalmol (2015)

Forest plot of any intra- or postoperative complication (including sensation of dry eyes). M-H: Mantel-Haenszel. CI: confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4553313&req=5

fig1: Forest plot of any intra- or postoperative complication (including sensation of dry eyes). M-H: Mantel-Haenszel. CI: confidence interval.
Mentions: Two of the included RCTs provided information on the number of complications (peri- and postoperative) in the two groups randomized to ISBCS or surgery on different days [24, 25]. The third study provided information on the total rate of complications for the two groups combined but not for each group separately (6/96 = a complication rate of 6.3%, including high intraocular pressure < 30 mmHg on the first postoperative day in 2 eyes and one with a corneal edema; at 2 months postoperatively 1 eye had iritis and at 4 months one eye had a vitreous detachment and 2 eyes (1 patient) had beginnings of posterior capsule opacification) [23]. The reported prevalence of postoperative complications was markedly different in the remaining two studies [24, 25], appearing to reflect different opinions in what was considered a postoperative complication; for example, only one of the studies included sutures in wound, first day postoperative pressure rise > 30 mmHg, or signs of posterior capsule fibrosis in the list of complications. Looking at any complication (intra- or postoperatively within the first month) the two studies [24, 25] reported a complication rate of 23% and 6%, respectively. The reported complications were capsule tears (n = 17), vitreous loss (n = 5), iridectomy or sphincterotomy (n = 7), sutures in wound (n = 34), intraocular pressure > 30 mmHg on the first postoperative day (n = 67), wound leak (n = 2), IOL decentration or deplacement (n = 6), and corneal edema (n = 31) and after one month IOL decentration (n = 2), corneal edema (n = 13), anterior chamber flare (n = 7), capsular fibrosis (n = 36), and macular edema (n = 3) in one study [25] and iris prolapse (n = 2), posterior capsule tear (n = 1), corneal edema on first postoperative day (n = 13), capsule opacification (n = 1) and foreign body sensation (n = 1), and dry eyes (n = 80) in the other study [24]. There was a tendency towards lower number of complications in the groups randomized to ISBCS (RR (95% CI) 0.76 (0.55, 1.07), p = 0.12, see Figure 1). Due to the large inconsistency in number of reported complications and the fact that the outcome assessors in the included RCTs were not blinded to patient randomization, the quality of the evidence was rated as very low; see Table 4 for a summary of the evidence and quality of the evidence assessment.

Bottom Line: The quality of evidence was rated as low to very low.In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence.Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Rigshospitalet-Glostrup, 2600 Glostrup, Denmark ; Danish Health and Medicines Authority, 2300 Copenhagen S, Denmark.

ABSTRACT
The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery on two different dates. The quality of evidence was rated as low to very low. None of the studies reported the prevalence of postoperative anisometropia. In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence. Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.

No MeSH data available.


Related in: MedlinePlus