Photobiomodulation efficacy in age-related macular degeneration: a systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of vision loss. Photobiomodulation (PBM) offers a controversial approach for managing dry AMD, aiming to halt or reverse progression through mitochondrial activity modulation. However, the efficacy and clinical relevance of PBM as a potential approach for managing dry AMD remain debated. METHODS: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing PBM versus a sham in patients with dry AMD. We performed trial sequential analysis (TSA) and minimal clinically important difference (MCID) calculations to assess statistical and clinical significance applying a random-effects model with 95% confidence intervals (CI). RESULTS: We included three RCTs comprising 247 eyes. The pooled analysis showed that PBM significant improved BCVA (MD 1.76 letters; 95% CI: 0.04 to 3.48) and drusen volume (MD -0.12 mm³; 95% CI: -0.22 to -0.02) as compared with a sham control. However, the TSA indicated that the current sample sizes were insufficient for reliable conclusions. No significant differences were observed in GA area. The MCID analysis suggested that the statistically significant results did not translate into clinically significant benefits. In the quality assessment, all studies were deemed to have a high risk of bias. CONCLUSION: This meta-analysis points limitations in the current evidence base for PBM in dry AMD treatment, with issues around small sample sizes. Statistically significant improvements do not translate into clinical benefits. The research underscores need for larger RCTs to validate PBM's therapeutic potential for dry AMD.

Efficacy of automated insulin delivery in pregnant women with type 1 diabetes: a meta-analysis and trial sequential analysis of randomized controlled trials.

BACKGROUND: Automated insulin delivery (AID) devices have shown to be a promising treatment to improve glycemic control in patients with type 1 diabetes mellitus (T1DM). However, its efficacy in pregnant women with T1DM remains uncertain. METHODS: PubMed, Scopus, Cochrane Central and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) comparing AID to standard care (SC), defined as use of sensor-augmented pump and multiple daily insulin injections. Outcomes included time in range (TIR), nocturnal TIR, time in hypoglycemic and hyperglycemic ranges, among others. Sensitivity and trial sequential analyses (TSA) were performed. PROSPERO ID: CRD42023474398. RESULTS: We included five RCTs with a total of 236 pregnant women, of whom 117 (50.6%) received AID. There was a significant increase in nocturnal TIR (mean difference [MD] 12.69%; 95% CI 8.74-16.64; p < 0.01; I2 = 0%) and a decrease in glucose variability (standard deviation of glucose; MD -2.91; 95% CI -5.13 to -0.69; p = 0.01; I2 = 0%). No significant differences were observed for TIR, HBGI, LGBI, mean glucose and time spent in hyperglycemia and hypoglycemia. Regarding TSA, the statistical significance obtained in nocturnal TIR was conclusive and with minimal risk of a type I error. CONCLUSION: Our findings suggest that AID systems can significantly improve nocturnal glycemic control and potentially reduce glycemic variability in pregnant women with T1DM, with no effect in the risk of hypoglycemia and hyperglycemia compared with current insulin treatments.

Systematic review and meta-analysis of myopia prevalence in Brazilian school children / Revisão sistemática e metanálise da prevalência de miopia entre as crianças brasileiras de idade escolar

ABSTRACT Introduction: Myopia is a growing global concern and there is a lack of studies on its prevalence among Brazilian schoolchildren. Methods: This study aimed to determine the prevalence of myopia in Brazilian children aged 3-18 years through a review and meta-analysis of published studies. Eleven high-quality studies were analyzed following the 2022 PRISMA guidelines. Prevalence was calculated using a meta-analysis, considering the heterogeneity among the studies. Results: The overall crude prevalence of myopia in Brazilian children was 7.65%. There was no significant association with the age of the children examined and no significant temporal trend was observed. Approximately one in 13 Brazilian schoolchildren had myopia. Conclusion: Given the increased exposure of Brazilian youth to the risk factors for myopia, it is crucial to monitor myopia in the country. Further studies are required to address and prevent myopia in Brazil.

RESUMO Introdução: A miopia é uma preocupação global crescente, estudos sobre sua prevalência entre os brasileiros ainda são escassos. Métodos: Este estudo teve como objetivo determinar a prevalência de miopia em crianças brasileiras com idades entre 3 e 18 anos por meio de uma revisão sistemática e meta-análise. Seguindo as diretrizes PRISMA de 2022, onze estudos foram analisados. A prevalência foi calculada usando uma meta-análise, considerando a heterogeneidade entre os estudos. Resultados: A prevalência bruta geral de miopia em crianças brasileiras foi de 7,65%. Não houve associação significativa com a idade das crianças examinadas, e não foi observada uma tendência temporal significativa. Aproximadamente um em treze escolares brasileiros tem miopia. Conclusão: Dado o aumento da exposição da juventude brasileira aos fatores de risco conhecidos da miopia, é crucial monitorar a miopia no país. Estudos adicionais são imperativos para abordar e prevenir a miopia no Brasil.