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Popovic MM, Balas M, Sadda SR, Sarraf D, Huang R, Bakri SJ, Berrocal A, Chang A, Gemmy Cheung CM, Garg S, Hillier RJ, Holz FG, Johnson MW, Kaiser PK, Kertes PJ, Lai TYY, Noble J, Park SS, Paulus YM, Querques G, Rachitskaya A, Ruamviboonsuk P, Saidkasimova S, Sandinha MT, Steel DH, Terasaki H, Weng CY, Williams BK, Wu L, Muni RH. International Classification System for Ocular Complications of Anti-VEGF Agents in Clinical Trials. Ophthalmology 2024:S0161-6420(24)00366-X. [PMID: 38878904 DOI: 10.1016/j.ophtha.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 04/10/2024] [Accepted: 06/06/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE Complications associated with intravitreal anti-VEGF therapies are reported inconsistently in the literature, thus limiting an accurate evaluation and comparison of safety between studies. This study aimed to develop a standardized classification system for anti-VEGF ocular complications using the Delphi consensus process. DESIGN Systematic review and Delphi consensus process. PARTICIPANTS Twenty-five international retinal specialists participated in the Delphi consensus survey. METHODS A systematic literature search was conducted to identify complications of intravitreal anti-VEGF agent administration based on randomized controlled trials (RCTs) of anti-VEGF therapy. A comprehensive list of complications was derived from these studies, and this list was subjected to iterative Delphi consensus surveys involving international retinal specialists who voted on inclusion, exclusion, rephrasing, and addition of complications. Furthermore, surveys determined specifiers for the selected complications. This iterative process helped to refine the final classification system. MAIN OUTCOME MEASURES The proportion of retinal specialists who choose to include or exclude complications associated with anti-VEGF administration. RESULTS After screening 18 229 articles, 130 complications were categorized from 145 included RCTs. Participant consensus via the Delphi method resulted in the inclusion of 91 complications (70%) after 3 rounds. After incorporating further modifications made based on participant suggestions, such as rewording certain phrases and combining similar terms, 24 redundant complications were removed, leaving a total of 67 complications (52%) in the final list. A total of 14 complications (11%) met exclusion thresholds and were eliminated by participants across both rounds. All other remaining complications not meeting inclusion or exclusion thresholds also were excluded from the final classification system after the Delphi process terminated. In addition, 47 of 75 proposed complication specifiers (63%) were included based on participant agreement. CONCLUSIONS Using the Delphi consensus process, a comprehensive, standardized classification system consisting of 67 ocular complications and 47 unique specifiers was established for intravitreal anti-VEGF agents in clinical trials. The adoption of this system in future trials could improve consistency and quality of adverse event reporting, potentially facilitating more accurate risk-benefit analyses. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Michael Balas
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - SriniVas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Ryan Huang
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Audina Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Andrew Chang
- Sydney Retina Clinic, Sydney Eye Hospital, University of New South Wales, Sydney, Australia
| | - Chui Ming Gemmy Cheung
- Department of Ophthalmology, National University of Singapore, Singapore, Republic of Singapore
| | - Sunir Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Mark W Johnson
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | | | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong, China
| | - Jason Noble
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Susanna S Park
- Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, California
| | - Yannis M Paulus
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Giuseppe Querques
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | | | - Maria Teresa Sandinha
- Department of Eye and Visual Science, University of Liverpool, Merseyside, United Kingdom
| | - David H Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom
| | | | - Christina Y Weng
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Basil K Williams
- Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lihteh Wu
- Department of Ophthalmology, Asociados de Mácula Vitreo y Retina de Costa Rica, San José, Costa Rica
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
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Chauhan A, Kotlier JL, Thompson AA, Mayfield CK, Abu-Zahra M, Hwang NM, Bolia IK, Petrigliano FA, Liu JN. Harms reporting in randomized controlled trials underpinning the American Academy of Orthopaedic Surgeons clinical practice guidelines for glenohumeral osteoarthritis. J Shoulder Elbow Surg 2024; 33:e109-e115. [PMID: 37898417 DOI: 10.1016/j.jse.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Glenohumeral osteoarthritis is one of the most common causes of shoulder pain. As such, the American Academy of Orthopaedic Surgeons (AAOS) has developed clinical practice guidelines (CPGs) to address the management of glenohumeral osteoarthritis. These CPG recommendations stem from the findings of randomized controlled trials (RCTs), which have been shown to influence clinical decision making and health policy. Therefore, it is essential that trial outcomes, including harms data (ie, adverse events), are adequately reported. We intend to evaluate the reporting quality of harms-related data in orthopedic literature specifically relating to AAOS CPG recommendations on the management of glenohumeral osteoarthritis. METHODS We adhered to the Preferred Reporting Items for Systematic Reviews (PRISMA) as well as guidance for reporting meta-research. The AAOS CPGs for glenohumeral osteoarthritis were obtained from orthoguidelines.org, and 2 authors independently screened the guidelines for the RCTs referenced. A total of 14 studies were identified. Data were extracted from the 14 included studies independently by the same 2 authors. Adherence to the Consolidated Standards of Reporting Trials (CONSORT) Extension for Harms Checklist was assessed using an 18-item scoring chart, with 1 point being awarded for meeting a checklist item and 0 points being awarded for not meeting a checklist item. Descriptive statistics, such as frequencies, percentages, and 95% confidence intervals were used to summarize RCT adherence to the CONSORT checklist. RESULTS The average score among the studies included was 7.36/18 items (39% adherence). No study adhered to all criteria, with the highest-performing study meeting 11 of 18 items (58%) and the lowest meeting 3 of 18 items (16%). A positive correlation between checklist score and year of publication was observed, with studies published more recently receiving a higher score on the CONSORT checklist (P < .05). Studies that disclosed funding information received a higher score than those that did not (P < .05), but there was no significant difference when the different funding sources were compared. Finally, double-blinded studies scored higher on the checklist than those with lower levels of blinding (single or no blinding, P < .05). CONCLUSION Adverse events are poorly reported amongst RCTs cited as supporting evidence for AAOS Management of Glenohumeral Osteoarthritis CPGs, evidenced by a CONSORT checklist compliance rate of only 41% in this study. We recommend the development of an updated checklist with information that makes it easier for authors to recognize, evaluate, and report on harms data. Additionally, we encourage authors to include information about adverse events or negative outcomes in the abstract.
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Affiliation(s)
- Avinash Chauhan
- Department of Orthopedic Surgery, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Jacob L Kotlier
- Department of Orthopedic Surgery, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ashley A Thompson
- Department of Orthopedic Surgery, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Cory K Mayfield
- Department of Orthopedic Surgery, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Maya Abu-Zahra
- Department of Orthopedic Surgery, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - N Mina Hwang
- Department of Orthopedic Surgery, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- Department of Orthopedic Surgery, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- Department of Orthopedic Surgery, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA.
| | - Joseph N Liu
- Department of Orthopedic Surgery, USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Abegao Pinto L, Sunaric Mégevand G, Stalmans I. European Glaucoma Society - A guide on surgical innovation for glaucoma. Br J Ophthalmol 2023; 107:1-114. [PMID: 38128960 DOI: 10.1136/bjophthalmol-2023-egsguidelines] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PROLOGUE: Glaucoma surgery has been, for many decades now, dominated by the universal gold standard which is trabeculectomy augmented with antimetabolites. Tubes also came into the scene to complement what we use to call conventional or traditional glaucoma surgery. More recently we experienced a changing glaucoma surgery environment with the "advent" of what we have become used to calling Minimally Invasive Glaucoma Surgery (MIGS). What is the unmet need, what is the gap that these newcomers aim to fill? Hippocrates taught us "bring benefit, not harm" and new glaucoma techniques and devices aim to provide safer surgery compared to conventional surgery. For the patient, but also for the clinician, safety is important. Is more safety achieved with new glaucoma surgery and, if so, is it associated with better, equivalent, or worse efficacy? Is new glaucoma surgery intended to replace conventional surgery or to complement it as an 'add-on' to what clinicians already have in their hands to manage glaucoma? Which surgery should be chosen for which patient? What are the options? Are they equivalent? These are too many questions for the clinician! What are the answers to the questions? What is the evidence to support answers? Do we need more evidence and how can we produce high-quality evidence? This EGS Guide explores the changing and challenging glaucoma surgery environment aiming to provide answers to these questions. The EGS uses four words to highlight a continuum: Innovation, Education, Communication, and Implementation. Translating innovation to successful implementation is crucially important and requires high-quality evidence to ensure steps forward to a positive impact on health care when it comes to implementation. The vision of EGS is to provide the best possible well-being and minimal glaucomainduced visual disability in individuals with glaucoma within an affordable healthcare system. In this regard, assessing the changes in glaucoma surgery is a pivotal contribution to better care. As mentioned, this Guide aims to provide answers to the crucial questions above. However, every clinician is aware that answers may differ for every person: an individualised approach is needed. Therefore, there will be no uniform answer for all situations and all patients. Clinicians would need, through the clinical method and possibly some algorithm, to reach answers and decisions at the individual level. In this regard, evidence is needed to support clinicians to make decisions. Of key importance in this Guide is to provide an overview of existing evidence on glaucoma surgery and specifically on recent innovations and novel devices, but also to set standards in surgical design and reporting for future studies on glaucoma surgical innovation. Designing studies in surgery is particularly challenging because of many subtle variations inherent to surgery and hence multiple factors involved in the outcome, but even more because one needs to define carefully outcomes relevant to the research question but also to the future translation into clinical practice. In addition this Guide aims to provide clinical recommendations on novel procedures already in use when insufficient evidence exists. EGS has a long tradition to provide guidance to the ophthalmic community in Europe and worldwide through the EGS Guidelines (now in their 5th Edition). The EGS leadership recognized that the changing environment in glaucoma surgery currently represents a major challenge for the clinician, needing specific guidance. Therefore, the decision was made to issue this Guide on Glaucoma Surgery in order to help clinicians to make appropriate decisions for their patients and also to provide the framework and guidance for researchers to improve the quality of evidence in future studies. Ultimately this Guide will support better Glaucoma Care in accordance with EGS's Vision and Mission. Fotis Topouzis EGS President
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Affiliation(s)
| | - Gordana Sunaric Mégevand
- Eye Research Centre, Adolphe de Rothschild Hospital, Geneva, Switzerland and Centre Ophtalmologique de Florissant, Geneva, Switzerland
| | - Ingeborg Stalmans
- Ingeborg Stalmans, University Hospitals UZ Leuven, Catholic University KU Leuven
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Romano V, Madrid-Costa D, Alfonso JF, Alio J, Allan B, Angunawela R, Auffarth G, Carones F, Khoramnia R, Moore J, Nanavaty MA, Savini G, Pagano L, Romano MR, Virgili G, Fernández-Vega-Cueto L. Recommendation for Presbyopia-Correcting Intraocular Lenses: A Delphi Consensus Statement by the ESASO Study Group. Am J Ophthalmol 2023; 253:169-180. [PMID: 37236521 DOI: 10.1016/j.ajo.2023.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/27/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE To establish consensus among experts in lens and refractive surgery to guide general ophthalmologists on issues related to presbyopia-correcting intraocular lenses (IOLs). DESIGN A modified Delphi method to reach a consensus among experts. METHODS A steering committee formulated 105 relevant items grouped into four sections (preoperative considerations, IOL selection, intraoperative considerations, and postoperative considerations). The consensus was defined as ≥ 70% of experts agreeing with the evaluation of a statement. RESULTS Ten experts participated and completed all rounds of questionnaires (100% response rate). Of 68 items considered in the preoperative considerations, consensus was achieved in 48 (70.6%). There was a lack of consensus over IOL selection, the experts only agreed on the importance of the patient's habits for the optical IOL design selection. Of the 14 considerations related to intraoperative issues, the experts reached a consensus on 10 (71.4%). The postoperative considerations section reached the highest consensus in 10 items of 13 (76.9%). CONCLUSIONS Key recommendations for a diffractive multifocal IOL were a potential postoperative visual acuity > 0.5, a keratometry between 40-45 diopters, a pupil >2.8 mm under photopic conditions and <6.0 mm under scotopic conditions, a root mean square of higher order corneal aberrations <0.5 µm for 6-mm pupil size, while monofocal or non-diffractive IOLs should be considered for patients with coexisting eye disorders. A lack of agreement was found in the issues related to the IOL selection.
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Affiliation(s)
- Vito Romano
- From Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (V.R.).
| | - David Madrid-Costa
- Faculty of Optics and Optometry, Universidad Complutense de Madrid, Spain (D.M.-C.)
| | - Jose F Alfonso
- Fernández-Vega Ophthalmological Institute, Oviedo, Spain (J.F.A., L.F.-V.-C.)
| | - Jorge Alio
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Calle Cabañal, Alicante, Spain (J.A.)
| | - Bruce Allan
- The Refractive Surgery Service, Moorfields Eye Hospital, London, United Kingdom (B.A.)
| | | | - Gerd Auffarth
- Department of Ophthalmology, David J Apple Center for Vision Research, University Hospital Heidelberg, Heidelberg, Germany (G.A.)
| | | | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC), University Eye Clinic Heidelberg, Heidelberg, Germany (R.K.)
| | | | | | | | - Luca Pagano
- Royal Liverpool University Hospital, Liverpool, United Kingdom (L.P.)
| | - Mario R Romano
- Eye Unit, Department of Biomedical science, Humanitas University, Milan, Italy (M.R.R.)
| | - Gianni Virgili
- Eye clinic, AOU Careggi Teaching Hospital, University of Florence, Florence, Italy (G.V.); Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
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Nguyen HX, Nguyen ND, Nguyen HT, Fan KRP, Vo HT, Nguyen CV, Pham HTT, Aung T, Nguyen HDTN, Do T. Comparing combined laser iridoplasty and surgical iridectomy with trabeculectomy in treatment of refractory acute primary angle closure without significant cataract: a randomized controlled trial. Eye (Lond) 2023; 37:2139-2144. [PMID: 36402857 PMCID: PMC10333335 DOI: 10.1038/s41433-022-02311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/20/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To compare the safety and efficacy of combined laser iridoplasty followed by surgical iridectomy (LI-SI) versus trabeculectomy in the management of medically unresponsive acute primary angle closure (APAC) with minimal cataract. PATIENTS AND METHODS This was a randomized controlled trial conducted among patients with medically unresponsive APAC without significant cataract. Study participants were randomized into: LI-SI or unaugmented trabeculectomy. Primary outcome of the study was the rate of post-operative surgical complications in the first 3 months after surgery. Secondary outcome assessed at 1 year was whether treatment was completely successful (IOP < 21 mmHg without IOP lowering drops), or partially successful (IOP < 21 mmHg with IOP lowering drops). Failure was defined as IOP ≥ 21 mmHg with IOP lowering drops. RESULTS The study included 67 eyes of 67 patients (59 females/8 males = 7.4/1) who were randomized into 2 groups: LI-SI (Group 1, 37 eyes), and trabeculectomy (Group 2, 30 eyes). There was no statistical difference between the two groups at baseline. Overall, there were more post-operative complications in Group 1 versus Group 2 (45.9% versus 33.3% - p = 0.23), although all responded well to medical treatment and resolved without sequelae. Complete success was found in 97.1% (34/35 eyes) in Group 1 and 92.6% in group 2 (p = 0.19, Fisher's exact test). CONCLUSIONS There was a higher rate of post-operative complications after LI-SI compared to trabeculectomy performed for medically unresponsive APAC with minimal cataract. Both procedures had similar surgical outcomes at 1 year.
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Affiliation(s)
| | - Ngan D Nguyen
- Military Hospital 103, Military Medical University, Hanoi, Vietnam
| | | | - Kenric Rui-Pin Fan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Hang T Vo
- Military Hospital 103, Military Medical University, Hanoi, Vietnam
| | - Cuong V Nguyen
- Military Hospital 103, Military Medical University, Hanoi, Vietnam
| | - Ha T T Pham
- Viet Nam National Eye Hospital, Hanoi, Vietnam
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
| | | | - Tan Do
- Viet Nam National Eye Hospital, Hanoi, Vietnam.
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Henein C, Fang CEH, Virgili G, Khaw PT, Azuara-Blanco A. Adverse events associated with minimally invasive glaucoma surgeries (MIGS) including bleb-forming microstent surgeries. Cochrane Database Syst Rev 2022. [PMCID: PMC9749612 DOI: 10.1002/14651858.cd015294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Christin Henein
- National Institute for Health Research Biomedical Research Centre for Ophthalmology; Moorfields Eye Hospital and UCL Institute of Ophthalmology; London UK
| | | | - Gianni Virgili
- Centre for Public Health; Queen's University Belfast; Belfast UK
| | - Peng T Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology; Moorfields Eye Hospital and UCL Institute of Ophthalmology; London UK
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Protasio JN, King A, Pasquale LR, Barton K, Bonnar J, Qureshi R, Virgili G, Azuara-Blanco A. How Can We Quantify and Compare Harm in Surgical Trials? Am J Ophthalmol 2022; 241:64-70. [PMID: 35526589 DOI: 10.1016/j.ajo.2022.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/07/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe methods that can be used to quantify and compare harm caused by surgical interventions in ophthalmology trials. DESIGN Perspective study. METHODS A published landmark glaucoma trial was used as an exemplar. A consensus-derived classification system of severity of complications was applied to published data of the Tube Versus Trabeculectomy glaucoma trial. The severity grade of each complication was multiplied to the number of patients who incurred that complication to estimate a total harm score for each intervention. Graphical tools were also used to display the differences in complications between trial arms. A review of literature on best practice for reporting harm data was also conducted. RESULTS Analyzing treatment harm is challenging with the relatively small number of events and sample sizes used in randomized controlled trials. However, quantification and graphical representation of harm after surgery is possible. Reframing the research question to one for detecting signals of adverse reactions and use of Bayesian analyses can be useful. CONCLUSIONS Analysis of harm data in clinical trials needs further attention. A severity classification system and a total harm score can be used to quantify harm after glaucoma surgery. Graphical tools can also help interpret complication data.
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Affiliation(s)
- Jesa Nadine Protasio
- From the Department of Ophthalmology (J.N.P.), Davao Doctors Hospital, Davao City, Philippines
| | - Anthony King
- Department of Ophthalmology (A.K.), Nottingham University Hospitals, Nottingham, United Kingdom
| | - Louis R Pasquale
- Department of Ophthalmology (L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keith Barton
- Moorfields Eye Hospital (K.B.), London, United Kingdom; Institute of Ophthalmology (K.B.), University College, London, United Kingdom
| | - Johnathan Bonnar
- Centre for Public Health (J.B., G.V., A.A-B.), Queen's University Belfast, United Kingdom
| | - Riaz Qureshi
- Department of Ophthalmology (R.Q.), University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gianni Virgili
- Centre for Public Health (J.B., G.V., A.A-B.), Queen's University Belfast, United Kingdom
| | - Augusto Azuara-Blanco
- Centre for Public Health (J.B., G.V., A.A-B.), Queen's University Belfast, United Kingdom.
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Comparison of Postoperative Hyphemas between Microhook Ab Interno Trabeculotomy and iStent Using a New Hyphema Scoring System. J Clin Med 2021; 10:jcm10235541. [PMID: 34884242 PMCID: PMC8658073 DOI: 10.3390/jcm10235541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
We have been using our in-house scoring system of hyphemas, i.e., Shimane University RLC postoperative hyphema scoring system (SU-RLC), which we designed to classify postoperative hyphema. SU-RLC classifies the severities of hyphemas based on three factors, i.e., red blood cells (RBCs) (R) 0-3, layer formation (L) 0-3, and clot (C) 0-1, by slit-lamp observation. To test the clinical usefulness of the SU-RLC for quantifying the postoperative hyphema severity, the SU-RLC scores were compared between eyes that underwent different minimally invasive glaucoma surgery (MIGS) procedures, i.e., Tanito microhook ab interno trabeculotomy and cataract extraction (TMH-CE) (n = 64 eyes of 64 subjects; mean age ± standard deviation, 72.4 ± 8.1 years) and iStent-CE (n = 21 eyes of 21 subjects; 76.1 ± 10.6 years). Compared to the iStent-CE, higher hyphema scores with the TMH-CE were found for the R scores on postoperative days 1, 2, and 3; for the L score on postoperative day 1; and for the C score on postoperative day 2. The sums of the R, L, and C scores (RLC) on postoperative day 1 were 3.2 ± 1.1 with the TMH-CE and 1.1 ± 1.3 with the iStent-CE; the scores reached almost 0 by 2 weeks in both groups. Significant differences in the RLC scores between the surgical groups were found on postoperative days 1, 2, and 3. Multivariate analyses showed that the TMH-CE rather than iStent-CE was associated with higher R, C, and RLC scores; anticoagulant/antiplatelet use was associated with higher R score; and myopia was associated with a higher C score. In the TMH-CE group, myopia was associated with a higher C score. In the iStent-CE group, anticoagulant/antiplatelet use was associated with higher R and RLC scores; and higher postoperative 1-day intraocular pressure was associated with a higher C score. The SU-RLC successfully detected the difference in hyphema severity between different MIGS procedures; thus, we concluded that our classification system may be feasible to evaluate hyphemas after glaucoma surgery.
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Kodjikian L, Baillif S, Couturier A, Creuzot-Garcher C, Delyfer MN, Matonti F, Weber M. Recommendations for the management of diabetic macular oedema with intravitreal dexamethasone implant: A national Delphi consensus study. Eur J Ophthalmol 2021; 32:2845-2856. [PMID: 34779302 DOI: 10.1177/11206721211052852] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The intravitreal dexamethasone implant (DEX-I) is an alternative to anti-VEGF for the first-line treatment of diabetic macular oedema (DME). However, several questions remain regarding its routine use and its place in certain situations not always specified in current recommendations. A national consensus approach was, therefore, initiated by French retinal experts. METHODS An iterative Delphi consensus approach was used. A steering committee (SC) of seven experts analysed data from the literature to formulate statements divided into five key areas of treatment. These statements were submitted to the independent and anonymous electronic vote of 87 French retina experts among whom 39 expressed their opinion and therefore constituted the voting panel. RESULTS After two rounds of voting, 22 and 7 of 38 statements received a strong consensus and a good consensus, respectively. The consensus level was higher for statements regarding first-line indications and safety of DEX-I compared to those regarding efficacy assessment, reprocessing time or pathophysiological biomarkers. The panellists recommended the preferential use of DEX-I for patients with limited availability for multiple injections, those who needed to undergo cataract surgery or who had a recent cardiovascular history, and as a therapeutic alternative to anti-VEGF in patients with a history of vitrectomy, retinal serous detachment, hyper-reflective points or dry exudates in optical coherence tomography (OCT). However, some statements proposed by SC experts were not validated. CONCLUSION This study provides some key recommendations to clinicians treating diabetic macular oedema, which may be useful when using intravitreal dexamethasone implants in daily practice.
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Affiliation(s)
- Laurent Kodjikian
- 386696Hospital La Croix-Rousse Ophthalmology, Lyon, Rhône-Alpes, France
| | - Stephanie Baillif
- Department of Ophthalmology, 37045Centre Hospitalier Universitaire de Nice, Nice, France
| | - Aude Couturier
- Department of Ophthalmology, 378772Hospital Lariboisière, Paris, Île-de-France, France
| | | | | | - Frédéric Matonti
- Centre Monticelli Paradis, Marseille, France.,Aix Marseille University, Marseille, France
| | - Michel Weber
- 26922University Hospital Centre Nantes, Nantes, Pays de la Loire, France
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Bicket AK, Le JT, Azuara-Blanco A, Gazzard G, Wormald R, Bunce C, Hu K, Jayaram H, King A, Otárola F, Nikita E, Shah A, Stead R, Tóth M, Li T. Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma: An Overview of Cochrane Systematic Reviews and Network Meta-analysis. JAMA Ophthalmol 2021; 139:983-989. [PMID: 34264292 PMCID: PMC8283665 DOI: 10.1001/jamaophthalmol.2021.2351] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Glaucoma affects more than 75 million people worldwide. Intraocular pressure (IOP)-lowering surgery is an important treatment for this disease. Interest in reducing surgical morbidity has led to the introduction of minimally invasive glaucoma surgeries (MIGS). Understanding the comparative effectiveness and safety of MIGS is necessary for clinicians and patients. OBJECTIVE To summarize data from randomized clinical trials of MIGS for open-angle glaucoma, which were evaluated in a suite of Cochrane reviews. DATA SOURCES The Cochrane Database of Systematic Reviews including studies published before June 1, 2021. STUDY SELECTION Reviews of randomized clinical trials comparing MIGS with cataract extraction alone, other MIGS, traditional glaucoma surgery, laser trabeculoplasty, or medical therapy. DATA EXTRACTION AND SYNTHESIS Data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines by one investigator and confirmed by a second. Methodologic rigor was assessed using the AMSTAR 2 appraisal tool and random-effects network meta-analyses were conducted. MAIN OUTCOMES AND MEASURES The proportion of participants who did not need to use medication to reduce intraocular pressure (IOP) postsurgery (drop-free). Outcomes were analyzed at short-term (<6 months), medium-term (6-18 months), and long-term (>18 months) follow-up. RESULTS Six eligible Cochrane reviews were identified discussing trabecular bypass with iStent or Hydrus microstents, ab interno trabeculotomy with Trabectome, subconjunctival and supraciliary drainage devices, and endoscopic cyclophotocoagulation. Moderate certainty evidence indicated that adding a Hydrus safely improved the likelihood of drop-free glaucoma control at medium-term (relative risk [RR], 1.6; 95% CI, 1.4 to 1.8) and long-term (RR, 1.6; 95% CI, 1.4 to 1.9) follow-up and conferred 2.0-mm Hg (95% CI, -2.7 to -1.3 mm Hg) greater IOP reduction at long-term follow-up, compared with cataract surgery alone. Adding an iStent also safely improved drop-free disease control compared with cataract surgery alone (RR, 1.4; 95% CI, 1.2 to 1.6), but the short-term IOP-lowering effect of the iStent was not sustained. Addition of a CyPass microstent improved drop-free glaucoma control compared with cataract surgery alone (RR, 1.3; 95% CI, 1.1 to 1.5) but was associated with an increased risk of vraision loss. Network meta-analyses supported the direction and magnitude of these results. CONCLUSIONS AND RELEVANCE Based on data synthesized in Cochrane reviews, some MIGS may afford patients with glaucoma greater drop-free disease control than cataract surgery alone. Among the products currently available, randomized clinical trial data associate the Hydrus with greater drop-free glaucoma control and IOP lowering than the iStent; however, these effect sizes were small.
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Affiliation(s)
- Amanda K. Bicket
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Jimmy T. Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology UCL & NIHR Biomedical Research Centre, London, United Kingdom
| | - Richard Wormald
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Research and Development Department & NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London & Surrey, United Kingdom
| | - Kuang Hu
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology UCL & NIHR Biomedical Research Centre, London, United Kingdom
| | - Anthony King
- Department of Ophthalmology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Francisco Otárola
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centro de la Visión, Clínica las Condes, Santiago, Chile
| | - Eleni Nikita
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anupa Shah
- Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard Stead
- Department of Ophthalmology, Nottingham University Hospital, Nottingham, United Kingdom
| | - Márta Tóth
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora
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Lakhani BK, Giannouladis K, Leighton P, Spry PGD, Harper RA, King AJ. Defining stable glaucoma: a Delphi consensus survey of UK optometrists with a specialist interest in Glaucoma. Eye (Lond) 2021; 35:2524-2534. [PMID: 33177657 PMCID: PMC8376980 DOI: 10.1038/s41433-020-01251-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Increasing demand on hospital services has led to the development of alternative community-based services, often run by optometrists for monitoring 'stable' and low-risk glaucoma patients. METHODS An online Delphi exercise was undertaken to derive a consensus definition of 'stable glaucoma' amongst optometrists with a special interest in glaucoma. Participants were asked to score their agreement for various clinical parameters. Results from each round were used to inform subsequent rounds. RESULTS 31 optometrists participated in the study. 100%, 77%, and 68% completion rates were achieved over three rounds respectively. Consensus was reached for 7 parameters: Stability should be defined over a period of 36-48 months, summary measure Visual Field (VF), and/or Trend Analysis should be used to assess VF stability. Two or more decibel (dB) of change of VF mean deviation (MD) is considered unstable. Intraocular pressure (IOP) should be below a target defined by the patient's clinician or a fixed-percentage reduction compared to the presenting IOP. No treatment change during the stability assessment period is considered stable. Imaging with Ocular Coherence Topography Retinal Nerve Fibre Layer (OCT RNFL) assessment should be used to define glaucoma stability. Overview by a glaucoma consultant was considered important for glaucoma monitoring schemes. CONCLUSION This Delphi exercise has generated a consensus definition for glaucoma stability by UK Optometrists with a specialist interest in glaucoma. This consensus definition can be used to inform the selection of suitable patients from hospital services for transfer to monitoring in community-based 'stable' optometry run glaucoma clinics.
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Affiliation(s)
- Bansri K Lakhani
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
| | - Konstantinos Giannouladis
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Kings Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, UK
| | - Paul G D Spry
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol, BS1 2LX, UK
| | - Robert A Harper
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Anthony J King
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
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12
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Han IC, Binkley EM. What Is So Complicated About Defining Surgical Complications? JAMA Ophthalmol 2021; 139:864-865. [PMID: 34165502 DOI: 10.1001/jamaophthalmol.2021.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ian C Han
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City
| | - Elaine M Binkley
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City
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13
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Xu ZY, Azuara-Blanco A, Kadonosono K, Murray T, Natarajan S, Sii S, Smiddy W, Steel DH, Wolfensberger TJ, Lois N. New Classification for the Reporting of Complications in Retinal Detachment Surgical Trials. JAMA Ophthalmol 2021; 139:857-864. [PMID: 34165493 PMCID: PMC8227451 DOI: 10.1001/jamaophthalmol.2021.1078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/05/2021] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Quantifying severity of complications in rhegmatogenous retinal detachment (RRD) surgical trials is needed. A consensus classification system will help surgeons to more effectively compare harms of different surgical techniques. OBJECTIVE To develop a new consensus-based classification to quantify severity of complications of RRD surgery. DESIGN, SETTING, AND PARTICIPANTS A comprehensive list of complications was developed followed by a Delphi consensus survey of international vitreoretinal surgeons. The survey was conducted in 17 countries in mainland Europe, the United Kingdom, the United States, Asia, South Africa, and Australia. Seventy vitreoretinal surgeons were invited to take part in the Delphi survey; 45 agreed to participate. Participants were selected through boards/members lists of retinal societies. Data were analyzed between April 2019 and August 2019. MAIN OUTCOMES AND MEASURES Consensus-derived classification of complications of RRD surgery, according to their severity. RESULTS Forty-three of 45 vitreoretinal surgeons who agreed to participate in the Delphi survey completed round 1 (96%); all but 1 (98%) completed round 2. Consensus was reached for 96% of the 84 complications assessed. Examples of complications classified as least severe (graded 1) included subconjunctival hemorrhage and chemosis while those classified as most severe included endophthalmitis and sympathetic ophthalmia (graded 9) and phthisis (graded 10). CONCLUSIONS AND RELEVANCE We propose a new classification for quantifying severity of surgical complications based on an international consensus of vitreoretinal surgeons to quantify harm and improve the reporting of complications of RRD surgery.
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Affiliation(s)
- Zheng Yang Xu
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | | | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Timothy Murray
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Samantha Sii
- Department of Ophthalmology, Lincoln County Hospital, Lincoln, England
| | | | - David H. Steel
- Sunderland Eye Infirmary, and Institute of Genetic Medicine, University of Newcastle Upon Tyne, Newcastle Upon Tyne, England
| | | | - Noemi Lois
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
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14
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Stringa F, Kastner A, Heuer D, Barton K, King AJ. Postoperative complications in glaucoma surgery: literature review-based recommendations to improve reporting consistency. Br J Ophthalmol 2021; 106:1696-1702. [PMID: 34162534 DOI: 10.1136/bjophthalmol-2021-318952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/01/2021] [Indexed: 11/03/2022]
Abstract
AIMS To recommend a list of complications of glaucoma surgery to be used in future glaucoma surgery research and reporting by exploring the spectrum of complications' names, the variety of definitions and time frames used for reporting them in glaucoma surgical trials. METHODS Complications' names, definitions and time frames identified from a previously conducted systematic review of glaucoma surgery trials (registration number: CRD42019121226) were reviewed. Only postoperative complications were considered. Surgical techniques described in the papers from the previous systematic review were retrieved and grouped according their mechanism of action.Reviewers independently recommended each complication's inclusion or exclusion in a list to be proposed as a potential standard for reporting in glaucoma interventions. A literature-based definition of a 'surgical complication' was used to inform these decisions. Recorded complication's details were used to inform the development of clinically relevant definitions, a consensus-driven exercise between reviewers resolved disagreements. RESULTS We identified 48/111 (43.2%) of the reported complications as suitable for inclusion, of which 17 were merged into other included complications having a broader meaning making up a final table of 32 postoperative complications. For 25 of them, the authors kept 'names' that were previously used in the systematic review, but provided a definition that was not mentioned in these papers. Five included complications were given both 'names' and definitions not previously mentioned. The authors maintained the name and definition for one complication. There were 16 complications that were in common to all the procedures retrieved from the previous review. CONCLUSIONS We propose a table of revised names and comprehensive definitions of postoperative complications, to simplify the process of reporting complications after glaucoma surgery and to improve consistency among surgical trials.
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Affiliation(s)
- Francesco Stringa
- Ophthalmology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alan Kastner
- Ophthalmology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dale Heuer
- Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles, California, USA.,Doheny Eye Institute, Los Angeles, California, USA
| | - Keith Barton
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Anthony J King
- Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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15
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Xu ZY, Azuara-Blanco A, Kadonosono K, Murray T, Natarajan S, Sii S, Smiddy W, Steel DH, Wolfensberger TJ, Lois N. Reporting of Complications in Retinal Detachment Surgical Trials: A Systematic Review Using the CONSORT Extension for Harms. JAMA Ophthalmol 2021; 139:2781201. [PMID: 34137800 DOI: 10.1001/jamaophthalmol.2021.1836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Knowledge on the frequency and severity of complications in surgical trials for rhegmatogenous retinal detachment (RRD) is essential to determine whether surgical procedures are developed and compared adequately, taking into account not only efficacy but also harms. OBJECTIVE To review standards of reporting of complications in recent randomized clinical trials of RRD surgery. EVIDENCE REVIEW This systematic review included randomized clinical trials on RRD surgery published between January 2008 and January 2021 in Embase, MEDLINE, and Web of Science Core Collection databases. Titles, abstracts, and full-text articles retrieved were reviewed for eligibility by 2 independent authors. Eligible studies were evaluated against checklist items from the Consolidated Standards of Reporting Trials Extension for Harms criteria by 2 independent authors, and discrepancies were resolved by discussion with a third author. FINDINGS Fifty studies were included. The median number of checklist items fulfilled was 8 (range, 0-15), of a possible total of 18. Frequently reported items were discussions balanced with regard to efficacy and adverse events (42 studies [84%]) and inclusions of harm-associated timing of data collection (41 studies [82%]). The least frequently reported items were distinctions between expected and unexpected adverse events (1 study [2%]) and mentions of the use of a validated instrument to report adverse event severity (4 studies [8%]). Frequency of complications was commonly reported (29 studies [58%]) in contrast with complication severity (10 studies [20%]). CONCLUSIONS AND RELEVANCE This review suggests that severity of complications of RRD surgery has been infrequently quantified and reported in randomized clinical trials and potentially represents an important area of improvement in future RRD surgical trials.
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Affiliation(s)
- Zheng Yang Xu
- Centre for Public Health, Queen's University, Belfast, United Kingdom
| | | | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Japan
| | | | | | - Samantha Sii
- Department of Ophthalmology, Lincoln County Hospital, United Kingdom
| | | | - David H Steel
- Sunderland Eye Infirmary, University of Newcastle Upon Tyne, United Kingdom
- Institute of Genetic Medicine, University of Newcastle Upon Tyne, United Kingdom
| | | | - Noemi Lois
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University, Belfast, United Kingdom
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16
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Sharkawi E, Lindegger DJ, Artes PH, Lehmann-Clarke L, El Wardani M, Misteli M, Pasquier J, Guarnieri A. Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up. Br J Ophthalmol 2020; 105:977-982. [PMID: 32727734 PMCID: PMC8237193 DOI: 10.1136/bjophthalmol-2020-315954] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/13/2020] [Accepted: 07/05/2020] [Indexed: 01/04/2023]
Abstract
AIM To report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with pseudoexfoliative glaucoma (PXG). METHODS Prospective, interventional, non-comparative case series. A total of 103 eyes from 84 patients with PXG were enrolled to undergo a 360-degree ab interno trabeculotomy with gonioscopic assistance using either a 5.0 polypropylene suture or an illuminated microcatheter with up to 24 months of follow-up. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥20% from baseline or IOP between 6 and 21 mm Hg, without further glaucoma surgery) and complication rate. RESULTS Mean preoperative IOP was 27.1 mm Hg (95% CI 25.5 to 28.7) using 2.9 (SD 1.1) glaucoma medications which decreased postoperatively to 13.0 mm Hg (95% CI 11.5 to 14.4) and 1.0 (SD 1.1) medications at 24 months (p<0.001). Success rate was 89.2% at 24 months of follow-up, and complication rate was 2.9%. CONCLUSION At 24 months of follow-up, our results for GATT in PXG demonstrate that this conjunctival sparing procedure effectively lowers IOP and reduces the medications with a low complication rate, in this relatively aggressive glaucoma subtype.
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Affiliation(s)
| | | | - Paul H Artes
- University of Plymouth, Plymouth, UK.,Southwest Eye Institute, Tavistock, UK
| | | | | | | | - Jérôme Pasquier
- Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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17
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Sunaric Megevand G, Bron AM. Personalising surgical treatments for glaucoma patients. Prog Retin Eye Res 2020; 81:100879. [PMID: 32562883 DOI: 10.1016/j.preteyeres.2020.100879] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
Surgical treatments for glaucoma have relied for decades on traditional filtering surgery such as trabeculectomy and, in more challenging cases, tubes. Antifibrotics were introduced to improve surgical success in patients at increased risk of failure but have been shown to be linked to a greater incidence of complications, some being potentially vision-threatening. As our understanding of glaucoma and its early diagnosis have improved, a more individualised management has been suggested. Recently the term "precision medicine" has emerged as a new concept of an individualised approach to disease management incorporating a wide range of individual data in the choice of therapeutic modalities. For glaucoma surgery, this involves evaluation of the right timing, individual risk factors, targeting the correct anatomical and functional outflow pathways and appropriate prevention of scarring. As a consequence, there is an obvious need for better knowledge of anatomical and functional pathways and for more individualised surgical approaches with new, less invasive and safer techniques allowing for earlier intervention. With the recent advent of minimally invasive glaucoma surgery (MIGS) a large number of novel devices have been introduced targeting potential new sites of the outflow pathway for lowering intraocular pressure (IOP). Their popularity is growing in view of the relative surgical simplicity and apparent lack of serious side effects. However, these new surgical techniques are still in an era of early experiences, short follow-up and lack of evidence of their superiority in safety and cost-effectiveness over the traditional methods. Each year several new devices are introduced while others are withdrawn from the market. Glaucoma continues to be the primary cause of irreversible blindness worldwide and access to safe and efficacious treatment is a serious problem, particularly in the emerging world where the burden of glaucoma-related blindness is important and concerning. Early diagnosis, individualised treatment and, very importantly, safe surgical management should be the hallmarks of glaucoma treatment. However, there is still need for a better understanding of the disease, its onset and progression, the functional and structural elements of the outflow pathways in relation to the new devices as well as their long-term IOP-lowering efficacy and safety. This review discusses current knowledge and the future need for personalised glaucoma surgery.
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Affiliation(s)
- Gordana Sunaric Megevand
- Clinical Eye Research Centre Memorial Adolphe de Rothschild, Geneva, Switzerland; Centre Ophtalmologique de Florissant, Geneva, Switzerland.
| | - Alain M Bron
- Department of Ophthalmology, University Hospital, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
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18
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Koivusalo R, Välimäki J. Effect of glaucoma drainage implant surgery on corneal topography: a prospective study. Acta Ophthalmol 2020; 98:305-309. [PMID: 31495070 DOI: 10.1111/aos.14247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/19/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To study the effect of glaucoma drainage implant (GDI) surgery on corneal topography during the first postoperative year. METHODS Twenty-one adult glaucoma patients were implanted with a Molteno3 or a Baerveldt 250 GDI. Corneal topography measurements were taken preoperatively and at 6 and 12 months after surgery. Untreated opposite eyes served as controls. RESULTS In the surgical group, the mean ± SD simulated average keratometry values were 44.36 ± 1.69 D, 44.08 ± 1.29 D (p = 0.266) and 44.15 ± 1.32 D (p = 0.554) before and 6 and 12 months after surgery, respectively. The corresponding simulated keratometry astigmatism values were 1.11 ± 1.11 D, 1.20 ± 1.01 D (p = 0.687) and 1.16 ± 0.71 D (p = 0.177). Posterior astigmatism and posterior average keratometry remained unchanged after GDI surgery as well. The mean ± SD central corneal thickness (CCT) was 530 ± 46 μm, 535 ± 56 μm (p = 0.049) and 536 ± 45 μm (p = 0.080) at 0, 6 and 12 months, respectively. A trend towards increased corneal thickness (CT) in response to GDI surgery was also seen in both the average peripheral and the tube-quadrant peripheral CT values. At 12 months postoperatively, the mean endothelial cell density (ECD) had decreased by 8% centrally and by 9% peripherally. Corneal topography parameters, CT and ECD did not significantly change in the control group during follow-up. CONCLUSION Glaucoma drainage implant (GDI) surgery did not significantly alter corneal keratometry parameters and thus seems to be an astigmatically neutral procedure. However a slight, although seemingly transient, increase in CCT was observed after GDI implantation.
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Affiliation(s)
- Riku Koivusalo
- Department of Ophthalmology Päijät‐Häme Central Hospital Lahti Finland
| | - Juha Välimäki
- Department of Ophthalmology Päijät‐Häme Central Hospital Lahti Finland
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Kastner A, Stringa F, King AJ. Reporting Complications in Glaucoma Surgery: A Systematic Review. Ophthalmology 2020; 127:550-552. [DOI: 10.1016/j.ophtha.2019.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 11/24/2022] Open
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20
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Adherence to World Glaucoma Association Guidelines for Surgical Trials in the Era of Microinvasive Glaucoma Surgeries. ACTA ACUST UNITED AC 2019; 2:78-85. [DOI: 10.1016/j.ogla.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/24/2018] [Accepted: 01/17/2019] [Indexed: 11/22/2022]
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