| Objective: To evaluate the efficacy of bimanual microcisional cataract surgery(B-MICS) versus conventional coaxial small-incision cataract surgery(C-SICS) on visual acuity, the loss of cornea endothelial cell, the mean phacoemulsification time and intraoperative complications using meta-analysis and to assess the surgical feasibility and outcome of the new technique, thereby offering directions for clinical application.Methods: A systematic review related with B-MICS and C-SICS was conducted by a computer search in Medline, EMCC, OVID, CBM, CNKI and a supplement of mannual search, moreover by literature retrospective. We collected the literatures published domestic and abroad. Strictly include and exclude the relevant articals from the resource with statistical criterion, we evaluated the quality of the included studies and got the needing data. We used the soft of Review manager 4.2 to analysis the heterogeneity and on the basis of the result to select fixed effort model or random effort model to carry out the meta-analysis. The naked visual acuity of 1 day, 1week, 1month after operation, the best corrected visual acuity of 1 month after operation and the intraoperative complications were measured as odds ratio (OR) between B-MICS and C-SICS. To calculate the pooled OR and its corresponding 95% confidence interval (95%CI). The surgically induced astigmatism of 1 month after operation, the loss of cornea endothelial cell and the mean phacoemulsification time were measured as weighted mean difference(WMD) between B-MICS and C-SICS. To calculate the pooled WMD and its corresponding 95%CI. And then sensitivity analysis was performed and the publication bias was evaluated by funnel plot, Begg's adjusted rank correlation test and Egger's regression test. Result: Strictly include and exclude the relevant articals from the resource, A total of 14 trials were included in the meta-analysis, 6 trials in relation to the naked visual acuity of 1 day after operation, 7 trials in relation to the naked visual acuity of 1 week after operation, 6 trials in relation to the naked visual acuity of 1 month after operation, 4 trials in relation to the best corrected visual acuity of 1 month after operation, 6 trials in relation to the surgically induced astigmatism of 1 month after operation, 7 trials in relation to the loss of cornea endothelial cell, 7 trials in relation to the mean phacoemulsification time and 8 trials in relation to the intraoperative complications.1 The combined OR and 95%CI of naked visual acuity 0.5 or better 1 day after operation was 1.82(95%CI is 1.38~2.39). There was statistically significant difference(P<0.0001).2 The combined OR and 95%CI of naked visual acuity 0.5 or better 1 week after operation was 2.36(95%CI is 1.27~4.37). There was statistically significant difference(P<0.05).3 The combined OR and 95%CI of naked visual acuity 0.5 or better 1 month after operation was 1.61(95%CI is 1.08~2.41). There was statistically significant difference(P<0.05).4 The combined OR and 95%CI of best corrected visual acuity 0.5 or better 1 month after operation was 1.69(95%CI is 0.93~3.07). There was no statistically significant difference(P>0.05).5 The combined WMD of the meta-analysis showed a significant reduction in B-MICS group in surgically induced astigmatism (WMD=-0.33D, 95%CI: -0.44D~-0.22D, P<0.00001).6 The combined WMD of the meta-analysis showed a significant reduction in B-MICS group in the percentage of the loss of cornea endothelial cell (WMD=-7%, 95%CI: -14%~0%, P<0.05).7 The combined WMD and 95%CI of the mean phacoemulsification time was -0.06min ( 95 % CI: -0.27min~0.15min). There was no statistically significant difference(P>0.05). 8 The combined OR of the meta-analysis showed a significant reduction in B-MICS group in the intraoperative complications (OR=0.48, 95%CI: 0.27~0.85, P<0.05).9 According to the characters of the literatures, sensitivity analysis was carried out to different factors, the literatures sensitivity analysis results were all similar to the original results, which proved that the conclusion of the research work was stable and reliable.10 The publication bias was evaluated by funnel plot, Begg's adjusted rank correlation test and Egger's regression test. The results showed the funnel plots were on the whole symmetrical which showing that the publication bias were under control.Conclusion: 1 The evidence currently available showed that B-MICS is a safer and more reliable surgery for restoration of visual acuity and reducing the surgically induced astigmatism in patients with cataract.2 The evidence currently available showed that B-MICS is a safer and more reliable surgery for preserving cornea endothelium and reducing the loss of cornea endothelial cell.3 The evidence currently available showed that B-MICS is a safer and more reliable surgery for reducing the intraoperative complications.4 The mean phacoemulsification time was similar between B-MICS and C-SICS.5 The sensitivity analysis and publication bias showed that the outcomes of this research work was stable and reliable which could authentically reflect B-MICS is a more feasible, secure and effective surgery comparing to C-SICS, and have the broad application prospect for cataract extraction. |
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