Kuo Po-Chin, Hung Jia-Horung, Su Yu-Chen, Fang Ching-Ju, Lee Chaw-Ning, Huang Yi-Hsun, Shao Shih-Chieh, Lai Edward Chia-Cheng
Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Front Med (Lausanne). 2022 Sep 28;9:1021941. doi: 10.3389/fmed.2022.1021941. eCollection 2022.
Phacoemulsification is an effective and widely performed technique in cataract surgery, but the comparative anatomical outcomes, including endothelial cell loss (ECL), central corneal thickness (CCT), and central macular thickness (CMT), between high-flow and low-flow phacoemulsification cataract surgery remain unclear.
This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Random-effects models were applied to measure pooled mean differences (MD) with 95% confidence intervals (CI) of anatomical outcomes between high-flow and low-flow phacoemulsification cataract surgery. We judged overall certainty of evidence (CoE) based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
We included six randomized controlled trials (RCTs) totaling 477 participants. The meta-analysis showed similar changes associated with these two surgery types in both ECL at postoperative days 2-14 (MD: -1.63%; 95% CI: -3.73 to 0.47%; CoE: very low), days 15-42 (MD: -0.65%; 95% CI -2.96 to 1.65%; CoE: very low) and day 43 to month 18 (MD: -0.35%; 95% CI: -1.48 to 0.78%; CoE: very low), and CCT at postoperative day 1 (MD: -16.37 μm; 95% CI: -56.91 to 24.17 μm; CoE: very low), days 2-14 (MD: -10.92 μm; 95% CI: -30.00 to 8.16 μm; CoE: very low) and days 15-42 (MD: -2.76 μm; 95% CI: -5.75 to 0.24 μm; CoE: low). By contrast, low-flow phacoemulsification showed less increase in CMT at postoperative days 15-42 (MD, -4.58 μm; 95% CI: -6.3 to -2.86 μm; CoE: low).
We found similar anatomical outcomes, except in CMT, for both high-flow and low-flow phacoemulsification cataract surgery. Future head-to-head RCTs on visual outcomes should confirm our findings.
PROSPERO, identifier: CRD42022297036.
超声乳化白内障吸除术是白内障手术中一种有效且广泛应用的技术，但高流量与低流量超声乳化白内障手术之间的比较解剖学结果，包括内皮细胞丢失（ECL）、中央角膜厚度（CCT）和中心黄斑厚度（CMT），仍不明确。
本研究遵循系统评价和Meta分析的首选报告项目（PRISMA）声明。应用随机效应模型测量高流量与低流量超声乳化白内障手术解剖学结果的合并平均差（MD）及95%置信区间（CI）。我们根据推荐分级评估、制定和评价（GRADE）标准判断证据的总体确定性（CoE）。
我们纳入了6项随机对照试验（RCT），共477名参与者。Meta分析显示，在术后2 - 14天（MD：-1.63%；95%CI：-3.73至0.47%；CoE：极低）、15 - 42天（MD：-0.65%；95%CI -2.96至1.65%；CoE：极低）以及43天至18个月（MD：-0.35%；95%CI：-1.48至0.78%；CoE：极低）的ECL方面，以及术后第1天（MD：-16.37μm；95%CI：-56.91至24.17μm；CoE：极低）、2 - 14天（MD：-10.92μm；95%CI：-30.00至8.16μm；CoE：极低）和15 - 42天（MD：-2.76μm；95%CI：-5.75至0.24μm；CoE：低）的CCT方面，这两种手术类型的变化相似。相比之下，低流量超声乳化白内障手术在术后15 - 42天的CMT增加较少（MD，-4.58μm；95%CI：-6.3至-2.86μm；CoE：低）。
我们发现高流量和低流量超声乳化白内障手术的解剖学结果相似，但CMT除外。未来关于视觉结果的直接对比RCT应证实我们的发现。
PROSPERO，标识符：CRD42022297036。
