New and Updated Cochrane Systematic Reviews

Cystoid macular edema (CME), a frequent complication of uveitis, is defined as central retinal thickening caused by accumulation of intra-retinal fluid in the outer plexiform and inner nuclear layers of the retina. Chronic retinal edema can lead to vision loss secondary to photoreceptor impairment and retinal pigment epithelium dysfunction. Patients suffering from CME often complain of decrease in visual acuity, contrast sensitivity and difficulty performing near tasks such as reading. The pathophysiology of CME revolves around disruption of the blood-retinal barrier due to release of proinflammatory mediators and/or Muller-cell dysfunction. Imaging modalities have advanced in recent years allowing earlier detection and better management of uveitic CME. Though often managed medically, when CME is refractory to antiinflammatory therapy such as corticosteroids and/or immunomodulators, underlying mechanical causes such as vitreomacular traction and internal limiting membrane gliosis must be considered as causes of CME formation. In such cases, Pars-plana vitrectomy with internal limiting membrane peel may be undertaken. New intraoperative imaging modalities, such as intraoperative optical coherence tomography, carry the promise of better and more accurate surgical manipulations. Publication type: Journal: Review Source: EMBASE 11.Title: Diabetes, fasting glucose, and the risk of glaucoma: A meta-analysis Citation: Ophthalmology, January 2015, vol./is. 122/1(72-78), 0161-6420;1549-4713 (01 Jan 2015) Author(s): Zhao D., Cho J., Kim M.H., Friedman D.S., Guallar E. Language: English Abstract: Topic: We performed a systematic review to summarize the association of diabetes and blood glucose levels with glaucoma, intraocular pressure (IOP), and ocular hypertension in the general population. Clinical Relevance: Diabetes has been proposed as a risk factor for glaucoma, but epidemiologic studies have been inconsistent, and the association is still controversial. Furthermore, no systematic reviews evaluated other metabolic abnormalities, such as the metabolic syndrome, with the risk of glaucoma. Methods: We identified the studies by searching the PubMed and EMBASE databases. We used inversevariance weighted random-effects models to summarize relative risks across studies. Results: We identified 47 studies including 2 981 342 individuals from 16 countries. The quality of evidence generally was higher in the cohort compared with case-control or cross-sectional studies. The pooled relative risk for glaucoma comparing patients with diabetes with those without diabetes was 1.48 (95% confidence interval [CI], 1.29-1.71), with significant heterogeneity across studies (I2 = 82.3%; P < 0.001). The risk of glaucoma increased by 5% (95% CI, 1%-9%) for each year since diabetes diagnosis. The pooled average difference in IOP comparing patients with diabetes with those without diabetes was 0.18 mmHg (95% CI, 0.09-0.27; I2 = 73.2%), whereas the pooled average increase in IOP associated with an increase in 10 mg/dl in fasting glucose was 0.09 mmHg (95% CI, 0.05-0.12; I2 = 34.8%). Conclusions: Diabetes, diabetes duration, and fasting glucose levels were associated with a significantly increased risk of glaucoma, and diabetes and fasting glucose levels were associated with slightly higher IOP. Publication type: Journal: Article Source: EMBASE Full text: Available Ophthalmology at Salisbury District Hospital Healthcare Library Full text: Available Ophthalmology at Ophthalmology 12.Title: Efficacy and adverse events of aflibercept, ranibizumab and bevacizumab in age-related macular degeneration: A trade-off analysis Citation: British Journal of Ophthalmology, February 2015, vol./is. 99/2(141-146), 0007-1161;1468-2079 (01 Feb 2015) Author(s): Schmid M.K., Bachmann L.M., Fas L., Kessels A.G., Job O.M., Thiel M.A. Language: English Abstract: Topic: To quantify the gain in visual acuity and serious side effects of ranibizumab, bevacizumab and aflibercept in age-related macular degeneration (AMD). Clinical relevance: There is an ongoing debate about the optimal treatment of AMD with these three antivascular endothelial growth factor (anti-VEGF) treatments. Methods: Network meta-analyses. (Pre)Medline, EMBASE, SCOPUS, Cochrane Library (until April 2013), Science Citation Index and reference lists were searched for placebo-controlled randomised trials or head-to-head comparisons. Outcomes were 1-year follow-up data of visual acuity (letters gained) and serious (vascular death, any death, stroke, myocardial infarction, transient ischaemic attack) and thrombotic events. Two investigators independently assessed eligibility and quality of included studies and extracted data. Results: 11 trials (enrolling 8341 patients) assessing five active treatments were included. Compared with placebo, all anti-VEGF treatments had a significantly higher percentage of letters gained: ranibizumab 0.3 mg 2.39% (95% CI 1.59 to 3.19; p<0.001), ranibizumab 0.5 mg 3.56% (95% CI 2.58 to 4.13; p<0.001), bevacizumab 1.25 mg 2.14% (95% CI 0.47 to 3.82; p=0.012), aflibercept 0.5 mg 2.91% (95% CI 0.99 to 4.82; p=0.003) and aflibercept 2 mg 3.44% (95% CI 1.73 to 5.14; p<0.001). Compared with placebo, serious side effects were higher in all other treatments: ranibizumab 0.3 mg 4.41% (95% CI 3.42 to 5.40; p<0.001), ranibizumab 0.5 mg 5.33% (95% CI 4.37 to 6.30; p<0.001), bevacizumab 1.25 mg 5.58% (95% CI 3.567 to 7.60; p<0.001), aflibercept 0.5 mg 5.65% (95% CI (3.28 to 8.02; p<0.001) and aflibercept 2 mg 5.29% (95% CI 3.18 to 7.39; p<0.001). Compared with placebo, systemic thrombotic events also occurred more often in all other treatments. Conclusions: The study revealed only a modest superiority of aflibercept 2 mg and ranibizumab 0.5 mg over other formulations and dosages. Publication type: Journal: Review Source: EMBASE Full text: Available The British journal of ophthalmology at British Journal of Ophthalmology 13.Title: Efficacy and safety of deep anterior lamellar keratoplasty vs. penetrating keratoplasty for keratoconus: A metaanalysis Citation: PLoS ONE, January 2015, vol./is. 10/1, 1932-6203 (29 Jan 2015) Author(s): Liu H., Chen Y., Wang P., Li B., Wang W., Su Y., Sheng M. Language: English Abstract: Purpose: To evaluate difference in therapeutic outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) for the clinical treatment of keratoconus. Methods: A comprehensive search was conducted in Pubmed, EMBASE, Cochrane Library, and Web of science. Eligible studies should include at least one of the following factors: best corrected visual acuity (BCVA), postoperative spherical equivalent (SE), postoperative astigmatism and endothelial cell count (ECC), central corneal thickness (CCT), graft rejection and graft failure, of which BCVA, graft rejection and graft failure were used as the primary outcome measures, and postoperative SE, astigmatism, CCT and ECC as the secondary outcome measures. Given the lack of randomized clinical trials (RCTs), cohort studies and prospective studies were considered eligible. Results: Sixteen clinical trials involving 6625 eyes were included in this review, including 1185 eyes in DALK group, and 5440 eyes in PKP group. The outcomes were analyzed using Cochrane Review Manager (RevMan) version 5.0 software. The postoperative BCVA in DALK group was significantly better than that in PKP group (OR = 0.48; 95%CI 0.39 to 0.60; p<0.001). There were fewer cases of graft rejection in DALK group than those in PKP group (OR = 0.28; 95%CI 0.15 to 0.50; p<0.001). Nevertheless the rate of graft failure was similar between DALK and PKP groups (OR = 1.05; 95%CI 0.81 to 1.36; p = 0.73). There were no significant differences in the secondary outcomes of SE (p = 0.70), astigmatism (p = 0.14) and CCT (p = 0.58) between DALK and PKP groups. And ECC in DALK group was significantly higher than PKP group (p<0.001). The postoperative complications, high intraocular pressure (high-IOP) and cataract were analyzed, fewer cases of complications occurred in DALK group than those in PKP group (high-IOP, OR 0.22, 95% CI 0.110.44, P<0.001) (cataract, OR 0.22; 95% CI 0.08-0.61, P = 0.004). And no cases of expulsive hemorrhage and endophthalmitis were reported. Conclusion: The visual outcomes for DALK were not equivalent to PKP. The rate of graft failure was similar between DALK and PKP. Fewer postoperative complications occurred in DALK group, indicating that compared with PKP, DALK has lower efficacy but higher safety. Publication type: Journal: Article Source: EMBASE Full text: Available ProQuest at PLoS ONE Full text: Available ProQuest at PLoS One 14.Title: Estrogen signalling in the pathogenesis of age-related macular degeneration Citation: Current Eye Research, February 2015, vol./is. 40/2(226-233), 0271-3683;1460-2202 (01 Feb 2015) Author(s): Kaarniranta K., Machalinska A., Vereb Z., Salminen A., Petrovski G., Kauppinen A. Language: English Abstract: Age-related macular degeneration (AMD) is a multifactorial eye disease that is associated with aging, family history, smoking, obesity, cataract surgery, arteriosclerosis, hypertension, hypercholesterolemia and unhealthy diet. Gender has commonly been classified as a weak or inconsistent risk factor for AMD. This disease is characterized by degeneration of retinal pigment epithelial (RPE) cells, Bruch's membrane, and choriocapillaris, which secondarily lead to damage and death of photoreceptor cells and central visual loss. Pathogenesis of AMD involves constant oxidative stress, chronic inflammation, and increased accumulation of lipofuscin and drusen. Estrogen has both anti-oxidative and antiinflammatory capacity and it regulates signaling pathways that are involved in the pathogenesis of AMD. In this review, we discuss potential cellular signaling targets of estrogen in retinal cells and AMD pathology. Publication type: Journal: Review Source: EMBASE 15.Title: Face-down positioning versus non-supine positioning in macular hole surgery Citation: British Journal of Ophthalmology, February 2015, vol./is. 99/2(236-239), 0007-1161;1468-2079 (01 Feb 2015) Author(s): Alberti M., La Cour M. Language: English Abstract: Aim: To evaluate the full thickness macular hole (FTMH) closure rate in patients positioning non-supine (NSP) compared with patients positioning face-down (FDP). Methods: We retrospectively reviewed two FTMH case series postoperative positioning was FDP and NSP, respectively. All eyes were pseudophakic and treatment consisted of pars plana vitrectomy, internal limiting membrane peeling and per fluoropropane gas tamponade. Primary outcome measure was FTMH closure verifi ed by optical coherence tomography. Secondary outcome was ETDRS visual acuity 6 months postoperatively. Results: Over 13.7 months 122 eyes were included in this study, 66 eyes in the FDP group and 56 eyes in the NSP group. Closure rates were 95.5% and 96.4% in the FDP group and the NSP group, respectively. Median postoperative visual acuity at 6 months was 69 ETDRS letters in both positioning groups (p=0.64). Neither positioning group fully complied with the recommended positioning protocol. Conclusions: Results from consistent FTMH repair indicate similar anatomical success rates in FDP and NSP groups, suggesting that FDP is unnecessary. Objective monitoring of positioning would be bene ficial in future FTMH studies to be able to adjust for positioning protocol compliance. Publication type: Journal: Article Source: EMBASE Full text: Available The British journal of ophthalmology at British Journal of Ophthalmology 16.Title: Fundus autofluorescence imaging in age-related macular degeneration Citation: Seminars in Ophthalmology, January 2015, vol./is. 30/1(65-73), 0882-0538;1744-5205 (01 Jan 2015) Author(s): Batiotlu F., Demirel S., Ozmert E. Language: English Abstract: Fundus autofluorescence (FAF) is a noninvasive imaging technology that provides information on the distribution of lipofuscin within the retinal pigment epithelial cells. Progressive accumulation of lipofuscin within retinal pigment epithelial cells is involved in the pathogenesis of age-related macular degeneration (AMD). Fundus autofluorescence imaging using a confocal scanning laser ophthalmoscope is a useful technique to identify high-risk characteristics in patients with nonexudative AMD. It gives also some valuable knowledge and clues in differantial diagnosis of exudative age-related macular degeneration. This review comprises an introduction to fundus autofluorescence, a review of FAF imaging in AMD, and the recent classification of geographic atrophy (GA) and early AMD phenotypes by the Fundus Autofluorescence in Age-related Macular Degeneration Study. The association of phenotype and atrophy progression and choroidal neovascularization development are also summarized. Publication type: Journal: Review Source: EMBASE 17.Title: Gender and cataract-The role of estrogen Citation: Current Eye Research, February 2015, vol./is. 40/2(176-190), 0271-3683;1460-2202 (01 Feb 2015) Author(s): Zetterberg M., Celojevic D. Language: English Abstract: There is evidence from epidemiologic data that cataract is more common in women than men. This is not solely due to a higher rate of cataract extraction in women, as is the case in the western world, but several population-based studies show that females have a higher prevalence of lens opacities, especially cortical. There is no firm evidence that lifestyle-related factors are the cause of this gender discrepancy. Focus has therefore been directed towards the role of estrogen in cataract formation. Although data on endogenous and exogenous estrogen involvement in cataractogenesis are conflicting, some studies have indicated that hormone therapy may decrease the risk of cataract and thus be protective. It has been hypothesized that the decrease in estrogen at menopause cause increased risk of cataract in women, i.e. not strictly the concentration of estrogen, but more the withdrawal effect. Estrogens are known to exert several anti-aging effects that may explain the longer lifespan in women, including metabolically beneficial effects, neuroprotection, preservation of telomeres and anti-oxidative properties. Since oxidative stress is considered important in cataractogenesis, studies have investigated the effects of estrogens on lens epithelial cells in culture or in animal models. Several investigators have found protection by physiological concentrations of 17beta-estradiol against oxidative stress induced by H2O2 in cultured lens epithelial cells. Although both main types of estrogen receptors, ERalpha and ERbeta, have been demonstrated in lens epithelium, most studies so far indicate that the estrogen-mediated protection in the lens is exerted through non-genomic, i.e. receptor-independent mechanisms, possibly through phosphorylation of extracellular signal-regulated kinase (ERK1/ERK2), a member of the mitogen-activated protein kinase (MAPK)-signaling pathway. Further studies are needed, both epidemiologic as to the role of hormone therapies, and laboratory studies regarding molecular estrogen-mediated mechanisms, in order to comprehend the role of estrogens on cataract formation. Publication type: Journal: Review Source: EMBASE 18.Title: Gender specific issues in hereditary ocular disorders Citation: Current Eye Research, February 2015, vol./is. 40/2(128-145), 0271-3683;1460-2202 (01 Feb 2015) Author(s): Iragavarapu S., Gorin M.B. Language: English Abstract: This review is intended to summarize the current knowledge from basic science and clinical medical literature cited within PubMed that pertain to gender-related factors and affect those individuals with hereditary ocular disorders. We consider gender-related biological factors that (a) affect disease onset and progression, (b) gender differences for major X-linked ocular disorders, (c) gender-specific conditions, (d) medications that may influence genetic eye disorders, and finally, (e) gender-related issues that influence the management and quality of life of these patients. Several studies have demonstrated the manner in which sex-related hormones in animal models are capable of influencing cell pathway and survival that are likely to affect hereditary eye disorders. There are very few clinical studies that provide compelling evidence for gender differences in human ocular conditions, other than for a number of X-linked disorders. Disease expression for X-linked disorders may be impacted by genetic mechanisms such as lyonization or uniparental disomy. Clinical evidence regarding the impact of gender-related medical conditions and therapies on eye conditions is extremely limited and primarily based on anecdotal evidence. Gender-specific factors may play a major role in the underlying biological pathways that influence the onset, rate of progression, and clinical findings associated with ocular genetic conditions. Clinicians need to be aware of the variable phenotypes observed in female carriers of X-linked disorders of gender specific issues, many of which are inadequately addressed in the current literature. Clinicians need to be sensitive to gender differences in social, cultural, and religious systems and they should also be aware of how their own gender biases may influence how they counsel patients. Finally, it is clear that the lack of effective clinical studies in this area creates an opportunity for future research that will have real benefits for these patients. Publication type: Journal: Review