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Cochrane Database of Systematic Reviews

Cirugía de cataratas en pacientes con degeneración macular asociada a la edad

Información

DOI:
https://doi.org/10.1002/14651858.CD006757.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 16 febrero 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Salud ocular y de la visión

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Heather Casparis

    Correspondencia a: Private practice, Ophthalmology, Via Antonio Ciseri 13, CH‐6600 Locarno, Switzerland

    [email protected]

  • Kristina Lindsley

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

  • Irene C Kuo

    Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA

  • Shameema Sikder

    Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, USA

  • Neil M Bressler

    Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, USA

Contributions of authors

Conceiving the review: NB

Designing the review: HC

Co‐ordinating the review: HC

Data collection for the review

  • Designing search strategies: Iris Gordon, HC

  • Undertaking searches: Iris Gordon

  • Screening search results: HC, NB, KL, IK, SS

  • Organizing retrieval of papers: HC, KL

  • Screening retrieved papers against inclusion criteria: HC, NB, KL, IK, SS

  • Appraising quality of papers: HC, KL, IK, SS

  • Extracting data from papers: HC, KL, IK, SS

  • Writing to authors of papers for additional information: HC, KL

  • Providing additional data about papers: HC, NB

  • Obtaining and screening data on unpublished studies: HC, NB

Data management for the review

  • Entering data into Review Manager 5: HC, KL

Analysis of data: HC, KL

Interpretation of data

  • Providing a methodological perspective: HC, NB, KL, IK, SS

  • Providing a clinical perspective: HC, NB, IK, SS

  • Providing a policy perspective: NB

  • Providing a consumer perspective: NB

Writing the review: HC, NB, KL

Providing general advice on the review: NB

Securing funding for the review: CEV US Project

Performing previous work that was the foundation of the current study: NB

Updating the review: HC, KL, IK, SS, NB

Sources of support

Internal sources

  • Johns Hopkins University, USA.

External sources

  • Grant 1 U01 EY020522, National Eye Institute, National Institutes of Health, USA.

  • National Institute for Health Research (NIHR), UK.

    • Richard Wormald, Co‐ordinating Editor for the Cochrane Eyes and Vision (CEV) acknowledges financial support for his CEV research sessions from the Department of Health through the award made by the NIHR to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology.

    • The NIHR also funds the CEV editorial base in London.

    The views expressed in this publication are those of the review authors and not necessarily those of the NIHR, the NHS or the Department of Health.

Declarations of interest

HC is retina specialist in private practice.
KL is the Project Director for the CEV US Project.
IK: None known.
SS: None known.
NB: None known.

Acknowledgements

We acknowledge Iris Gordon, Information Specialist for Cochrane Eyes and Vision (CEV), for devising and running the electronic searches. We thank Anupa Shah, the Managing Editor for CEV, as well as Jennifer Evans, Barbara Hawkins, Dayse Sena, and Gianni Virgili, for their assistance and comments.

Version history

Published

Title

Stage

Authors

Version

2017 Feb 16

Surgery for cataracts in people with age‐related macular degeneration

Review

Heather Casparis, Kristina Lindsley, Irene C Kuo, Shameema Sikder, Neil M Bressler

https://doi.org/10.1002/14651858.CD006757.pub4

2012 Jun 13

Surgery for cataracts in people with age‐related macular degeneration

Review

Heather Casparis, Kristina Lindsley, Irene C Kuo, Shameema Sikder, Neil M Bressler

https://doi.org/10.1002/14651858.CD006757.pub3

2009 Jan 21

Surgery for cataracts in people with age‐related macular degeneration

Review

Heather Casparis, Kristina Lindsley, Neil B Bressler

https://doi.org/10.1002/14651858.CD006757.pub2

2007 Oct 17

Surgery for cataracts in people with age‐related macular degeneration

Protocol

Heather Casparis, Neil Bressler

https://doi.org/10.1002/14651858.CD006757

Differences between protocol and review

In the protocol for this review (Casparis 2007), secondary outcomes were to be assessed at one‐, two‐, and three‐year follow‐up. As of 2012, we also assessed secondary outcomes at six months (Casparis 2012).

For this update, we included a 'Summary of findings' table and GRADE assessments in accordance with Cochrane standards.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans; Middle Aged;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Immediate surgery versus delayed surgery, Outcome 1 Mean best‐corrected visual acuity.
Figuras y tablas -
Analysis 1.1

Comparison 1 Immediate surgery versus delayed surgery, Outcome 1 Mean best‐corrected visual acuity.

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Comparison 1 Immediate surgery versus delayed surgery, Outcome 2 Mean change in cumulative drusen and geographic atrophy size at 12 months.
Figuras y tablas -
Analysis 1.2

Comparison 1 Immediate surgery versus delayed surgery, Outcome 2 Mean change in cumulative drusen and geographic atrophy size at 12 months.

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Comparison 1 Immediate surgery versus delayed surgery, Outcome 3 Development of choroidal neovascularization at 6 months.
Figuras y tablas -
Analysis 1.3

Comparison 1 Immediate surgery versus delayed surgery, Outcome 3 Development of choroidal neovascularization at 6 months.

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Comparison 1 Immediate surgery versus delayed surgery, Outcome 4 Quality of life scores.
Figuras y tablas -
Analysis 1.4

Comparison 1 Immediate surgery versus delayed surgery, Outcome 4 Quality of life scores.

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Summary of findings for the main comparison. Immediate cataract surgery compared with delayed cataract surgery in eyes with age‐related macular degeneration

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
(95% CI)

No of participants
(studies)

Certainty of the evidence
(GRADE)

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
(1 study)

⊕⊕⊕⊝
moderate1

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
(1 study)

⊕⊕⊝⊝
low1,2

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
(1 study)

⊕⊝⊝⊝
very low1,3

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
(1 study)

⊕⊕⊝⊝
low1,2

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
High‐certainty: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate‐certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low‐certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low‐certainty: We are very uncertain about the estimate.

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).
2Downgraded (‐1) for imprecision (wide confidence intervals).
3Downgraded (‐2) for imprecision (very wide confidence intervals).

Figuras y tablas -
Summary of findings for the main comparison. Immediate cataract surgery compared with delayed cataract surgery in eyes with age‐related macular degeneration
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Comparison 1. Immediate surgery versus delayed surgery

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]
Figuras y tablas -
Comparison 1. Immediate surgery versus delayed surgery
Ir a la tabla de la revisión