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首页> 外文OA文献 >Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract.
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Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract.

机译：后房型人工晶状体超声乳化与后房型人工晶状体囊外白内障摘除术（ECCE）治疗年龄相关性白内障。

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BACKGROUND: Age-related cataract is one of the leading causes of blindness worldwide. Therefore, it is important to establish the most effective surgical technique for cataract surgery. OBJECTIVES: The aim of this review is to examine the effects of two types of cataract surgery for age-related cataract: phacoemulsification and extracapsular cataract extraction (ECCE). SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2013), EMBASE (January 1980 to May 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to May 2013), Web of Science Conference Proceedings Citation Index - Science (CPCI-S) (January 1970 to May 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 May 2013. SELECTION CRITERIA: We included randomised controlled trials of phacoemulsification compared to ECCE for age-related cataract. DATA COLLECTION AND ANALYSIS: Two authors independently selected and assessed all studies. We defined two primary outcomes: 'good functional vision' (presenting visual acuity of 6/12 or better) and 'poor visual outcome' (best corrected visual acuity of less than 6/60) at three and 12 months after surgery. We also collected data on intra and postoperative complications, and the cost of the procedures. MAIN RESULTS: We included 11 trials in this review with a total of 1228 participants, ranging from age 45 to 94. The studies were generally at unclear risk of bias due to poorly reported trial methods. No study reported presenting visual acuity, so we report both uncorrected (UCVA) and best corrected visual acuity (BCVA). Studies varied in visual acuity assessment methods and time frames at which outcomes were reported. Participants in the phacoemulsification group were more likely to achieve UCVA of 6/12 or more at three months (risk ratio (RR) 1.81, 95% confidence interval (CI) 1.36 to 2.41, two studies, 492 participants) and one year (RR 1.99, 95% CI 1.45 to 2.73, one study, 439 participants). People in the phacoemulsification group were also more likely to achieve BCVA of 6/12 or more at three months (RR 1.12, 95% CI 1.03 to 1.22, four studies, 645 participants) and one year (RR 1.06, 95% CI 0.99 to 1.14, one study, 439 participants), but the difference between the two groups was smaller. No trials reported BCVA less than 6/60 but three trials reported BCVA worse than 6/9 and 6/18: there were fewer events of this outcome in the phacoemulsification group than the ECCE group at both the three-month (RR 0.33, 95% CI 0.20 to 0.55, three studies, 604 participants) and 12-month time points (RR 0.62, 95% CI 0.36 to 1.05, one study, 439 participants). Three trials reported posterior capsule rupture: this occurred more commonly in the ECCE group than the phacoemulsification group but small numbers of events mean the true effect is uncertain (Peto odds ratio (OR) 0.56, 95% CI 0.26 to 1.22, three studies, 688 participants). Iris prolapse, cystoid macular oedema and posterior capsular opacification were also higher in the ECCE group than the phacoemulsification group. Phacoemulsification surgical costs were higher than ECCE in two studies. A third study reported similar costs for phacoemulsification and ECCE up to six weeks postoperatively, but following this time point ECCE incurred additional costs due to additional visits, spectacles and laser treatment to achieve a similar outcome. AUTHORS' CONCLUSIONS: Removing cataract by phacoemulsification may result in a better visual acuity compared to ECCE, with a lower complication rate. The review is currently underpowered to detect differences for rarer outcomes, including poor visual outcome. The lower cost of ECCE may justify its use in a patient population where high-volume surgery is a priority, however, there are a lack of data comparing phacoemulsification and ECCE in lower-income settings.
机译：背景：与年龄有关的白内障是全世界失明的主要原因之一。因此，重要的是建立最有效的白内障手术技术。目的：本综述旨在探讨两种类型的白内障手术对年龄相关性白内障的影响：超声乳化术和囊外白内障摘除术（ECCE）。搜索方法：我们搜索了CENTRAL（包含Cochrane眼睛和视觉团体试验注册簿）（Cochrane图书馆，2013年第4期），Ovid MEDLINE，Ovid MEDLINE进行中和其他非索引引文，Ovid MEDLINE日报，Ovid OLDMEDLINE（ 1946年1月至2013年5月），EMBASE（1980年1月至2013年5月），拉丁美洲和加勒比海地区健康科学文献（LILACS）（1982年1月至2013年5月），Web of Science会议论文集引文索引-科学（CPCI-S）（ 1970年1月至2013年5月），对照试验的metaRegister（mRCT）（www.control-trials.com），ClinicalTrials.gov（www.clinicaltrials.gov）和WHO国际临床试验注册平台（ICTRP）（www.who .int / ictrp / search / en）。在电子搜索中，我们没有使用任何日期或语言限制。我们上次搜索电子数据库的时间是2013年5月13日。选择标准：与年龄相关的白内障相比，我们进行了与ECCE相比的超声乳化术随机对照试验。数据收集与分析：两位作者独立选择并评估了所有研究。我们定义了两个主要结局：手术后3个月和12个月时“良好的功能性视力”（表现为6/12或更高的视力）和“较差的视觉结果”（最佳矫正视力低于6/60）。我们还收集了术中和术后并发症以及手术费用的数据。主要结果：本评价纳入了11项试验，共有1228名参与者，年龄从45岁到94岁不等。由于试验方法报道不充分，这些研究通常存在偏倚风险。没有研究报告显示视力，因此我们报告了未矫正视力（UCVA）和最佳矫正视力（BCVA）。关于视力评估方法和报告结果的时间框架的研究各不相同。超声乳化组的参与者在三个月内的UCVA更有可能达到6/12或更高（风险比（RR）1.81，95％置信区间（CI）1.36至2.41，两项研究，492名参与者）和一年（RR） 1.99，95％CI 1.45至2.73，一项研究，439名参与者）。超声乳化组的人在三个月（RR 1.12，95％CI 1.03至1.22，四项研究，645名参与者）和一年（RR 1.06，95％CI 0.99至190）下更可能达到6/12或更高的BCVA。 1.14，一项研究，共有439名参与者），但两组之间的差异较小。没有试验报告BCVA低于6/60，但是三项试验报告BCVA低于6/9和6/18：在三个月的时间里，超声乳化组的结局事件均少于ECCE组（RR 0.33，95） ％CI 0.20至0.55，三项研究，604名参与者）和12个月时间点（RR 0.62，95％CI 0.36至1.05，一项研究，439名参与者）。三项试验报告了后囊破裂：在ECCE组中这种情况比超声乳化组更普遍，但事件数量少意味着真正的效果尚不确定（皮托比值比（OR）0.56，95％CI 0.26至1.22，三项研究，688参与者）。 ECCE组的虹膜脱垂，黄斑囊样水肿和后囊混浊也高于超声乳化组。在两项研究中，超声乳化术的手术费用均高于ECCE。第三项研究报道了在术后六周内进行超声乳化术和ECCE的相似费用，但是在此时间点之后，ECCE由于进行额外的就诊，戴眼镜和激光治疗以达到相似的结果而产生了额外的费用。作者的结论：与ECCE相比，通过超声乳化术去除白内障可能会导致更好的视力，并降低并发症发生率。目前，这项检查功能不足以检测出罕见结果（包括不良视觉结果）之间的差异。 ECCE的成本较低，可能在需要大剂量手术的患者人群中证明其使用是合理的，但是，缺乏在低收入人群中比较超声乳化和ECCE的数据。

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