The effectiveness of ocriplasmin versus surgery for the treatment of macular holes: A systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review looking at the effects of ocriplasmin compared to pars plana vitrectomy on macular holes to assess the effectiveness of the treatment options. METHODS: Literature was searched through MEDLINE, EMBASE, CINAHL, Clinical Trials.gov, and ProQuest Dissertations and Theses until June 12, 2018. Conferences held through Association for Research in Vision and Ophthalmology, Canadian Society of Ophthalmology, and American Academy of Ophthalmology were searched until June 18, 2018. A total of 208 records were screened leaving 26. One author independently reviewed them for quality and extracted data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed. The adverse events, MH closure rate, change in MH size, and the extent to which the patients' visual acuity is restored by each treatment option; ocriplasmin and vitrectomy. RESULTS: Twenty-six articles were included for qualitative and quantitative analysis. Meta-analysis results showed a 34% closure of macular holes after ocriplasmin treatment compared to 92% after vitrectomy. A significant improvement in visual acuity was seen after vitrectomy (SMD = -1.42; CI: [-1.98, -0.86]) as well as the ocriplasmin treatment (SMD = -0.73; CI: [-0.98, -0.48]). CONCLUSIONS: Results suggested 92% macular hole closure after vitrectomy compared to 34% after ocriplasmin. A significant improvement in visual acuity of patients was seen after both treatments. More good quality randomized controlled trials are required to make strong conclusions.

Dry eye after refractive surgery: a meta-analysis.

OBJECTIVE: To examine and compare the rates of dry eye after various refractive surgeries, including laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), femtosecond lamellar extraction (FLEx), and small incision lenticule extraction (SMILE). DESIGN: Systematic review and meta-analysis. METHODS: This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Databases searched included MEDLINE (Ovid), Embase, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature, Web of Science, ProQuest Dissertations and Theses, and ClinicalTrials.gov. Meeting abstracts from European Society of Cataract and Refractive Surgeons, American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, and Canadian Ophthalmological Society were also examined. Articles underwent 3 stages of screening before data extraction and meta-analysis. RESULTS: In total, 3232 studies were found; 261 remained after title screening, 92 remained after abstract screening, and 14 studies progressed to data extraction. Meta-analysis indicated a significant reduction in tear break-up time (TBUT) with LASIK (standardized mean difference [SMD] = -0.3; confidence interval [CI]: -0.53 to -0.08) and FLEx (SMD = -1.09; CI: -1.44 to -0.74), and a nonsignificant reduction in TBUT with SMILE (SMD = -0.34; CI: -0.95 to 0.27) and PRK (SMD = -0.11; CI: -0.29 to 0.08). Meta-analysis also indicated a significant reduction in tear production with LASIK (SMD = -0.23; CI: -0.46 to -0.01), and a nonsignificant reduction in tear production with SMILE (SMD = 0.04; CI: -0.28 to 0.36), FLEX (SMD = -0.05; CI: -0.37 to 0.28), and PRK (SMD = -0.07; CI: -0.32 to 0.19). CONCLUSIONS: Overall, a significant reduction in postoperative tear production as well as TBUT time was seen with LASIK, and a nonsignificant reduction in postoperative tear production and TBUT was seen with SMILE, FLEx, and PRK. Ultimately, more high-quality randomized controlled trials are required to make concrete conclusions about dry eye parameters after refractive surgery.

Intense pulsed light therapy with meibomian gland expression for dry eye disease.

OBJECTIVES: To examine the effectiveness of intense pulsed light therapy (IPL) with meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD) and dry eye symptoms. DESIGN: Systematic review followed by a meta-analysis. METHODS: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Literature sources included MEDLINE, Embase, Cochrane Library, and meeting abstracts from Canadian Ophthalmological Society, The Association for Research in Vision and Ophthalmology, The American Academy of Ophthalmology, and The European Society for Cataract and Refractive Surgeons. Articles underwent 3 stages of screening before data extraction and meta-analysis. RESULTS: After the initial search, 502 studies were found. Six articles were included for meta-analysis, and data were extracted after 3 stages of screening. Meta-analysis indicated significant increase in tear break-up time (TBUT) post-treatment in the <1-month follow-up (standardized mean difference [SMD] = 1.29; confidence interval [CI]: 1.10-1.48), up-to-6-month follow-up (SMD = 1.71; CI: 1.46-1.96), and >6-month follow-up (SMD = 2.04; CI: 1.68-2.40) groups. Moreover, meta-analysis suggested a nonsignificant improvement in Standardized Patient Evaluation of Eye Dryness (SPEED) scores after IPL with MGX at the <1-month follow-up (SMD = -1.35; CI: -1.70 to -1.01), up-to-6-month follow-up (SMD = -1.68; CI: -1.93 to -1.43), and >6-month follow-up (SMD = -2.04; CI: -2.40 to -1.68) groups. Meta-analysis also indicated a nonsignificant improvement in Schirmer's test values at the up-to-2-month follow-up (SMD = -0.27; CI: -0.66 to 0.12), up-to-6-month follow-up (SMD = 0.04; CI: -0.25 to 0.33), and >6-month follow-up (SMD = -0.01; CI: -0.31 to 0.28) groups. CONCLUSIONS: The results suggested a significant increase in TBUT and a nonsignificant increase in SPEED and Schirmer's test values at all follow-up periods post-treatment. Ultimately, IPL with MGX appears to be a promising therapy for MGD.