Powe N R, Schein O D, Gieser S C, Tielsch J M, Luthra R, Javitt J, Steinberg E P
Program for Medical Technology and Practice Assessment, Johns Hopkins School of Public Health, Baltimore, Md.
Arch Ophthalmol. 1994 Feb;112(2):239-52. doi: 10.1001/archopht.1994.01090140115033.
To better define the effectiveness and risks of modern cataract surgery.
Meta-analysis (formal systematic identification, selection, review, and synthesis) of published literature.
Patients described in 90 studies published between 1979 and 1991 that addressed visual acuity (n = 17,390 eyes) or complications (n = 68,316 eyes) following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phaco-emulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation.
The proportion of eyes with postoperative Snellen visual acuity of 20/40 or better and the proportion of eyes with each of 18 complications.
The pooled percentage of eyes (weighted by sample size) with postoperative visual acuity of 20/40 or better was 95.5% (95% confidence interval [CI], 95.1% to 95.9%) among eyes without preexisting ocular comorbidity and 89.7% (95% CI, 89.3% to 90.2%) for all eyes. The pooled percentage of eyes experiencing complications (weighted by sample size and, when pertinent, by quality score of the individual studies but not adjusted for variation in duration of follow-up) ranged from 0.13% for endophthalmitis to 19.7% for posterior capsule opacification. Pooled proportions of eyes with other complications were as follows: bullous keratopathy, 0.3%; intraocular lens malposition/dislocation, 1.1%; clinically apparent cystoid macular edema, 1.5%; and retinal detachment, 0.7%. Pooled results for postoperative Snellen visual acuity and most complications were similar for surgery performed via phacoemulsification vs standard extracapsular cataract extraction, although comparisons of the outcomes between these procedures should be interpreted with caution.
The published literature indicates that modern cataract surgery yields excellent visual acuity and, although not free of complications, is a very safe procedure regardless of the extraction technique used.
更好地明确现代白内障手术的有效性和风险。
对已发表文献进行荟萃分析（正式的系统识别、选择、综述和综合）。
1979年至1991年间发表的90项研究中描述的患者，这些研究涉及标准囊外白内障摘除联合后房型人工晶状体植入、超声乳化联合后房型人工晶状体植入或囊内白内障摘除联合可折叠前房型人工晶状体植入后的视力（n = 17,390只眼）或并发症（n = 68,316只眼）。
术后Snellen视力为20/40或更好的眼的比例以及18种并发症中每种并发症的眼的比例。
在无既往眼部合并症的眼中，术后视力为20/40或更好的眼的合并百分比（按样本量加权）为95.5%（95%置信区间[CI]，95.1%至95.9%），所有眼中为89.7%（95%CI，89.3%至90.2%）。发生并发症的眼的合并百分比（按样本量加权，必要时按各研究的质量评分加权，但未针对随访时间的差异进行调整）范围从眼内炎的0.13%到后囊膜混浊的19.7%。其他并发症的眼的合并比例如下：大泡性角膜病变，0.3%；人工晶状体位置异常/脱位，1.1%；临床明显的黄斑囊样水肿，1.5%；视网膜脱离，0.7%。尽管对这些手术方法之间的结果比较应谨慎解释，但超声乳化手术与标准囊外白内障摘除术术后Snellen视力和大多数并发症的合并结果相似。
已发表的文献表明，现代白内障手术能产生极佳的视力，并且尽管并非没有并发症，但无论采用何种摘除技术，都是一种非常安全的手术。
