拨开迷雾：撒哈拉以南非洲白内障手术术后视力不良患病率及相关因素的系统评价与荟萃分析
Through the fog: Systematic review and meta-analysis of the prevalence and associated factors of poor post-operative visual outcome of cataract surgery in Sub-Saharan Africa.
作者信息
Asmare Zufan Alamrie, Seifu Beminate Lemma, Fente Bezawit Melak, Negussie Yohannes Mekuria, Asebe Hiwot Altaye, Bezie Meklit Melaku, Melkam Mamaru, Asnake Angwach Abrham
机构信息
Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
Department of Public Health, College of Medicine and Health Science, Samara University, Afar, Ethiopia.
出版信息
PLoS One. 2024 Dec 9;19(12):e0315263. doi: 10.1371/journal.pone.0315263. eCollection 2024.
BACKGROUND
Cataract, despite being treatable, persists to have a devastating impact on people's health and livelihoods all over the world. In Sub-Saharan Africa (SSA), 1.7 million people are blind and 6.94 million are visually impaired due to cataract. Also, Cataract surgery outcomes remain below the World Health Organization (WHO) recommendations in SSA. Hence, this review aimed to estimate the pooled prevalence and associated factors of poor post-operative visual outcome in SSA.
METHOD
An intensive literature search was performed from PubMed, Google Scholar, EMBASE, HINARI, Scopus, and Web of Sciences. Data were extracted by using a pre-tested and standardized data extraction format and analyzed by using STATA 17 statistical software. I2 tests to appraise the heterogeneity across the included studies, a random-effect model to estimate the pooled prevalence, and a sub-group analysis to discern the viable source of heterogeneity were executed. Potential publication bias was also assessed by funnel plot, Egger's weighted correlation, and Begg's regression. The odds ratio with its 95% confidence was used to reckon the association between the prevalence and factors.
RESULT
From 201 identified studies, 25 articles were included. The pooled prevalence of poor post-operative visual outcome of cataract surgery in SSA was 14.56% (95% CI 11.31, 17.81). The presence of intra-operative complications (AOR = 2.99, 95% CI: 1.79, 4.98) and the presence of post-operative complications (AOR = 3.56, 95% CI: 2.86, 4.43) were statistically significant with the pooled poor post-operative visual outcome. According to the subgroup analysis, the pooled prevalence of poor post-operative visual outcome was found lower in phacoemulsification, with a sub-pooled prevalence of 12.32% (95% CI 7.89, 16.74) compared to incisional with a sub-pooled prevalence of 16.28% (95% CI 10.98, 21.59).
CONCLUSION
This meta-analysis revealed that a substantial proportion of cataract-operated patients had poor post-operative visual outcome. The presence of intra-operative complications and post-operative complications were independent predictors of poor post-operative visual outcome. Therefore, improvement of post-operative visual outcome through decreasing intra-operative complications, managing post-operative complications, and investing in specialized training and equipment for ophthalmic surgeons are pivotal and need significant emphasis.
背景
白内障尽管可以治疗，但仍对世界各地人们的健康和生计产生毁灭性影响。在撒哈拉以南非洲（SSA），有170万人因白内障失明，694万人视力受损。此外，SSA地区白内障手术的效果仍低于世界卫生组织（WHO）的建议。因此，本综述旨在评估SSA地区白内障手术后视力不良的合并患病率及相关因素。
方法
通过PubMed、谷歌学术、EMBASE、HINARI、Scopus和科学网进行了深入的文献检索。使用预先测试和标准化的数据提取格式提取数据，并使用STATA 17统计软件进行分析。进行I2检验以评估纳入研究之间的异质性，使用随机效应模型估计合并患病率，并进行亚组分析以辨别异质性的可能来源。还通过漏斗图、Egger加权相关性和Begg回归评估潜在的发表偏倚。使用比值比及其95%置信区间来计算患病率与因素之间的关联。
结果
从201项已识别的研究中，纳入了25篇文章。SSA地区白内障手术后视力不良的合并患病率为14.56%（95%CI 11.31，17.81）。术中并发症的存在（AOR = 2.99，95%CI：1.79，4.98）和术后并发症的存在（AOR = 3.56，95%CI：2.86，4.43）与合并的术后视力不良在统计学上具有显著相关性。根据亚组分析，发现超声乳化白内障吸除术的术后视力不良合并患病率较低，亚合并患病率为12.32%（95%CI 7.89，16.74），而切口手术的亚合并患病率为16.28%（95%CI 10.98，21.59）。
结论
这项荟萃分析表明，相当一部分接受白内障手术的患者术后视力不良。术中并发症和术后并发症的存在是术后视力不良的独立预测因素。因此，通过减少术中并发症、处理术后并发症以及投资于眼科医生的专业培训和设备来改善术后视力至关重要，需要给予高度重视。
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