[In Press] Changes in intraocular pressure and central corneal thickness during pregnancy: a systematic review and Meta-analysis

AIM: To conduct a Meta-analysis for investigating the variations in intraocular pressure (IOP) and central corneal thickness (CCT) during normal pregnancy. METHODS: We searched for clinical trials published up to November 2015 without language or region restrictions in PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, Ovid, EBSCO, Elsevier, the Chinese Biomedicine Database, WanFang, CNKI, CQVIP and Google Scholar. Studies of the ocular changes observed in pregnant women were selected. The main outcomes were assessed by changes in IOP and CCT. RESULTS: Fifteen studies were included. In subgroup analyses, IOP was significantly decreased during the second (MD=-1.53, 95% CI [-2.19, -0.87]; P<0.00001) and third (MD=-2.91, 95% CI [-3.74, -2.08]; P<0.00001) trimesters of pregnancy. CCT was increased during the second (MD=10.12, 95% CI [2.01, 18.22]; P=0.01) trimester of pregnancy; moreover, during the third trimester of pregnancy, the CCT displayed an increasing trend, but the difference was not significant (MD=5.98, 95% CI [-1.11, 13.07]; P=0.1). CONCLUSION: A decrease in IOP was accompanied by an increase in CCT in the second and third trimesters of a normal pregnancy in women.     

Fixed combination of latanoprost and timolol vs the individual components for primary open angle glaucoma and ocular hypertension:a systematic review and meta-analysis

AIM:To assess the effects of the fixed combination of 0.005% latanoprost and 0.5% timolol (FCLT) vs their individual components for primary open angle glaucoma (POAG) and ocular hypertension (OHT).METHODS:After searched PubMed, EMBASE, the Cochrane Library and SCI, all randomized controlled clinical trials (RCTs) and cross-over studies were included. The control groups were the mono therapy or the concomitant therapy of latanoprost and timolol. The outcomes were visual field defect, optic atrophy, mean intraocular pressure (IOP) and IOP fluctuation. The analysis was carried out in RevMan version 5.1 software.RESULTS:The post-intervention mean IOP of FCLT was significantly lower compared to timolol [mean difference (MD) -2.92, 95%CI -3.28 to -2.55, P<0.00001] and latanoprost (MD -1.11, 95%CI -1.51 to -0.72, P＜0.00001). The post-intervention IOP fluctuation was also significantly lower compared to timolol (MD -0.88, 95%CI -1.23 to -0.53, P<0.00001) and latanoprost (MD -0.63, 95%CI -1.04 to -0.22, P=0.002). The mean IOP was higher in FCLT morning dose group than the one in unfixed combination of 0.005% latanoprost and 0.5% timolol (UFCLT) (MD 1.10, 95%CI 0.81 to 1.39, P<0.00001). Otherwise, there was no difference between FCLT evening dose group and UFCLT (MD 0.34, 95% CI -0.01 to 0.69, P=0.06). There was no statistical difference for the incidence of visual field defect and optic atrophy between FCLT and the monotherapy of components.CONCLUSION:A better IOP lowering effect has been demonstrated for FCLT compared to the mono therapy of components. The IOP lowering effect was worse for FCLT morning dose and almost same for FCLT evening dose compared to the UFCLT. We need more long-term high quality RCTs to demonstrate the outcomes of visual field defect and optic atrophy.     

Effect of pregnancy on intraobserver and intertechnique agreement in intraocular pressure measurements

AIM: To evaluate the effect of pregnancy on intraobserver and intertechnique agreement for intraocular pressure (IOP) measurements. MATERIAL AND METHODS: Right eyes of 88 healthy women who were likely to become pregnant and of 94 healthy age-matched females were included in the study. Complete ocular examinations were performed on each eye. IOP measurements were obtained by Goldmann, Schiotz and non-contact tonometers (NCT) during 3-week exam periods before (within 6 weeks of conception) and during pregnancy (first, second and third trimesters) for pregnant cases, and in similar time intervals for control subjects. In each exam period, three readings with each of three separate tonometers were obtained, at least 1 day apart. Intraobserver and intertechnique agreements for IOP measurements were assessed. RESULTS: The mean visual acuity, keratometry and refractive error of both control and pregnant subjects did not change significantly during the study (all p values >0.01). In late pregnancy, pregnant cases demonstrated significant decreases in IOP measurements obtained with each of the three tonometers, and in intraobserver agreement with Goldmann and Schiotz tonometers (all p values <0.01). Intertechnique agreement of both Goldmann and Schiotz tonometers with NCT decreased significantly in the third trimester. Both intraobserver and intertechnique agreement in IOP measurements of control subjects were not found to change significantly during the study (all p values >0.01). CONCLUSION: IOP significantly decreased in the third trimester of pregnancy. Perfect intraobserver agreement in IOP readings of pregnant subjects was obtained with NCT. This may suggest that NCT is a viable option for IOP measurements during the follow-up of pregnant patients at risk for glaucoma.     

Pulsatile ocular blood flow during pregnancy

PURPOSE: To study pulsatile ocular blood flow (POBF) throughout pregnancy. METHODS: We enrolled twenty-seven healthy women in the first trimester of gestation, only ten of which were followed through the second trimester, and fourteen non pregnant healthy women. In each subject we measured POBF with the POBF pneumotonometer (OBF Ltd. UK), IOP, blood pressure (BP) and heart rate (HR). An unpaired Student t-test was used to compare pregnant women with non-pregnant women, and a two-tailed paired Student t-test was used to compare the same women in the first and second trimester of pregnancy. p <0.05 is considered statistically significant. RESULTS: Results are presented as means +/- SD. In the first trimester of pregnancy the age was 32 +/- 6, POBF 1516.4 +/- 382 ml/min, IOP 13 +/- 3 mmHg, BP 92 +/- 6 mmHg, and HR 86 +/- 14 beats/min. In the second trimester POBF was 1629.11 +/- 352.4 ml/min, intraocular pressure (IOP) 12 +/- 3 mmHg, BP 96 +/- 3 mmHg, and HR 93 +/- 10 beats/min. In the control group the age was 27 +/- 9, POBF 972.23 +/- 329.3 ml/min, BP 88 +/- 4.3 mmHg, and HR 80 +/- 14 beats/min. POBF increases during the first trimester (p = 0.00008). In the second trimester POBF was higher compared to the first trimester (p = 0.0008). Non significant differences were observed for the other parameters. CONCLUSIONS: The POBF increases throughout gestation. During pregnancy there is an increase in estrogen which induces endothelial-dependent vasodilatation in several tissues. The estrogen changes may influence POBF.     

Corneal thickness and visual field damage in glaucoma patients

PURPOSE: To verify whether there was a significant correlation between central corneal thickness (CCT) and visual field damage in patients with primary open angle glaucoma (POAG). METHODS: A total of 99 eyes with POAG were consecutively recruited. Patients were classified as glaucomatous based on visual field and optic nerve head damage. All underwent applanation tonometry, Humphrey perimetry, and measurement of CCT with ultrasonic pachymetry. Based on CCT value, the sample was split at the mode in two groups (group 1<535 microm, n=49; group 2>or=535 microm, n=50). RESULTS: Entire cohort: mean CCT 554 microm+/-45.03; mean deviation (MD) -6.68 dB+/-7.32; pattern standard deviation (PSD) 5.33+/-3.75; intraocular pressure (IOP) 17.91+/-4.16 mmHg with treatment. Group 1: CCT was 504.8 microm+/-30.8; MD -9.01 dB+/-8.72; PSD 6.38+/-3.99; IOP 18.02 mmHg+/-4.66. Group 2: mean CCT 574.6 microm+/-35.03; MD -4.39 dB+/-4.70; PSD 4.25+/-3.19; IOP 17.79 mmHg+/-3.57. A significant difference was found between the two groups for both MD and PSD. Linear regression analysis showed a significant correlation between CCT and PSD (P<0.001). CONCLUSIONS: Our data show that patients with a thinner cornea had a worse MD and PSD. As a thinner CCT causes an underestimation of the true IOP, there may be a delay in the diagnosis of POAG or an inadequate estimate of the clinical course despite apparently desirable IOP applanation readings.     

Topical ketotifen treatment for allergic conjunctivitis: a systematic review and Meta-analysis

AIM: To assess the efficacy of ketotifen in treating allergic conjunctivitis. METHODS: A systematic search of systematic reviews and Meta-analyses was conducted on the PubMed and Web Science of Science until October 2021 to address this knowledge gap. Mean difference with 95%CI and P values were used to assess the efficacy of ketotifen. The heterogeneity (I2) was used to evaluate the impact of heterogeneity. RESULTS: Eight randomized controlled trials (RCTs) involving 1589 patients were included in this Meta-analysis. The results revealed that after treating with ketotifen, itching (MD=-0.91, 95%CI: -1.63 to -0.20, I2=94%, P=0.01), tearing (MD=-0.40, 95%CI: -0.61 to -0.18, I2=75%, P=0.0003) and total signs and symptoms (MD=-0.85, 95%CI: -1.12 to -0.58, I2=0, P<0.00001) showed better benefit effect compared to the placebo group. CONCLUSION: Topical ketotifen is an effective treatment for patients with allergic conjunctivitis.     

Treatment of Vogt-Koyanagi- Harada's disease during pregnancy

BACKGROUND: Caution should be exercised in treating patients with autoimmune diseases during pregnancy. CASES: We successfully treated three cases of Vogt-Koyanagi-Harada's disease (VKH disease) during pregnancy. OBSERVATIONS: In the second trimester (14-27 weeks) of 1 patient, inflammation was mild and could be treated by topical corticosteroid. There is the possibility that her immune response had been modified by pregnancy. Systemic corticosteroid in a high dose was administered to the two cases in the second and third trimesters of pregnancy (28-41 weeks). The severity of inflammation in these 2 patients was similar to that in nonpregnant women. Inflammation subsided immediately without recurrence in all cases. No abnormality was found during the deliveries or in the babies. CONCLUSIONS: Treatment for VKH disease during pregnancy should be chosen according to the severity of inflammation, the stage of pregnancy, and the maternal and fetal conditions.     

Effect of prostaglandin analogues on central corneal thickness in patients with glaucoma: A systematic review and meta-analysis with trial sequential analysis

The objective of this meta-analysis was to evaluate the effect of prostaglandin analogues (PGA) on central corneal thickness (CCT) in patients with glaucoma. Key electronic databases were searched for randomized controlled trials (RCTs) involving the CCT effects of prostaglandin use for glaucoma. Primary outcome measures were the mean difference in the CCT measurement from baseline to the last available assessment. Intraocular pressure and other corneal changes were recorded as secondary. Efficacy estimates were measured by their weighted mean difference (WMD) with 95% confidence intervals (CI’s) by using the random-effects model for primary and secondary outcomes Trial sequential analysis was used to determine if the current evidence was sufficient and conclusive. Eight RCTs met our inclusion criteria. A total of 879 patients were included. The overall effect showed that PGA’s had a significant CCT lowering effect (WMD = −7.04, 95%CI: −10.07 to −4.00, P < 0.00001). We pooled results of 5 RCT’s on Travoprost (WMD = −10.44, 95%CI: −16.80 to −4.08, P = 0.001), seven trials on Latanoprost (WMD = −4.73, 95% CI: −9.70 to 0.25, P = 0.06), and three trials on Bimatoprost (WMD = −11.88, 95%CI: −21.03 to −2.73, P = 0.01). The WMD across groups in >6 months of PGA use was −11.37 (95%CI: −17.17 to −5.58, P = 0.0001), and in <6 months of PGAs group was −8.35 (95% CI: −12.01 to −4.69, P < 0.00001), suggesting a longitudinal effect of PGAs on CCT. In conclusion, Bimatoprost and Travoprost caused a statistically significant reduction in the thickness of central cornea. Though only a few studies were included, the narrow confidence intervals and adequate sample size suggest that these findings are valid.     

原发性开角型青光眼非对称性视野损害的影响因素

目的：探讨原发性开角型青光眼（POAG）非对称性视野损害的相关因素，并了解非对称性视野损害者双眼间眼部参数的差异。方法：横断面研究。收集2014年1月至2018年12月温州青光眼进展研究 （WGPS）中确诊的POAG患者，分析双眼眼部参数，包括眼压、眼轴长度（AL）、中央角膜厚度（CCT）、 前房深度（ACD）、晶状体厚度（LT）、视野平均偏差（MD）、视网膜神经纤维层厚度（RNFLT）、盘沿 面积、视盘面积、杯盘比、视杯容积。非对称性视野损害定义为双眼视野MD的绝对差值≥5 dB， 根据此标准将受检者分为对称组和非对称组，分析2组眼部参数与非对称性视野损害的关系。非对称组进一步行双眼间眼部参数的比较。采用独立样本t检验、Mann-Whitney U检验、配对t检验、 Wilcoxon检验、Logistic回归分析对数据进行分析。结果：共纳入POAG患者142例（284眼），对称组 92例（64.8%），男39例（42.4%），年龄（65.3±1.0）岁；非对称组50例（35.2%），男32例（64.0%），年 龄（67.6±9.1）岁。男性[OR=4.52，95%可信区间（CI）：1.90～10.73，P=0.001]、较差眼的CCT较薄 （OR=0.97，95%CI：0.95～0.99，P=0.003）、双眼平均RNFLT差值增大（OR=1.10，95%CI：1.04～1.15， P<0.001）为非对称性视野损害的危险因素。非对称组中，视野损害较重眼相比对侧眼，其平均 RNFLT较薄（Z=-7.80，P<0.001），盘沿较窄（t=-4.97，P<0.001），视盘面积较大（t=2.38，P=0.02）， 平均杯盘比（Z=-4.51，P<0.001）和垂直杯盘比（Z=5.16，P<0.001）均较大，视杯容积较大（Z=-3.31， P<0.001），但双眼间眼压、等效球镜度（SE）、AL、CCT、LT和ACD的差异均无统计学意义。结论：男性、CCT较薄、双眼平均RNFLT差值增大为POAG非对称性视野损害的独立危险因素，而非对称性视野损害者其双眼中的较大视盘眼，更容易发生视神经损害。     

Predictive factors of visual function recovery after pituitary adenoma resection: a literature review and Meta-analysis

AIM: To determine the dominant predictive factors of postoperative visual recovery for patients with pituitary adenoma. METHODS: PubMed, Google Scholar, Web of Science and Cochrane Library were searched for relevant human studies, which investigated the prediction of the postoperative visual recovery of patients with pituitary adenoma, from January 2000 to May 2017. Meta-analyses were performed on the primary outcomes. After the related data were extracted by two independent investigators, pooled weighted mean difference (WMD) and odds ratio (OR) with 95% confidence interval (CI) were estimated using a random-effects or a fixed-effects model. RESULTS: Nineteen studies were included in the literature review, and nine trials were included in the Meta-analysis, which comprised 530 patients (975 eyes) with pituitary adenoma. For the primary outcomes, there was a significant difference between preoperative and postoperative mean deviation (MD) values of the visual field (WMD -5.85; 95%CI: -8.19 to -3.51; P<0.00001). Predictive characteristics of four factors were revealed in this Meta-analysis by assigning the patients to sufficient and insufficient groups according to postoperative visual field improvements, including preoperative visual field defect (WMD 10.09; 95%CI: 6.17 to 14.02; P<0.00001), patient age (WMD -12.32; 95%CI: -18.42 to -6.22; P<0.0001), symptom duration (WMD -5.04; 95%CI: -9.71 to -0.37; P=0.03), and preoperative peripapillary retinal nerve fiber layer (pRNFL) thickness (OR 0.1; 95% CI: 0.04 to 0.23; P<0.00001). CONCLUSION: Preoperative visual field defect, symptom duration, patient age, and preoperative pRNFL thickness are the dominant predictive factors of the postoperative recovery of the visual field for patients with pituitary adenoma.     

Comparison of intraocular pressure measured by Pascal dynamic contour tonometry and Goldmann applanation tonometry

AIMS: To compare the intraocular pressure (IOP) measurements obtained using the Pascal dynamic contour tonometer (PDCT) with the standard Goldmann applanation tonometer (GAT) and to correlate these with central corneal thickness (CCT) in patients with normal corneas. METHODS: A prospective, masked, comparative case series of 116 eyes from patients attending a glaucoma clinic. IOP was measured with PDCT by one examiner and with GAT by a masked, independent examiner. A mean of six CCT readings was used for analysis. RESULTS: IOP measured by the two instruments correlated significantly (r=0.77; P<0.0001). IOP measured by GAT correlated strongly with CCT (r=0.37, P=0.0001) whereas the relationship between IOP measured by PDCT and CCT approached significance (r=0.17, P=0.073). The differences between GAT and PDCT measured IOP also correlated strongly with CCT (r=0.37, P<0.0001). The 95% limits of agreement between GAT and PDCT were +/-4.2 mmHg. Dividing the eyes into three groups on the basis of CCT, demonstrated those in the thickest tertile showed a poorer agreement between instruments and the GAT measured significantly higher IOP in this group (P=0.003) while the PDCT showed no significant differences with different CCTs (P=0.37). CONCLUSION: Demonstration of the relative independence of PDCT IOP measurements from CCT supports a potential clinical role for this instrument, particularly for subjects with CCT outside the normal range.     

Patterns of exacerbations of chronic non-infectious uveitis in pregnancy and puerperium

PURPOSE: To determine patterns of exacerbations of recurrent non-infectious uveitis during pregnancy and puerperium. DESIGN: Retrospective cohort study. METHODS: The medical records of 32 women with a history of chronic non-infectious uveitis, who were pregnant during their follow-up at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary, from 1983 through 2003, were reviewed. The uveitis relapse rate during pregnancy was compared to the relapse rate during pregnancy-free periods in these women and to the relapse rate in a control group of women of childbearing age with recurrent non-infectious uveitis. RESULTS: Among the 32 women who were pregnant during follow-up (40 pregnancies), the rate of flare-ups during pregnancy (1.0 recurrence per year) was lower than that observed during non-pregnant periods (2.4 per year; p<0.001) and lower than that observed in the non-pregnant control group (3.1 per year; p<0.001). Flare-ups were most frequent in the first trimester of pregnancy and decreased markedly in the second and third trimesters (2.3, 0.5, and 0.4 recurrences per year, respectively; p<0.001). CONCLUSIONS: Pregnancy is associated with lower numbers of flare-ups of non-infectious uveitis compared to the non-pregnant state. If flare-ups do occur during pregnancy, they happen predominantly in the first trimester.     

Central corneal thickness and visual field progression in patients with chronic primary angle-closure glaucoma with low intraocular pressure

PURPOSE: To determine the association of central corneal thickness (CCT) and visual field progression in patients with chronic primary angle-closure glaucoma (CPACG) with low intraocular pressure (IOP). DESIGN: Retrospective, comparative case series. METHODS: A total of 163 eyes with CPACG and sustained IOP <18 mm Hg were included. Initial and three-year after mean deviation (MD) on Humphrey field analyzer and CCT with ultrasonic pachymetry were recorded. On the basis of the CCT value, the sample was split in two groups (group 1 <540 microm; group 2 > or =540 microm). RESULTS: Mean CCT was 525.8 +/- 11.6 microm in group 1 and 574.4 +/- 24.0 microm in group 2. There was no significant difference for initial MD (P = .979), but a significant difference was found between two groups for follow-up MD (P = .023). CONCLUSIONS: Patients with CPACG with a thinner cornea are at greater risk for visual field progression even if they maintain a low IOP after treatment.     

The relationship between age and intraocular pressure in a Japanese population: the influence of central corneal thickness

PURPOSE: Previous cross-sectional Japanese studies have shown that intraocular pressure (IOP) decreases with age. However, central corneal thickness (CCT) variation should also be considered when examining the relationship between age and IOP, since tonometry has an inherent measurement error due to CCT variations. This study investigates the influence of CCT variation on the age-IOP relationship in a Japanese population. METHODS: The right eyes of 1317 subjects from 40 to 80 years old selected from a general population using a random sampling method were assessed in cross-section. The IOP was measured with a non-contact tonometer, and CCT was measured with a specular microscope. The relationships between age, IOP, and CCT were assessed using correlation analyses, while the relationship between age and IOP controlled for CCT, blood pressure, and body mass index was investigated using multivariate regression analyses. RESULTS: The mean (+/- SD) IOP value was 13.6 (+/- 2.6) mmHg in men and 13.3 (+/- 2.6) mmHg in women. The IOP correlated inversely with age in men (r = -0.14, p < 0.001), but showed only a marginal inverse correlation in women (r = -0.07, p = 0.066). The mean (+/- SD) CCT value was 518.3 (+/- 33.2) microm in men and 511.1 (+/- 33.0) microm in women. Only in men was an inverse correlation seen between CCT and age (r = -0.10, p = 0.009), but both genders had positive correlations between CCT and IOP (man: r = 0.44, p < 0.001; woman: r = 0.48, p < 0.001). In multivariate analyses, CCT was shown to have an effect on IOP measurement, however, it was shown that IOP still decreases with age in both sexes even when adjusted for CCT (p = 0.001). CONCLUSIONS: The IOP decreases with age in the Japanese, and CCT variation has practically no effect on the unique age-IOP relationship.     

Relationship between travoprost and central corneal thickness in ocular hypertension and open-angle glaucoma

PURPOSE: To evaluate whether treatment with travoprost, an F2a prostaglandin analog, affects central corneal thickness (CCT) and whether intraocular pressure (IOP) response to the medication is related to baseline CCT. METHODS: This was a prospective, interventional, nonrandomized, nonconsecutive, clinical trial. In this multicenter study, 379 total patients, 220 with newly or previously diagnosed open-angle glaucoma (OAG), 141 with ocular hypertension (OHT), and 18 unspecified, were recruited from 15 Canadian sites. IOP and CCT assessments were performed at baseline and 6 weeks after treatment with travoprost. Patients on IOP-lowering therapy at the time of enrollment were washed out for 4 weeks before baseline examinations. IOP was measured with Goldmann tonometers and CCT with Accutome IV pachymeters. Statistical analysis was performed with S-PLUS software. RESULTS: Posttherapy mean IOP decreased by 6.31 mm Hg or 24.4% (P < 0.001), and regression analysis indicated relatively greater IOP reduction in patients with higher pretherapy IOP (slope = 0.64; 95% CI, 0.54-0.76). Mean CCT decreased by 6.9 microm (P < 0.001). IOP reduction was not related to CCT reduction (slope = 0.253; 95% CI, -0.232 to 0.739; P = 0.305). Percent IOP decrease was not related to baseline CCT (slope = -0.02; 95% CI, -0.06 to 00.02; P = 0.33) in the total study sample. When OHT and OAG groups were considered separately, the OAG patients had less percent IOP decrease with thicker baseline CCT (slope = -0.067; 95% CI, -0.13 to -0.004; P = 0.037). CONCLUSIONS: Treatment with travoprost decreased IOP significantly and was associated with CCT thinning, which had little or no effect on actual IOP decrease. In the OAG group, IOP decrease was found to be statistically smaller in patients with thicker corneas.     

Comparison of intravitreal aflibercept and dexamethasone implant in the treatment of macular edema associated with diabetic retinopathy or retinal vein occlusion: a Meta-analysis and systematic review

AIM: To compare the efficacy and safety of intravitreal aflibercept with dexamethasone implant in the treatment of macular edema (ME) associated with diabetic retinopathy (DR) or retinal vein occlusion (RVO). METHODS: A comprehensive search of studies comparing dexamethasone and aflibercept in patients with ME was conducted at PubMed, Embase, and Cochrane Central Register of Controlled Trials from the beginning of library to April 16, 2021. Extracting the data including best-corrected visual acuity (BCVA), central retinal thickness (CRT), number of injections and serious adverse events (SAEs) from the final qualified articles. RevMan 5.3 software was used for Meta-analysis of the included studies. RESULTS: Totally 7 studies with 369 eyes were included. The causes of ME in the final screening study included RVO and DR. Compared with the aflibercept treatment group, the BCVA of the dexamethasone implant treatment group showed no significant difference in the follow-up for 3mo [mean difference (MD): -0.05, 95% confidence interval (CI): -0.11, 0.02; P=0.17] and 12mo (MD: -0.01, 95%CI: -0.38, 0.37; P=0.98), but it was slightly worse than the aflibercept group at 6mo (MD: 0.12, 95%CI: 0.03, 0.21; P=0.008). In terms of CRT reduction, there was no significant difference between the two groups at 3mo (MD: -28.14, 95%CI: -79.95, 23.67; P=0.29), 6mo (MD: 27.67, 95%CI: -84.89, 140.24; P=0.63), and 12mo (MD: -59.00, 95%CI: -127.37,9.37; P=0.09). However, dexamethasone implant had fewer injections, but more adverse events such as elevated intraocular pressure (IOP) and cataract. CONCLUSION: Intravitreal injection of aflibercept and dexamethasone implant can both effectively increase BCVA and reduce CRT. Compared with aflibercept, dexamethasone implant is not inferior in improving vision and reducing CRT in the initial treatment period (3mo) and long-term treatment period (12mo). Besides, it has fewer injections and more likely to cause elevated IOP and cataract.     

Assessment of the diurnal variation in central corneal thickness and intraocular pressure for patients with suspected glaucoma

OBJECTIVE: To assess whether a single daily measurement using ultrasonic pachymetry gives a representative assessment of mean central corneal thickness (CCT) in patients with suspected glaucoma and whether diurnal changes in CCT are related to diurnal variations in intraocular pressure (IOP). DESIGN: Cross-sectional study. METHOD: Central CCT and IOP were measured by a single observer in 56 eyes of 28 patients with suspected glaucoma using an ultrasonic pachymeter and a Goldmann tonometer. Four measurements were made over a 24-hour period: at 8:00 AM, 12:00 PM, 4:00 PM, and 8:00 PM. MAIN OUTCOME MEASURES: Intraocular pressure and pachymetry. RESULTS: Mean IOP was 19.80 mmHg at 8:00 AM (95% confidence interval [CI], 18.95-20.66 mmHg), 20.38 mmHg at 12:00 PM (95% CI, 19.49-21.26 mmHg), 19.91 mmHg at 4:00 PM (95% CI, 19.99-21.83 mmHg), and 19.23 mmHg at 8:00 PM (95% CI, 18.35-20.11 mmHg). Mean CCT was 569.4 microm (95% CI, 560.2-578.7 microm), 567.6 microm (95% CI, 558.4-576.7 microm), 569.1 microm (95% CI, 559.5-578.6 microm), and 567.2 microm (95% CI, 557.9-576.4 microm) at the four respective time points. There was no significant correlation between IOP and CCT in any patient (Pearson rank correlation coefficient); nor was there any significant correlation between the mean diurnal variations of IOP and CCT. CONCLUSIONS: In this group of patients with suspected glaucoma, there was no significant variation in CCT. Therefore, a single measurement of CCT is sufficient when assessing patients with suspected glaucoma. There was no correlation between change of IOP and change of CCT.     

玻璃酸钠联合rhEGF滴眼液治疗白内障术后干眼疗效的Meta分析

目的:运用Meta分析方法系统评价近5a玻璃酸钠联合重组人表皮生长因子(rhEGF)滴眼液治疗白内障术后干眼的疗效。方法:计算机检索2015-01/2020-05中国知网数据库、万方数据库、重庆维普中文科技期刊全文数据库、中国生物医学文献数据库(CBM)、Cochrane Library、PudMed、MEDLINE等数据库关于采用玻璃酸钠联合rhEGF滴眼液治疗白内障术后干眼的的临床对照研究相关文献,使用Rev-man 5.3统计软件进行Meta分析和统计处理。结果:共纳入14项随机对照研究,患眼1529例。其中14项研究在治疗结束后进行了角膜荧光素染色(FL)评分,结果显示差异有统计学意义[MD=-0.86,95%CI(-1.07~-0.66),P<0.00001];14项研究在治疗结束后进行了泪膜破裂时间(BUT)测定,结果显示差异有统计学意义[MD=2.33,95%CI(1.64~3.03),P<0.00001];12项研究在治疗结束后进行了泪液分泌试验(SⅠt)测定,结果显示差异无统计学意义[MD=0.49,95%CI(-0.52~1.50),P=0.34];12项研究在治疗结束后进行了总体有效率计算,结果显示差异有统计学意义[OR=4.88,95%CI(3.34~7.14),P<0.00001];4项研究在治疗结束后进行了干眼症状评分测定,结果显示差异有统计学意义[MD=-1.09,95%CI(-1.58~-0.61),P<0.00001]。结论:玻璃酸钠联合rhEGF滴眼液治疗白内障术后干眼能显著提高角膜修复能力和BUT,在治疗白内障术后干眼总体疗效上更具优势。     

Atropine 0.01% eye drops slow myopia progression: a systematic review and Meta-analysis

AIM: To evaluate the effects of atropine 0.01% on slowing myopia progression. METHODS: We searched for relevant studies in the Cochrane Library, PubMed, Embase, Ovid, CBM, CNKI, VIP and Wan Fang Data in Chinese. A supplementary search was conducted in OpenGrey (System for Information on Grey Literature in Europe), the ISRCTN registry, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from the dates of inception to June 30, 2018. RESULTS: Seven randomized controlled trials (RCTs) with a total of 1079 subjects were included (505 in the atropine 0.01% group and 574 in the control group). The results showed that the atropine 0.01% group exhibited significantly greater control of axial growth than the control group [MD=-0.12, 95%CI (-0.19, -0.06)]. There was also a statistically significant difference between the atropine 0.01% and control groups in the changes in axial length [MD=-0.14, 95%CI (-0.25, -0.03)], but the quality of evidence was low. There were no significant differences between the atropine 0.01% and control groups in the overall effect with respect to diopter value, change in diopter, distance vision and intraocular pressure [MD=0.08, 95%CI (-0.27, 0.42); MD=0.09, 95%CI (-0.17, 0.36); MD= -0.01, 95%CI (-0.02, 0.00); MD=0.08, 95%CI (-0.56,0.40)]. The sensitivity analysis showed that the conclusion of the Meta-analysis is relatively stable. With respect to adverse events, there were significant differences between the atropine 0.01% and control groups [OR=0.26, 95%CI (0.11, 0.61)]. CONCLUSION: Based on the available evidence, atropine 0.01% eye drops offer benefits in controlling axial growth and safety without causing significant differences in diopter values, distance vision and intraocular pressure.     

Surgical treatment for primary angle closure-glaucoma: a Meta analysis

AIM:To evaluate the efficacy and safety of trabeculectomy, phacotrabeculectomy plus intraocular lens implantation(phacotrab+IOL group) and phacoemulsification with IOL(phaco+IOL) in primary angle-closure glaucoma(PACG). METHODS: It was a systematic review and meta-analysis, randomized controlled trials(RCT) and clinical controlled trials(CCT) were collected through electronic searches of the Cochrane Library, PubMed, EMbase, Wanfang Database online, Chinese journal Full-text Database, Chinese Scientific Journals Full-text Database (from the date of building the database to October 2010) We also checked the bibliographies of retrieved articles. All the related data that matched our standards were abstracted. The quality of included trials was evaluated according to the Dutch Cochrane Centre. RevMan 5.0 software was used for Meta-analysis. RESULTS: A total of 5 RCT and 11 CCT involving 1495 eyes were included. The results of meta-analysis showed that phacotrab+IOL group was superior than trabeculectomy(trab group) (MD -3.93,95%CI [-7.31, -0.54]) which was also superior than phaco+IOL group(MD 0.52,95%CI [0.10, 0.95]) in decreasing Intraocular Pressure(IOP). Phacotrab group(MD -1.45,95%CI [-1.68, -1.22])and phaco group (MD-1.12,95%CI [-1.87, -0.37])are both deeper than trab group in the anterior chamber depth. In increasing the coefficient of outflow facility of aqueous humor(C values) there was no statistical difference in the three groups. And there was no statistical difference between phacotrab groups and phaco groups in visual acuity but phacotrab group was superior than phaco group (MD 1.07, 95%CI [0.73, 1.40])in the use of IOP-lowering drugs. There was no statistical difference among three groups. CONCLUSION: Current evidence suggests that phacotrab+ IOL group was superior than trab group which was also superior than phaco+IOL group in decreasing IOP. Phacotrab group and phaco group are both deeper than trab group in the anterior chamber depth. Phacotrab group was superior than phaco group in the use of IOP-lowering drugs.