RESUMO
Background: Cataract surgery is one of the most frequently performed eye surgeries worldwide, and among several techniques, phacoemulsification has become the standard of care due to its safety and efficiency. We evaluated the advantages and disadvantages of two phacoemulsification techniques: phaco-chop and divide-and-conquer. Methods: PubMed, Cochrane, Embase, and Web of Science databases were queried for randomized controlled trial (RCT), prospective and retrospective studies that compared the phaco-chop technique over the divide-and-conquer technique and reported the outcomes of (1) Endothelial cell count change (ECC); (2) Ultrasound time (UST); (3) Cumulated dissipated energy (CDE); (4) Surgery time; and (5) Phacoemulsification time (PT). Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity. Results: Nine final studies, (6 prospective RCTs and 3 observational), comprising 837 patients undergoing phacoemulsification. 435 (51.9%) underwent the phaco-chop technique, and 405 (48.1%) underwent divide-and-conquer. Overall, the phaco-chop technique was associated with several advantages: a significant difference in ECC change postoperatively (Mean Difference [MD] -221.67 Cell/mm2; 95% Confidence Interval [CI] -401.68 to -41.66; p < 0.02; I2=73%); a shorter UST (MD -51.16 sec; 95% CI -99.4 to -2.79; p = 0.04; I2=98%); reduced CDE (MD -8.68 units; 95% CI -12.76 to -4.60; p < 0.01; I2=84%); a lower PT (MD -55.09 sec; 95% CI -99.29 to -12.90; p = 0.01; I2=100). There were no significant differences in surgery time (MD -3.86 min; 95% CI -9.55 to 1.83; p = 0.18; I2=99%). Conclusion: The phaco-chop technique proved to cause fewer hazards to the corneal endothelium, with less delivered intraocular ultrasound energy when compared to the divide-and-conquer technique.
RESUMO
OBJECTIVE: Polycystic ovary syndrome (PCOS) is an endocrinopathy with a high prevalence in women of reproductive age. Different treatments were tested to increase insulin sensitivity and hormone regulation, and recently polyphenols have emerged as a promising option for these women. We aimed to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing polyphenols to placebo in PCOS. DESIGN: A systematic review and meta-analysis. METHODS: PubMed, Cochrane Library, and Embase databases were searched for RCTs comparing polyphenols to placebo. Random-effects model was used to calculate the Mean Difference (MD) and Standardized Mean Difference (SMD), with 95% confidence interval (CIs). RESULTS: A total of fifteen RCTs comprising 916 patients were included, of whom 445 (49 %) received polyphenols. Compared to placebo, polyphenols significantly reduced serum insulin level (MD -2.49; 95 % CI [-3.72, -1.25]; p < 0.01), BMI levels (MD -0.12; 95 % CI [-0.18, -0.06]; p < 0.01), and LH levels (MD -0.87; 95 % CI [-1.54, -0.20]; p = 0.01). There was no significant difference between groups in testosterone levels (SMD -0.14; 95 % CI [-0.53, 0.25]; p = 0.48). CONCLUSION: In this meta-analysis polyphenols were associated with a reduction in serum insulin, LH levels, and BMI in women with PCOS, compared to placebo. These findings support the effectiveness of polyphenols in women with PCOS. SIGNIFICANT STATEMENT: There are no comprehensive systematic recommendations for polyphenols in PCOS treatment. However, increasing evidence has highlighted its substantial impact on women's health. This systematic review and meta-analysis provide evidence for the efficacy of polyphenols in reducing serum insulin, LH, and BMI in women with PCOS compared with placebo.