Comparison of oral versus intravenous steroid in the management of Bell's palsy: a systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Bell's palsy is a condition affecting cranial nerve VII that results in acute peripheral unilateral facial weakness or paralysis of unclear etiology. Corticosteroids are the primary therapy choice, because they improve outcomes. According to a recent study, prednisolone effectively treats Bell's palsy in the short and long term. This study aimed to assess the effectiveness and safety of Single-Dose Intravenous Methylprednisolone to Oral Prednisolone in treating Bell's palsy patients. METHODS: PRISMA statement guidelines were used to design and conduct this systemic review. MEDLINE, Cochrane Library, and EMBASE databases were used in our search. We conducted the database search in November 2022. RESULTS: Thirty-three publications were reviewed as a result of the literature review. Three studies were included in the meta-analysis after applying our criteria. 317 Bell's palsy patients were included in our study. Regarding complete recovery to grade 1 in 1 month, IV methylprednisolone was higher than oral prednisolone; (log OR = 0.52, 95% CI [0.08, 0.97], P = 0.022). However, at 3 months, the two groups had no significant difference. Patients with grade 4 Bell's palsy were more likely to fully recover to grade 1 in 1 month with IV methylprednisolone than with oral prednisolone (log OR = 0.73, 95% CI [0.19, 1.26], P = 0.008), but not for patients with grade 3 or grade 2 Bell's palsy. CONCLUSION: This study shows evidence that patients with Bell's palsy can fully recover to grade 1 in 1 month when IV methylprednisolone is used instead of oral prednisolone. At 3 months, however, there was no discernible difference between the two treatments. Within 3 days of the onset of symptoms, IV methylprednisolone treatment can be started, which may help patients recover fully to grade 1 in 1 month. However, administering IV methylprednisolone may not always have long-term advantages compared to oral prednisolone.

Safety and efficacy of a laser refractive procedure in eyes with previous keratoplasty: systematic review and meta-analysis.

Post-keratoplasty (KP) patients' visual acuity can be severely limited by ametropia. Irregular astigmatisms are frequently encountered in these patients and is commonly associated with high degrees of hyperopia or myopia. This systematic review investigates the safety and efficacy of laser refractive surgery for post KP vision correction. 31 studies with 683 participants (732 eyes) enrolled in this review. Mean astigmatism improved significantly (mean difference [MD] = -2.70, 95% CI, -3.13 to -2.28, P < .0001). As well as Mean spherical equivalent (MD = -3.35, 95% CI, -3.92 to -2.78, P < .0001). From 586 participants 5.8% lost 2 or more lines of corrected distance visual acuity after treatment. The proportion of eyes with 20/40 uncorrected distance visual acuity or better was reported and the percentage was 46.79% overall. Laser refractive procedures (laser in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK] or transepithelial PRK) on eyes with corneal transplantation were found to be relatively safe and effective. Our systematic review shows there is improvement in all outcomes. Main adverse effects were haze for PRK and epithelial ingrowth for LASIK.