Visual Acuity Outcomes After Trans Scleral Cyclophotocoagulation: A Systematic Review and Meta-analysis.

IF 4.2 1区 医学 Q1 OPHTHALMOLOGY
Chris Zajner,Bhadra Pandya,Michael Balas,David J Mathew
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引用次数: 0

Abstract

TOPIC The aim of this systematic review and meta-analysis is to evaluate best-corrected visual acuity (VA) outcomes following transscleral cyclophotocoagulation (TSCPC) in patients with refractory glaucoma. CLINICAL RELEVANCE TSCPC is typically reserved for cases of refractory glaucoma, due to apprehension of negative affects on VA. Prior studies have reported the VA outcomes from TSCPC, but no comprehensive review of the literature has yet been conducted. METHODS The full protocol was registered on PROSPERO (42023485891). The electronic databases OVID MEDLINE, and EMBASE were searched using keywords related to TSCPC and visual acuity outcomes (start date to February 7, 2025). Meta-analysis was completed using random effects models and risk ratios to calculate pooled estimates. RESULTS In total, 90 studies with 6331 eyes were included. Weighted mean patient age was 61.8 (SD 9.8) years, with 53.3% males (n=3374). Follow-up periods of the studies consisted of 19.8% with less than 1 year follow-up, 38.4% with between 1-2 years, and 40.7% with more than 2 year follow-up. Among 19 studies and 1,246 eyes, the weighted mean pre-operative VA was 1.11 LogMAR (SE 0.02)(20/258 Snellen), and 1.12 LogMAR (SE 0.02)(20/264 Snellen) post-procedure. Meta-analysis of 19 studies and 1,246 eyes did not show a statistically significant difference between VA before TSCPC and at last follow-up (Mean Difference: -0.10 LogMAR, 95% confidence interval: -0.22 to 0.01, I2=78.9%, p=0.077). In 59 studies and 3,855 eyes, 50.0% (SE 0.3) of patients maintained their VA at final follow-up, with 6.8% (SE 0.2) showing a 1-line improvement, 9.0% (SE 0.2) improving by 2 or more lines, 17.6% (SE 0.2) decreasing by 1 line, and 16.9% (SE 0.3) decreasing 2 lines or more. In 84 studies and 5,941 eyes, the mean pre-operative IOP was 34.2 (SE 0.09) mmHg, which dropped to 18.3 (SE 0.05) mmHg, with 79.3% of patients achieving an IOP below 22 mmHg. Meta-analysis of 42 studies and 2,393 eyes showed a mean reduction of 1.1 glaucoma medications pre-procedure to last follow-up (95%CI: 0.89-1.31, I2:91.76, p<0.0001). There was a significant negative linear relationship between total energy (Joules) administered with logMAR BCVA outcome (correlation coefficient: -0.008, I2:77.7%, p=0.038). There was no significant correlation between BCVA with duration (milliseconds) of TSCPC application (correlation coefficient: -7.4 × 10-6, I2: 21.5%, p=0.876). CONCLUSION This meta-analysis suggests no significant decrease in VA after TSCPC, with a moderate degree of certainty. Larger amounts of total energy during TSCPC was found to be correlated with worse BCVA. However, given the substantial heterogeneity and observational nature of most studies, these findings should be interpreted with caution.
经巩膜光凝术后的视力结果:一项系统回顾和荟萃分析。
本系统综述和荟萃分析的目的是评估难治性青光眼患者经巩膜光凝治疗(TSCPC)后的最佳矫正视力(VA)结果。由于担心对VA的负面影响,TSCPC通常用于难治性青光眼病例。先前的研究报道了TSCPC的VA结果,但尚未对文献进行全面的回顾。方法完整方案在PROSPERO(42023485891)上注册。电子数据库OVID MEDLINE和EMBASE使用与TSCPC和视力结果相关的关键词进行检索(起始日期至2025年2月7日)。meta分析采用随机效应模型和风险比计算汇总估计值。结果共纳入90项研究,共6331只眼。加权平均患者年龄为61.8岁(SD 9.8),男性占53.3% (n=3374)。随访期为:随访1年以下的占19.8%,1-2年的占38.4%,2年以上的占40.7%。19项研究,1246只眼,术前加权平均VA为1.11 LogMAR (SE 0.02)(20/258 Snellen),术后加权平均VA为1.12 LogMAR (SE 0.02)(20/264 Snellen)。19项研究1,246只眼的meta分析显示,TSCPC前的VA与最后一次随访时无统计学差异(平均差异:-0.10 LogMAR, 95%可信区间:-0.22 ~ 0.01,I2=78.9%, p=0.077)。在59项研究和3,855只眼睛中,50.0% (SE 0.3)的患者在最终随访时保持VA,其中6.8% (SE 0.2)显示1条线改善,9.0% (SE 0.2)显示2条线或更多改善,17.6% (SE 0.2)下降1条线,16.9% (SE 0.3)下降2条线或更多。在84项研究和5,941只眼睛中,平均术前IOP为34.2 (SE 0.09) mmHg,降至18.3 (SE 0.05) mmHg, 79.3%的患者IOP低于22 mmHg。42项研究和2393只眼睛的荟萃分析显示,手术前至最后一次随访平均减少了1.1种青光眼药物(95%CI: 0.89-1.31, 92:91.76, p<0.0001)。总能量(焦耳)与logMAR BCVA结果呈显著负线性关系(相关系数:-0.008,I2:77.7%, p=0.038)。BCVA与TSCPC应用时间(毫秒)无显著相关(相关系数:-7.4 × 10-6,I2: 21.5%, p=0.876)。结论:本荟萃分析显示,TSCPC术后VA无显著降低,且有中等程度的确定性。TSCPC期间总能量的增加与BCVA的恶化相关。然而,考虑到大多数研究的实质性异质性和观察性,这些发现应该谨慎解释。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.20
自引率
7.10%
发文量
406
审稿时长
36 days
期刊介绍: The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.
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