Cirugía de cataratas en pacientes con degeneración macular asociada a la edad
Appendices
Appendix 1. CENTRAL search strategy
#1 MeSH descriptor Retinal Degeneration
#2 MeSH descriptor Retinal Neovascularization
#3 MeSH descriptor Choroidal Neovascularization
#4 MeSH descriptor Macula Lutea
#5 maculopath*
#6 macula* or retina* or choroid* near degener*
#7 macula* or retina* or choroid* near neovasc*
#8 (#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7)
#9 MeSH descriptor Cataract explode all trees
#10 MeSH descriptor Cataract Extraction explode all trees
#11 cataract* near/4 (extract* or aspirat* or operat* or remov* or surg* or excis* or implant*)
#12 lens* near/4 (extract* or aspirat* or operat* or remov* or surg* or excis* or implant*)
#13 phacoemulsif* or capsulorhexis or lensectomy
#14 (#9 OR #10 OR #11 OR #12 OR #13)
#15 (#8 AND #14)
Appendix 2. MEDLINE Ovid search strategy
1. randomized controlled trial.pt.
2. (randomized or randomised).ab,ti.
3. placebo.ab,ti.
4. dt.fs.
5. randomly.ab,ti.
6. trial.ab,ti.
7. groups.ab,ti.
8. or/1‐7
9. exp animals/
10. exp humans/
11. 9 not (9 and 10)
12. 8 not 11
13. exp retinal degeneration/
14. retinal neovascularization/
15. choroidal neovascularization/
16. exp macula lutea/
17. maculopath$.tw.
18. ((macul$ or retina$ or choroid$) adj3 degener$).tw.
19. ((macul$ or retina$ or choroid$) adj3 neovasc$).tw.
20. or/13‐19
21. exp cataract/
22. exp cataract extraction/
23. ((extract$ or aspirat$ or operat$ or remov$ or surg$ or excis$ or implant$) adj3 cataract$).tw.
24. ((extract$ or aspirat$ or operat$ or remov$ or surg$ or excis$ or implant$) adj3 lens$).tw.
25. (pha?oemulsif$ or capsulorhexis or lensectomy).tw.
26. or/21‐25
27. 20 and 26
28. 12 and 20 and 27
The search filter for trials at the beginning of the MEDLINE strategy is from the published paper by Glanville 2006.
Appendix 3. Embase Ovid search strategy
1. exp randomized controlled trial/
2. exp randomization/
3. exp double blind procedure/
4. exp single blind procedure/
5. random$.tw.
6. or/1‐5
7. (animal or animal experiment).sh.
8. human.sh.
9. 7 and 8
10. 7 not 9
11. 6 not 10
12. exp clinical trial/
13. (clin$ adj3 trial$).tw.
14. ((singl$ or doubl$ or trebl$ or tripl$) adj3 (blind$ or mask$)).tw.
15. exp placebo/
16. placebo$.tw.
17. random$.tw.
18. exp experimental design/
19. exp crossover procedure/
20. exp control group/
21. exp latin square design/
22. or/12‐21
23. 22 not 10
24. 23 not 11
25. exp comparative study/
26. exp evaluation/
27. exp prospective study/
28. (control$ or prospectiv$ or volunteer$).tw.
29. or/25‐28
30. 29 not 10
31. 30 not (11 or 23)
32. 11 or 24 or 31
33. exp retina degeneration/
34. retina neovascularization/
35. subretinal neovascularization/
36. exp retina macula lutea/
37. maculopath$.tw.
38. ((macul$ or retina$ or choroid$) adj3 degener$).tw.
39. ((macul$ or retina$ or choroid$) adj3 neovasc$).tw.
40. or/33‐39
41. exp cataract/
42. exp cataract extraction/
43. ((extract$ or aspirat$ or operat$ or remov$ or surg$ or excis$ or implant$) adj3 cataract$).tw.
44. ((extract$ or aspirat$ or operat$ or remov$ or surg$ or excis$ or implant$) adj3 lens$).tw.
45. (pha?oemulsif$ or capsulorhexis or lensectomy).tw.
46. or/41‐45
47. 40 and 46
48. 32 and 47
Appendix 4. LILACS search strategy
cataract$ or IOL or phaco$ and macula$ degenerat$ or AMD or ARMD
Appendix 5. ISRCTN search strategy
(Macular Degeneration OR AMD OR ARMD) AND (Cataract OR Phacoemulsification OR IOL)
Appendix 6. ClinicalTrials.gov search strategy
(Macular Degeneration OR AMD OR ARMD) AND (Cataract OR Phacoemulsification OR IOL)
Appendix 7. WHO ICTRP search strategy
age related macular degeneration AND cataract
Study flow diagram.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Immediate surgery versus delayed surgery, Outcome 1 Mean best‐corrected visual acuity.
Comparison 1 Immediate surgery versus delayed surgery, Outcome 2 Mean change in cumulative drusen and geographic atrophy size at 12 months.
Comparison 1 Immediate surgery versus delayed surgery, Outcome 3 Development of choroidal neovascularization at 6 months.
Comparison 1 Immediate surgery versus delayed surgery, Outcome 4 Quality of life scores.
| Immediate cataract surgery compared with delayed cataract surgery in eyes with age‐related macular degeneration | ||||||
| Population: people with cataract and age‐related macular degeneration Settings: ophthalmology clinics Intervention: immediate cataract surgery (within 2 weeks) Comparison: delayed cataract surgery (after 6 months) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Delayed cataract surgery | Immediate cataract surgery | |||||
| Mean best‐corrected visual acuity (BCVA) (measured on the LogMAR scale; 0 = good vision, higher scores = worse vision) | At 6 months' follow‐up | — | 56 | ⊕⊕⊕⊝ | Neither trial reported visual acuity outcomes as dichotomous or categorical outcomes. At 12 months, 1 trial reported mean distance visual acuity, but the unit of measure was not reported. | |
| Mean BCVA in the delayed‐cataract surgery group was 0.28 LogMAR units. | Mean BCVA in the immediate‐cataract surgery group was 0.15 LogMAR units lower (better) (0.28 lower to 0.02 lower). | |||||
| At 12 months' follow‐up | ||||||
| See comment | ||||||
| Mean change in cumulated drusen or geographic atrophy area size (CDGAS) | At 6 months' follow‐up | 1 trial did not report any outcome related to drusen or geographic atrophy. | ||||
| Not reported | ||||||
| At 12 months' follow‐up | — | 49 | ⊕⊕⊝⊝ | |||
| The mean change in CDGAS in the delayed‐cataract surgery group was ‐1.125 CDGAS units. | The mean change in CDGAS in the immediate‐cataract surgery group was 0.76 CDGAS units higher (8.49 lower to 10.00 higher). | |||||
| Development of choroidal neovascularization | At 6 months' follow‐up | RR 3.21 (0.14 to 75.68) | 56 | ⊕⊝⊝⊝ | At 6 months, none of 29 participants in the delayed‐cataract surgery group compared with 1 of 27 participants in the immediate‐cataract surgery group developed choroidal neovascularization. The other trial reported that no participant in either group developed exudative AMD up to 12 months' follow‐up. | |
| Not estimated (see comment) | ||||||
| At 12 months' follow‐up | ||||||
| See comment | ||||||
| Quality of life (measured by the Impact of Vision Impairment questionnaire; higher mean scores represent better quality of life in the analyses, scale of 0 to 5) | At 6 months' follow‐up | — | 56 | ⊕⊕⊝⊝ | The other trial measured quality of life using the Visual Function‐14 questionnaire to assess patient satisfaction at baseline and 12 months' follow‐up; however, no between‐group analysis of results could be performed. | |
| Mean overall score in the delayed‐cataract surgery group was 1.8. | Mean overall score in the immediate‐cataract surgery group was 1.60 higher (0.61 to 2.59 higher). | |||||
| At 12 months' follow‐up | ||||||
| See comment | ||||||
| Complications | Not reported | |||||
| *The basis for the assumed risk is the risk in the control group. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the control group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Downgraded (‐1) for unclear risks of bias such as selection bias (methods of randomization and allocation concealment not reported), performance and detection bias (effect of lack of masking on outcome unclear), and attrition bias (nine of 114 participants not included in analyses). | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mean best‐corrected visual acuity Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.1 At 6 months | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 2 Mean change in cumulative drusen and geographic atrophy size at 12 months Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3 Development of choroidal neovascularization at 6 months Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 4 Quality of life scores Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.1 Overall scores | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 4.2 Emotional well‐being scores | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 4.3 Mobility and independence scores | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 4.4 Reading and accessing information scores | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
