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INTRODUCTION: Diabetic Retinopathy (DR) is a common microvascular complication of diabetes. This review reports the prevalence of DR in Asia and guides healthcare provision in screening and treatment. EVIDENCE ACQUISITION: Medline was searched for articles describing the prevalence of DR in Asia. Statistical analysis was performed using freeman turkey double arcsine transformation and the DerSimonian and Laird model. The prevalence of DR was estimated according to the following subgroups: Economic status (High Income, Middle Income, Low Income), Country, and Ethnicity. The risk of bias of the articles was also assessed. EVIDENCE SYNTHESIS: A total of 66 studies were included, and out of 2,599,857 patients with diabetes, 201,646 were diagnosed with DR. The overall prevalence of DR, nonproliferative DR (NPDR), proliferative DR (PDR) and maculopathy were recorded at 21.7% (CI:19.1% - 24.6%), 19.9% (CI:17.3% - 22.8%), 2.3% (CI:1.6% - 3.4%) and 4.8% (CI:3.5% - 6.7%) respectively. Low-income countries had the lowest prevalence of DR, NPDR, PDR and maculopathy compared to the middle- and high-income countries. Middle-income countries had the highest prevalence of DR (23.9%; CI:19.4% - 29.2%), NPDR (21.1%; CI:17.0% - 25.9%), moderate NPDR (7.9%; CI: 5.7% - 11.0%), PDR (3.0%; CI: 1.8% - 4.9%) and maculopathy (4.7%; CI:3.0% - 7.4%), while high-income countries had the highest prevalence of mild (10.3%; CI:4.2% - 23.2%) and severe NPDR (3.0%; CI:1.0% - 8.4%). CONCLUSIONS: One in five people with diabetes have diabetic retinopathy. It is imperative that public healthcare take heeds to heighten the screening program to provide all patients with diabetes equitable access to DR screening and ophthalmology services.
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BACKGROUND: Recent clinical trials have demonstrated favorable outcomes associated with trans-anal colonic pull-through for rectal resection followed by delayed coloanal anastomoses (DCA), resulting in a resurgence in popularity of the technique. This meta-analysis aims to review existing literature to evaluate the postoperative complications associated with DCA, and to make comparisons with immediate coloanal anastomoses (ICA) after colorectal resection to assess the suitability of DCA as an alternative form of surgical treatment. METHODS: Medline and Embase databases were reviewed from inception until 31 July 2020 in accordance with PRISMA guidelines. Single-arm studies that involved patients undergoing DCA for benign or malignant causes were selected, and meta-analysis of proportions was conducted to determine the prevalence of postoperative complications following DCA. Comparative studies comparing postoperative outcomes between DCA and ICA were also included for comparative meta-analysis. RESULTS: Patients undergoing DCA were significantly less likely to require diverting stoma construction as compared to ICA (odds ratio [OR] = 0.04; confidence interval [CI]: 0.02-0.07; P < 0.001). Overall postoperative morbidity (OR = 0.50; 95% CI: 0.23-1.12; P = 0.09) and mortality (OR = 0.49, 95% CI: 0.12-1.98; P = 0.32) was comparable between DCA and ICA groups. No significant differences in perioperative complications, such as anastomotic leakage (OR = 0.42; 95% CI: 0.11-1.64; P = 0.21), postoperative ileus, pelvic abscesses, or sepsis, were noted between DCA and ICA. CONCLUSION: Our study shows no differences in complications or functional outcomes between DCA and ICA. Pooled analysis expectedly revealed a lower rate of diverting stoma in patients undergoing DCA. DCA is thus a safe alternative to current surgical practices where avoidance of a stoma is desired.
