Diabetic-retinopathy progression following phacoemulsification: A metaanalysis

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.

Laser in situ keratomileusis (LASIK) for high myopia

EXCIMER laser vision correction in the form of LASIK and PRK/LASEK has been proved to be highly effective and safe in the treatment of low-to moderate myopia (less than -6 diopters [D]) and astigmatism. It is the most common refractive-surgery procedure done worldwide. However, the outcome of laser vision correction among those with high myopia (greater than -6D) may not be the same as in those with low to moderate myopia CLINICAL SCENARIO: A 26-year-old, female, myopic patient unhappy with spectacle correction and contact lenses heard about LASIK and sought opinion regarding the probability of her achieving 20/20 vision. Her last refraction was -7.00 sphere -1.00 cylinder x 100 in the right eye (OD) and -9.00 sphere -0.50 cylinder x 90 in the left eye (OS). Best-corrected visual acuity (BCVA) was 20/20 OD and 20/20 OS. Her refraction has been stable for 5 years CLINICAL QUESTION: The patient has high myopia and is concerned about her chances of seeing 20/20 after undergoing laser vision correction. Among patients with high myopia, how effective is LASIK in achieving 20/20 vision? SEARCH METHOD: An electronic literature search was performed using MEDLINE (PubMed). The following search terms were used: "Myopia," "LASIK," "laser in situ keratomileusis," "technology assessment." The search was further limited to the English language and human studies published from 1968 to April 2005. The search yielded 5 articles but only one was relevant to the clinical question CITATION: Sugar A, Rapuano CJ, Culbertson WW, et al. Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy. A Report by the American Academy of Ophthalmology. Ophthalmology 2002; 109:175-187. (Author)