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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 number of serious postoperative complications (corneal edema, macular edema, wound leak, or iris prolapse) detected within the first month. M-H: Mantel-Haenszel. CI: confidence interval.
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fig2: Forest plot of number of serious postoperative complications (corneal edema, macular edema, wound leak, or iris prolapse) detected within the first month. M-H: Mantel-Haenszel. CI: confidence interval.

Mentions: None of the studies included enough patients to be able to detect rare but serious side effects and sight-threatening complications. Instead, we evaluated serious complications as the complications that could potentially be of threat to visual outcome, for example, corneal edema, macular edema, wound leakage, or iris prolapse. In total, the number of serious complications found within the three included RCTs was 26 with corneal edema, three with macular edema, two with wound leakage, and 0 with iris prolapse. The rate of serious complications detected within the first postoperative month was 0.8% [24] and 1.8% [25], respectively. There was no significant difference in the rate of serious postoperative complications between patients randomized to ISBCS or surgery on different days (p = 0.38); see Figure 2. One study reevaluated the hospital files one year after termination of the study and did not find any cases of retinal detachment within the first year postoperatively [25]. Due to the fact that the outcome assessors were not blinded to the patients' randomization status and that the studies were not large enough to assess serious complications, the quality of the evidence was rated as low; see Table 4.


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 number of serious postoperative complications (corneal edema, macular edema, wound leak, or iris prolapse) detected within the first month. M-H: Mantel-Haenszel. CI: confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig2: Forest plot of number of serious postoperative complications (corneal edema, macular edema, wound leak, or iris prolapse) detected within the first month. M-H: Mantel-Haenszel. CI: confidence interval.
Mentions: None of the studies included enough patients to be able to detect rare but serious side effects and sight-threatening complications. Instead, we evaluated serious complications as the complications that could potentially be of threat to visual outcome, for example, corneal edema, macular edema, wound leakage, or iris prolapse. In total, the number of serious complications found within the three included RCTs was 26 with corneal edema, three with macular edema, two with wound leakage, and 0 with iris prolapse. The rate of serious complications detected within the first postoperative month was 0.8% [24] and 1.8% [25], respectively. There was no significant difference in the rate of serious postoperative complications between patients randomized to ISBCS or surgery on different days (p = 0.38); see Figure 2. One study reevaluated the hospital files one year after termination of the study and did not find any cases of retinal detachment within the first year postoperatively [25]. Due to the fact that the outcome assessors were not blinded to the patients' randomization status and that the studies were not large enough to assess serious complications, the quality of the evidence was rated as low; see Table 4.

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