ABSTRACT
Purpose: To determine the effect of phacoemulsification on the progression of diabetic retinopathy. Methods: We conducted an electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 1, 2005), MEDLINE, and the reference lists of identified trials evaluating the effects of phacoemulsification on the progression of diabetic retinopathy. There were no language or date restrictions in the electronic search. Two reviewers independently assessed the articles for inclusion. Odds ratio at 95 percent confidence interval was determined using Review Manager 4.2.2 (The Cochrane Collaboration, Oxford, United Kingdom). Results: No randomized controlled trials were found. Five non randomized, prospective, case-controlled trials involving a total of 804 eyes were included in this review. All 5 trials studied the effects of phacoemulsification on the progression of diabetic retinopathy using the fellow nonoperated eye as control. Pooled analysis showed weak evidence to support the progression of diabetic retinopathy (RR=1.36: 95 percent; CI 0.95-1.96) in eyes that underwent phacoemulsification compared with eyes that did not. Conclusion: The available literature consists mainly of retrospective case reviews and case-controlled trials that are difficult to compare and analyze due to variations in the definition of progression and retinopathy assessment and surgical technique. However, the 5 studies reviewed show that uncomplicated phacoemulsification had minimal or no effect on the progression of diabetic retinopathy. Further randomized, controlled trials are needed to confirm this finding.
Subject(s)
Diabetic Retinopathy , Phacoemulsification , Meta-Analysis , Retrospective StudiesABSTRACT
RETINOBLASTOMA is the most common malignant intraocular tumor in children; it is also one of the most highly curable pediatric solid tumors if detected early. The conventional treatment of retinoblastoma is primary enucleation. Recent research reported a trend toward decreasing frequency of enucleation in the management of retinoblastoma. The trend toward globe-sparing interventions has been largely attributed to earlier diagnosis and recent success with conservative globe-sparing treatment options. Currently, globe-sparing interventions include first-line chemotherapy or chemoreduction, subconjunctival chemotherapy, systemic chemotherapy for metastasis, transpupillary thermotherapy (TIT), chemothermotherapy (CTT), laser photocoagulation, cryotherapy, brachytherapy, and external beam radiotherapy (EBRT). Expanded clinical options currently available have markedly decreased the overall enucleation rate for retinoblastoma CLINICAL SCENARIO: A 10-month old boy is brought to an ophthalmologist because of cats eye reflex in the left eye. The patient had undergone enucleation of his right eye for glaucomatous stage retinoblastoma 6 months earlier. Examination revealed the presence of a solitary retinal mass of about 12 mm in diameter, located nasal to the disc. There was no evidence of vitreous seeding Realizing that this was the only eye of the patient, the ophthalmologist wants to do everything humanly possible to preserve it. He has heard about chemothermotherapy (CTT) but is not sure if this was the best alternative he can offer CLINICAL QUESTION: Among patients with retinoblastoma, is chemoreduction combined with adjuvant treatment effective in preserving the globe and vision? (Author)