Effectiveness of amniotic membrane transplantation combined with mitomycin C in the treatment of pterygium: a meta-analysis

AIM: To evaluate the recurrence rate and safety of amniotic membrane transplantation (AMT) augmented with mitomycin C (MMC) compared with amniotic membrane transplantation alone during the pterygium excision. METHODS: We took a meta-analysis on this program. Pertinent studies were selected through extensive searches of the Cochrane Library, MEDLINE, EMBASE, CBMdisc, CNKI. Pooled estimates were carried out in RevMan software v.4.2. RESULTS: Six trials reported postoperative recurrence rate of pterygium, included 882 eyes, three trials reported the complications. The results of meta-analysis showed that recurrence rate of AMT plus MMC group was 5.41%, AMT alone group was 16.89%, RR was 0.32, 95%CI ranged from 0.19 to 0.56, Z was 4.06, P <0.001. Two trials reported early complication as punctata keratitis, the incidence rate of AMT plus MMC group and AMT alone group were 17.14% and 0.00%, RR was 12.11, 95%CI ranged from 1.62 to 90.76. CONCLUSION: Amniotic membrane transplantation with MMC was associated with lower recurrence rate compared with amniotic membrane transplantation alone in pterygium excision,whether accompanied a higher risk with adverse events need more investigation.     

Comparison of the Efficacy of Pterygium Resection Combined with Conjunctival Autograft versus Pterygium Resection Combined with Amniotic Membrane Transplantation

 PURPOSE:To compare the efficacy of pterygium resection combined with conjunctival autograft versus pterygium resection combined with amniotic membrane transplantation in the treatment of pterygium. METHODS:A total of 118 cases (133 eyes) were randomly assigned to receive pterygium resection combined with conjunctival autograft (n=81) or pterygium resection combined with amniotic membrane transplantation (n=52). Corneal wound healing and neovascularization and the presence or absence of conjunctival proliferation and hyperemia were analyzed at 12 months post-operatively. RESULTS:In the conjunctival autograft group, 6 eyes (7.4%) had recurrent pterygium, while in the amniotic membrane transplantation group, 10 eyes showed recurrence (19.2%, P<0.05, chi-square). Patients in the conjunctival autograft group recovered significantly faster compared with those in the amniotic membrane transplantation group. CONCLUSION:Patients receiving pterygium surgery combined with conjunctival autograft had lower recurrence rates and experience faster recovery compared with those undergoing pterygium resection combined with amniotic membrane transplantation.     

Semaphorin 7a participants in pterygium by regulating vascular endothelial growth factor

AIM: To investigate the relationship between semaphorin 7a expression and cell proliferation and migration in pterygium fibroblasts. METHODS: Twenty-six patients with surgically diagnosed pterygium were enrolled, including 15 cases of primary pterygium and 11 cases of recurrent pterygium. In addition, 12 cases of normal conjunctival tissue were collected. The expression of semaphorin 7a in normal conjunctival tissue, primary pterygium and recurrent pterygium was detected by real-time polymerase chain reaction. Recurrent pterygium fibroblasts were isolated and cultured, and the expression of semaphorin 7a was silenced by small interfering RNA (siRNA) interference technique. Furthermore, the effects of si-semaphorin 7a interference on the mRNA and protein levels of β1-integrin, vascular endothelial growth factor A (VEGFA) and vascular endothelial growth factor receptor (VEGFR), and on fibroblast proliferation were analyzed. Transwell assay was used to detect the effect of semaphorin 7a interference on fibroblast migration. RESULTS: Semaphorin 7a was highly expressed in the primary pterygium and recurrent pterygium samples than that of the normal conjunctival tissue. Compared with the primary pterygium, the expression of semaphoring 7a in the recurrent pterygium samples was significantly increased (P<0.05). The mRNA and protein expression levels of β1-integrin, VEGFA and VEGFR were decreased after si-semaphorin 7a transfection, and as well as the cell proliferation and migration. CONCLUSION: Semaphorin 7a might play important roles in the pathogenesis of pterygium by affecting the expression of β1-integrin, VEGFA and VEGFR.     

Intravenous glucocorticoids therapy in the treatment of Graves’ ophthalmopathy: a systematic review and Meta-analysis

AIM: To evaluate the benefit and harms of high-dose intravenous glucocorticoids (IVGC) as first-line treatment for Graves’ ophthalmopathy (GO). METHODS: A systematic review and Meta-analysis of randomized clinical trials (RCTs) comparing IVGC for the treatment of GO, with placebo or other treatments, were conducted. Electronic databases were searched, and standard methodological guidance of Cochrane Handbook for Systematic Reviews of Interventions was used. The primary outcome was overall response, and secondary outcomes included the improvement and change in clinical activity score (CAS), and adverse events. RESULTS: Ten RCTs were included in the Meta-analysis. Low quality evidence (one trial) showed that participants receiving IVGC achieved significantly higher response compared to participants receiving placebo [risk ratio (RR) 7.50, 95% confidence interval (CI) 1.14 to 49.26]. Moderate quality evidence (four trials) support appreciable benefit of IVGC in response compared with oral glucocorticoids (OGC), with of RR being 1.51 (95%CI 1.25 to 1.83). There was low quality evidence (one trial) compatible with appreciable benefit for IVGC plus orbital radiotherapy in response (RR 1.38, 95%CI 1.07 to 1.79), compared with OGC plus orbital radiotherapy. One IVGC versus rituximab trial provided moderate quality evidence suggesting that participants using IVGC achieved significantly lower response compared to participants using rituximab (RR 0.70, 95%CI 0.50 to 0.98). One IVGC versus mycophenolate mofetil (MMF) trial provided moderate quality evidence suggesting that participants using IVGC achieved significantly lower response compared to participants using MMF (RR 0.74, 95%CI 0.63 to 0.88). Very low quality evidence (one trial) showed that participants with dysthyroid optic neuropathy (DON) receiving IVGC were more likely to achieve response compared to participants receiving orbital decompression (RR 3.33, 95%CI 0.51 to 21.89). CONCLUSION: The current evidence is moderate quality, which is sufficient to support IVGC to be as the first-line treatment for moderate-to-severe GO, and the use of rituximab or MMF to be the second-line treatment instead of IVGC. However, the evidence is very low quality, which is insufficient to support the use of IVGC or orbital decompression as the first-line treatment of DON.     

Bare sclera resection followed by mitomycin C and/or autograft limbus conjunctiva in the surgery for pterygium:a Meta-analysis

AIM:Toevaluate the recurrence andcomplicationsafter bare sclera resection (BSR) combined with mitomycin C (MMC) treatment and/or autograft limbus conjunctiva (ALC) in the surgery for pterygium.METHODS:Meta-analysis was used to evaluate the differences in patient outcomes between BSR of pterygium with or without MMC and/or ALC. All included studies were randomized trials of patients with pterygium who received BSR followed by MMC and/or ALC in the surgery. The recurrence of pterygium and other complications resulting from different treatments were extracted for analysis.RESULTS:Thirteen studies met the inclusion criteria. The recurrence of pterygium with intraoperative (IO) MMC was higher than that with ALC (OR=2.38,95% confidence interval 1.45-3.91, I²=29%). Postoperative MMC resulted in an incidence of recurrence similar to that of ALC (OR=0.66, 95% confidence interval 0.30-1.42, I²=0%), and IO MMC treatment in combination with ALC produced similar patient outcomes to ALC alone (OR=0.41, 95% confidence interval 0.16-1.01, I²=16%). Other complications such as punctate epitheliopathy, scleral thinning and ischemia, irritation and persistent epithelium defect, were more common in patients in the MMC group as compared to those treated with ALC.CONCLUSION:The recurrence of pterygium with BSR followed by ALC is lower than that of BSR followed by MMC, and the incidence of other complications is lower. While ALC is a more effective strategy for treating pterygium, the quality of the ALC transplant should be considered when the patient has a history of glaucoma.     

Complications of fibrin glue in pterygium surgery with amniotic membrane transplant

 Purpose:   To compare the complications and the recurrence rate between fibrin glue (TISSEEL) and Vicryl 8-0 sutures in amniotic membrane transplant during pterygium surgery. Methods: Patients who underwent pterygium surgery with amniotic membrane transplant (AMT) in the Wang Eye Clinic (Doraville, USA) were randomly categorized into two groups: one group received TISSEEL and the other group received Vicryl 8-0 sutures. All procedures for both groups were performed by one ophthalmologist. Twenty-four patients (24 eyes) participated in the TISSEEL group (22 eyes with primary surgery and 2 eyes with surgery for recurrence) and 19 patients (19 eyes) took part in the suture group (18 primary eyes and 1 recurrence). The patients with recurrent pterygium in both groups had not received AMT previously. Post-operatively, patients were followed up for one week and then one year to check for any signs of complications and recurrence. Results: Conjunctival inflammation occurred in 3 eyes (12.5%) in the TISSEEL group, and 6 eyes (31.6%) in the suture group (P<0.05, Chi-square test).  In the TISSEEL group, 1 eye (4.2%) showed recurrence, while there were no recurrences in the sutures group. There were 3 dry eyes (15.8%) in the suture group and 2 dry eyes (8.3%) in the TISSEEL group (P>0.05). No dislocated conjunctival grafts, Dellen, inflammation, infection, bleeding, pyogenic granuloma, or scleromalacia was observed in either group. Conclusion: Pterygium surgery with AMT had less conjunctival inflammation and dry eye in patients receiving fibrin glue than those with Vicryl 8-0 sutures.     

应用活体共焦显微镜观察翼状胬肉组织结构

目的 应用活体共焦显微镜(德国海德堡视网膜激光断层扫描系统Ⅱ代与Rostock角膜模 块组成)对人眼翼状胬肉进行活体组织成像分析.方法 系列病例分析.采取2010年3月门诊就诊的翼 状胬肉患者中选择11例14只眼,应用活体共焦显微镜对翼状胬肉头部、颈部和体部进行检查,记录各部分图像,分析其组织形态特点.结果 应用共焦显微镜观察到翼状胬肉头部两种上皮结构:一种是翼状胬肉上皮细胞,包括浅表上皮细胞和深层上皮细胞.浅表上皮细胞呈边界高反光的不规则多边形,浅表上皮细胞间见核/浆比显著失调的不规则细胞,深层上皮细胞间可见大量成熟的朗格汉斯细胞浸润;另一种是角膜上皮细胞,细胞间散在炎性细胞浸润.头部角膜浅基质层可见一些基质细胞和层间走行的纤维组织.翼状胬肉颈部和体部的上皮细胞结构与头部胬肉上皮结构相似,颈部血管较正常结膜血管丰富,在头部形成栏栅样结构,未跨越透明角膜,同时可以看到血管中流动的血细胞.体部基质层清晰可辨,由大量纤维组织构成,走行与基质平面基本平行并相互交错成致密的网状结构,可见新生血管横跨其间.结论 活体共焦显微镜是一种非侵入性的组织观察方法,提供了翼状胬肉的活体、实时、动态的图像资料,是研究翼状胬肉组织结构的一种有效工具.

Abstract：

Objective To study the histology of the pterygia in vivo by confocal microscopy. Methods Series of case study. Fourteen pterygium eyes in 11 patients were selected for using in vivo confocal mieroscopy. Results Two kinds of epithelial cells were observed in the transitional zone of cornea and pterygium. Superficial epithelium cells of the pterygium characterized as polygon cells with brightly refractive border. There were many mature Langerhans cells and big irregular cells with significantly decreased nuclear/cytoplasm ratio within the Epithelial. Irregularly brightly reflective cells presented in the corneal epithelia. Fibrous tissue from the pterygium and cornea stroma cells were found in the superficial stroma. The blood vessels became dilated in the neck and body of pterygium, terminated at the head as palisade-like structures with lots of blood cells. The stroma of the pterygium body was filled with a lot of fibers which formed a dense net with neovascular across. Conclusions IVCM is a powerful technique for studying the vivo histology of the pterygium.Noninvasive technique for living tissue has provided in vivo, real-time, dynamic image data. It is a useful tool for investigating the structures ofpterygium.     

Efficacy and safety of atropine at different concentrations in prevention of myopia progression in Asian children: a systematic review and Meta-analysis of randomized clinical trials

AIM: To assess the efficacy versus the adverse effects of various concentrations of atropine in the prevention of myopia in Asian children. METHODS: Databases (PubMed, EMBASE, the Cochrane Library and Web of science) were comprehensively searched from inception to April 2022. Types of studies included were randomized clinical trials (RCTs). The published languages were limited to English. Two researchers assessed the quality of included studies independently using Cochrane risk of bias tool based on the Cochrane Handbook for Systematic Reviews of Interventions. Funnel plots and Egger’s test were used for detection of publication bias. Meta-analyses were conducted using STATA (version 15.0; StataCorp). RESULTS: A total of 15 RCTs involving 2268 patients were included in the study. In the atropine group, spherical equivalent progressed at a significantly lower rate [weighted mean difference (WMD)=0.39, 95% confidence interval (CI): 0.23, 0.54] than in the control group. A WMD of 0.15 mm was associated with less axial elongation (95%CI -0.19, -0.10). Different doses showed statistically significant differences (P<0.05) and an improved effect could result from a higher concentration. Changes in photopic pupil size and mesopic pupil size in atropine group is 0.70 mm (95%CI: 0.33, 1.06) and 0.38 mm (95%CI: 0.22, 0.54) more than the control group. In the present Meta-analysis, no changes in accommodative amplitude (AA) were associated with atropine administration. Atropine administration increased the risk of adverse effects by 1.37 times. CONCLUSION: Concentrations of less than 1% atropine are able to effectively retard diopter and axis growth of myopia in Asian children in a dose-dependent manner. Meanwhile, it caused pupil enlargement, but induced no change in the AA within this range. Further study is required to determine the dosage needed to achieve maximum efficacy and minimal side effects.     

翼状胬肉治疗中应用贝伐单抗的疗效的Meta分析

目的 探讨贝伐单抗（bevacizumab）在翼状胬肉治疗中的临床疗效。设计 Meta分析。研究对象 国内外于从2001年1月1日至2014年9月30日发表的以翼状胬肉患者作为研究对象,治疗方案采用贝伐单抗与对照组相比的随机对照试验。方法 应用循证医学的研究方法检索美国国立医学图书馆、荷兰医学文摘、循证医学数据库、中国知网、万方数据库、中国期刊全文数据库及维普中文科技期刊数据库并辅以手工检索,遵循Cochrane Handbook 5.0偏倚风险评估工具评价纳入研究的质量,采用RevMan 5.0和SPSS 10.0软件进行统计学处理。主要指标 贝伐单抗用于翼状胬肉的复发率和并发症的比值比（OR）。结果 纳入7项随机对照试验,共398眼。分析结果显示：与空白对照组相比,贝伐单抗组在防止胬肉复发方面,差异无统计学意义[OR=0.60,95%CI(0.34~1.05),P=0.07,I2=7%];在术后并发症方面,两组比较差异无统计学意义[OR=0.68,95％CI (0.38~1.22),P=0.19, I2=0%]。结论 在翼状胬肉治疗中,应用贝伐单抗不能降低复发率。     

Macular laser photocoagulation with or without intravitreal triamcinolone pretreatment for diabetic macular edema: a result from five randomized controlled trials

AIM: To assess possible benefits of intravitreal triamcinolone acetonide (IVTA) injection as pretreatment for macular laser photocoagulation (MLP) in patients with diabetic macular edema (DME). METHODS: Published randomized controlled trials (RCTs) concerning MLP with or without IVTA pretreatment for DME were retrieved from databases CNKI, Medline, EMbase, Web of Science, and the Cochrane Library. A Meta-analysis on eligible studies was conducted using RevMan 5.0 software. Two investigators independently assessed the quality of the trials and extracted data. Main outcome measures included the change in best corrected visual acuity (BCVA), difference in central macular thickness (CMT) and adverse events reporting in particular elevated intraocular pressure within the follow-up period. The results were pooled using weight mean difference (WMD) or odds risk (OR) with their corresponding 95% confidence intervals (CI). A fixed- or random-effect model was employed depending on the heterogeneity of the inclusion trials. RESULTS: Finally, five independent RCTs were identified and used for comparing MLP with IVTA pretreatment (131 eyes) with MLP alone (133 eyes, control group). The overall study quality was relatively higher according to the modified Jadad scale. The Meta-analysis showed that MLP with IVTA pretreatment significantly reduced CMT at one, three and six months (P=0.002, 0.0003 and 0.04, respectively), compared with MLP alone. The IVTA pretreatment group showed statistically significant improvements in BCVA at the one-month follow up as compared with the control group (P=0.03). At three- and six-month follow up, there was a beneficial trend towards improving visual acuity in the IVTA pretreatment group without statistical significance between groups (P=0.06 and 0.20, respectively). The incidence of elevation of intraocular pressure was significantly higher in the IVTA pretreatment group than in the control group (P<0.0001). No evidence of publication bias was present according to Begg’s test and Egger’s test. There was a low level of heterogeneity in the included studies. CONCLUSION: This Meta-analysis indicates that MLP with IVTA pretreatment has a better therapeutic effect in terms of CMT reduction and earlier (1mo) visual improvement for patients with DME as compared with MLP alone. Further confirmation with rigorously well-designed multi-center trials is needed.     

Bevacizumab as adjuvant therapy in the management of pterygium: a systematic review and Meta-analysis

AIM: To evaluate the clinical effect of bevacizumab in pterygium treatment. METHODS: A systematic review and quantitative Meta-analysis was performed. PubMed, EMBASE, Web of Science and Cochrane database were searched for eligible literatures published in English until June 2016. The endpoint was recurrence rate and pooled risk ratio (RR) was calculated. RESULTS: Nine eligible studies were included and Meta-analysis results showed no significantly difference in patients treated with bevacizumab in short term follow-up [3mo: RR=0.70 (0.34, 1.45); 6mo: RR=0.55 (0.23, 1.32)] compared with control groups. No significant effects were observed in favor of bevacizumab in subgroup analyses: patients with subconjunctival injection of bevacizumab [3mo: RR=0.95 (0.70, 1.29); 6mo: RR=0.83 (0.55, 1.28)], primary pterygium [3mo: RR=0.59 (0.23, 1.54; 6mo: RR=0.59 (0.23, 1.53)], simple pterygium excision [3mo: 0.32 (0.05, 2.04), P=0.23; 6mo: 0.27 (0.05, 1.53)] and excision with conjunctival autograft [3mo: 1.51 (0.25, 9.15); 6mo: 1.11 (0.06, 21.69)]. CONCLUSION: In this Meta-analysis, we did not found the significant effect of bevacizumab in pterygium treatment, at least in short term follow-up (3mo and 6mo).     

抗VEGF与激光治疗1型早产儿视网膜病变的Meta分析

目的:系统评价抗VEGF与激光治疗1型早产儿视网膜病变(ROP)的疗效分析。方法:通过计算机检索PubMed、EMbase、CBM、The Cochrane Library、WanFang Data、CNKI和VIP数据库,收集比较抗VEGF与激光用于治疗1型ROP疗效的随机对照试验(RCT),检索时限均从建库至2020-01-06,按照纳入与排除标准提取资料,行质量评价后,采用RevMan 5.3软件进行Meta分析。结果:共纳入6个RCT。Meta分析结果显示:抗VEGF与激光组相比,复发率无差异[RR=0.94,95%CI(0.17~5.23),P=0.94];亚组分析Ⅰ区有差异[RR=0.17,95%CI(0.05~0.62),P=0.007];Ⅱ区无差异[RR=2.20,95%CI(0.07~73.48),P=0.66]。与激光组相比,再治疗率无差异[RR=2.36,95%CI(0.70~7.99),P=0.17],亚组分析Ⅰ区无差异[RR=0.33,95%CI(0.01~7.50),P=0.49];Ⅱ区有差异[RR=13,95%CI(1.84~92.01),P=0.01]。两者不良反应发生率无差异[RR=0.87,95%CI(0.54~1.40),P=0.57]。结论:激光和抗VEGF疗效相当,但在降低Ⅰ区复发率方面抗VEGF则更有优势,降低Ⅱ区再治疗率方面激光更有优势。     

翼状胬肉切除联合自体球结膜移植术中使用纤维蛋白胶和缝线有效性的随机对照试验的Meta分析

背景目前国外已将医用纤维蛋白胶用于翼状胬肉切除联合自体球结膜移植术植片的固定,其临床效果和安全性评价的临床随机对照试验（RCT）和回顾性研究已有报道,但单个研究的样本量较少。目的采用荟萃分析的方法对翼状胬肉切除联合自体球结膜移植术中使用纤维蛋白胶和缝线的有效性和安全性进行评价,为临床提供高等级的研究证据。方法按照拟定的检索策略,计算机检索MEDLINE（2000年1月至2010年10月）、Embase（2000年1月至2010年10月）、Cochrane协作网“CENTRAL”数据库（2010年4期）、中国生物医学文献数据库（2000年1月至2010年10月）、中国期刊全文数据库（2000年1月至2010年10月）,并采用手工检索等方法收集会议文献及检索检出文献的参考文献,最大限度地收集与翼状胬肉切除联合自体球结膜移植术中使用纤维蛋白胶和缝线相关的临床RCT文献,采用Jadad量表评分对纳入的文献进行质量评价,采用RevMan5．0软件进行异质性检验和合并效应量的统计学分析,用Meta分析对纤维蛋白胶和缝线用于翼状胬肉切除联合自体球结膜移植术植片固定的有效性进行评价,其评价指标为手术时间、复发率、术后并发症。结果按照纳入标准和排除标准共纳入与翼状胬肉切除联合自体球结膜移植术中使用纤维蛋白胶和缝线相关的RCT文献6篇,发表于2004--2010年,研究文献来自中国、新西兰、瑞典、以色列、土耳其、马来西亚等国家,发表文种均为英文。纳入文献的Jadad评分为4～5分,总样本量377例401眼。Meta分析结果表明,与缝线固定法相比,纤维蛋白胶用于翼状胬肉切除联合自体球结膜移植术植片的固定可缩短手术时间[MD=14．23,95％CI（-16．18～-12．29）,P=0．00]并降低复发率[RR=0．49,95％CI（0．26～0．95）,P=0．03]。在植片裂开或丢失率方面,两种固定方法的差异无统计学意义[RR=3．41,95％CI（0．85～13．68）,P=0．08]。结论在翼状胬肉切除联合自体球结膜移植术中,使用纤维蛋白胶黏合植片代替缝线缝合植片疗效好,操作简单。由于本系统评价纳入研究病例数较少,上述结论有待更多设计严谨的大样本RCT加以验证。     

中西医结合治疗外伤性视神经病变疗效评价的Meta分析

目的:系统评价中西医结合治疗外伤性视神经病变(TON)的临床疗效及安全性。方法:通过计算机检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普数据库自建库至2020-05的关于中西医结合与单纯西医治疗TON的随机对照研究,使用Cochrane评价手册对纳入文献进行质量评价,使用RevMan5.3统计软件进行资料提取与Meta分析。结果:共筛选出12篇符合纳入、排除标准的文献;Meta分析结果显示,与单纯西药治疗TON比较,中西医结合治疗有效率更高[RR=1.33,95%CI(1.23~1.45),P<0.001];在改善视力[MD=0.18,95%CI(0.14~0.23),P<0.001]、视野平均缺损[MD=-3.08,95%CI(-5.20~0.96),P=0.004]、视觉诱发电位P100波峰潜时[MD=-9.47,95%CI(-16.37~2.57),P=0.007]以及视觉诱发电位P100波峰振幅[MD=1.44,95%CI(0.22~2.66),P=0.02]上作用更显著。纳入文献有2篇提及不良反应的发生和处理,余10篇均未描述。结论:与单纯西医治疗相比,中西医结合治疗TON的疗效更佳。     

环孢素A在防止翼状胬肉术后复发中作用的meta分析

背景翼状胬肉是常见的眼表疾病，目前主要采取手术行翼状胬肉切除治疗，然而术后复发率较高。近年来有研究提出术后局部应用环孢素A（CsA）能有效降低其术后复发概率，但尚缺乏循证医学评价的证据。目的为CsA在翼状胬肉切除术中临床疗效的评价寻求循证依据。方法采用检索策略并选择关联检索词对数据库建库至2012年10月已发表有关比较翼状胬肉术后是否使用CsA滴眼剂的随机对照试验（RCT）和前瞻性队列研究（Cohort）进行检索，检索的数据库包括MEDLINE、EMBASE、Cochrane图书馆、中国期刊全文数据库（CNKI）、万方数据库和维普数据库（VIP），由2名研究者独立提取资料，对符合纳入标准的文献进行meta分析。Meta分析中纳入的关联结局指标包括术后复发率、Schirmer试验I（sIt）及术后并发症发生率。采用RevMan5．0软件进行统计分析，若纳入的各研究无异质性（P≥0．1，异质性检验，2〈50％），对计数指标的相对危险度（RR）和计量指标的加权均数差（WMD）采用固定效应模型进行分析，反之则采用随机效应模型，计算各指标95％可信区间（CI）。结果共检索到符合纳入标准的相关文献6篇，包括RCT4篇和Cohort研究2篇，1篇RCT的Jadad量表评分为5分，另3篇均为2分；2篇Cohort研究的纽卡斯尔一渥太华量表（NOS）评分为6～7分，共纳入309例366眼。6篇文献发表时间为2008--2012年。Meta分析显示，CsA组术后翼状胬肉的复发率和并发症的发生率均明显低于对照组，差异均有统计学意义（RR：0．39；95％CI：0．24～0．64，P=0．0002；RR=0．24；95％CI：0．13—0．44，P〈0．00001）。CsA组术眼术后sIt较术前的提高值明显高于对照组，差异有统计学意义（WMD=2．47，95％CI：1．59～3．35，P〈0．00001）。亚组分析结果与合并结果吻合。结论翼状胬肉切除术中使用CsA滴眼剂能有效降低术后复发率及术后并发症的发生率。     

Twenty-four hours intraocular pressure in keratoconic eyes assessed by applanation tonometry and Tono-Pen AVIA

AIM: To assess intraocular pressure (IOP) during the daily curve of intraocular pressure (DCPo) in keratoconic eyes and compare Goldmann applanation tonometer (GAT), without and with astigmatism correction (nGAT and cGAT) and Tono-Pen AVIA (TPA) assessment methods. METHODS: Thirty-nine keratoconic eyes of 24 patients were assessed. DCPo was evaluated with five IOP measurements; four were performed with a GAT (nGAT and cGAT), and a Tono-Pen AVIA (TPA) at various times throughout the day. RESULTS: Mean IOP DCPo values (mm Hg) were: nGAT, 9.9±2.6; cGAT, 11.3±2.6; TPA 12.3±3.1. Mean IOP DCPo differences (mm Hg) and Spearman’s correlation coefficients were as follows: cGATc-nGAT, 1.32±1.31, rs=0.879 (P<0.01); cGAT-TPA, -1.02±2.08, rs=0.723 (P<0.01); and nGAT-TPA, -2.35±2.23, rs=0.730 (P<0.01). Bland-Altman analysis for agreement between cGAT-TPA and nGAT-TPA mean IOP DCPo measurements revealed a mean difference of 1.02 (95%CI, 0.35-1.70) and 2.35 (95%CI, 1.62-3.07) mm Hg, respectively. Regression analysis yielded the following equation: TPA IOP=5.49+0.775×cGAT-0.015×ACD-0.299×corneal astig matism, which allowed us to infer TPA IOP values from other parameters. CONCLUSION: In keratoconic eyes, IOP peaks of DCPo measurements are identified at 6 a.m., independent of the tonometer. The mean DCPo values are: TPA>cGAT>nGAT. IOP TPA measures are predictive of cGAT values, adjusted according to anterior chamber depth and corneal astigmatism.     

Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery: a technique note

AIM: To report a technique used with intermittent sliding-lock-knot (ISLK) fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent (RI) fixation. METHODS: Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed. Primary outcome measures were mean duration of surgery and suture removal, degree of conjunctival hyperemia on postoperative day 1, pain score at suture removal, postoperative symptoms at 6mo, including conjunctival hyperemia, foreign body sensation, and graft stability. RESULTS: Ninety-eight patients underwent monocular surgery and were divided into ISLK (51 eyes) and RI (47 eyes) groups according to the type of conjunctiva autograft fixation method planned. There was no significant difference in mean duration of surgery between the two groups (18.59±2.39min vs 18.15±2.20min, P=0.417); however, compared to the RI group, shorter suture removal times were observed in the ISLK group [0.58min (0.42-0.87) vs 3.00min (2.21-4.15), P<0.001]. The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group (P<0.001). Pain scores at suture removal were lower in the ISLK group than in RI group [1 (0-3) vs 2 (1-4), P<0.001]. Postoperative symptoms at 6mo were comparable between the groups (P=0.487), with no recurrence. CONCLUSION: ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision. Compared to RI fixation, ISLK facilitates suture removal and reduces discomfort, with comparable surgery duration and less conjunctival hyperemia.     

羊膜移植联合丝裂霉素C治疗翼状胬肉的Meta分析

目的：比较羊膜移植联合丝裂霉素C（mitomycin C,MMC）与羊膜移植在翼状胬肉治疗中的有效性和安全性. 方法：我们进行Meta分析进行比较.计算机扩大检索Cochrane图书馆,MEDLINE,EMBASE,CBMdisc,CNKI.等数据库获得数据.通过Cochrane协作网提供的RevMan4.2软件进行数据统计分析. 结果：羊膜移植联合MMC显著降低了翼状胬肉的复发率.但是否会增加术后的并发症仍需更多的临床试验证实.入选的6项临床试验均报道了翼状胬肉术后的复发率,包括882眼,3项临床试验报道了术后并发症情况.Meta分析的结果显示羊膜移植联合MMC组复发率为5.41%,只进行羊膜移植组复发率为16.89%,相对危险度为0.32,95%可信区间为0.19-0.56,Z值为4.06,P〈0.001.2项研究报道了术后早期点状角膜炎的发生情况,羊膜移植联合MMC组与羊膜移植组的发病率分别为17.14%和0.00%,相对危险度为12.11,95%可信区间为1.62-90.76. 结论：与羊膜移植相比,羊膜移植联合MMC联合治疗翼状胬肉显著降低了术后复发率.     

Amniotic membrane grafting in the surgical management of primary pterygium

BACKGROUND: To evaluate the efficacy of amniotic membrane transplantation in primary pterygium surgery. METHODS: Patients presenting to the outpatient clinic of the Royal Victorian Eye and Ear Hospital with primary pterygium requiring surgical management were included in this study. The pterygia were excised to bare sclera and the conjunctival defects were closed with amniotic membrane grafts. The primary outcome was pterygium recurrence. RESULTS: Twenty-eight pterygia of 26 patients were included. Twenty-three patients (88%, 25 eyes) completed 12 months follow up. By 12 months postoperatively 16 of these eyes (64%) had developed corneal recurrence and a further two had developed a limbal recurrence (9%). Five required repeat surgery during the 12 month follow-up period. No association was found between pterygium recurrence and pterygium size (P = 0.33), amniotic membrane graft dimension (P = 0.12), patient age (P = 0.53) or patient sex (P = 0.63). CONCLUSION: Amniotic membrane grafting for primary pterygium was associated with an unacceptably high recurrence rate in this population.