Comparative anatomical outcomes of high-flow vs. low-flow phacoemulsification cataract surgery: A systematic review and meta-analysis

Po-Chin Kuo; Jia-Horung Hung; Yu-Chen Su; Ching-Ju Fang; Chaw-Ning Lee; Yi-Hsun Huang; Shih-Chieh Shao; Edward Chia-Cheng Lai

doi:10.3389/fmed.2022.1021941

Comparative anatomical outcomes of high-flow vs. low-flow phacoemulsification cataract surgery: A systematic review and meta-analysis

Front Med (Lausanne). 2022 Sep 28:9:1021941. doi: 10.3389/fmed.2022.1021941. eCollection 2022.

Authors

Po-Chin Kuo¹, Jia-Horung Hung^{2

3}, Yu-Chen Su², Ching-Ju Fang^{4

5}, Chaw-Ning Lee^{6

7}, Yi-Hsun Huang², Shih-Chieh Shao^{7

8}, Edward Chia-Cheng Lai⁷

Affiliations

¹ Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Medical Library, National Cheng Kung University, Tainan, Taiwan.
⁵ Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁶ Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁸ Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.

Abstract

Background: Phacoemulsification is an effective and widely performed technique in cataract surgery, but the comparative anatomical outcomes, including endothelial cell loss (ECL), central corneal thickness (CCT), and central macular thickness (CMT), between high-flow and low-flow phacoemulsification cataract surgery remain unclear.

Methods: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Random-effects models were applied to measure pooled mean differences (MD) with 95% confidence intervals (CI) of anatomical outcomes between high-flow and low-flow phacoemulsification cataract surgery. We judged overall certainty of evidence (CoE) based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

Results: We included six randomized controlled trials (RCTs) totaling 477 participants. The meta-analysis showed similar changes associated with these two surgery types in both ECL at postoperative days 2-14 (MD: -1.63%; 95% CI: -3.73 to 0.47%; CoE: very low), days 15-42 (MD: -0.65%; 95% CI -2.96 to 1.65%; CoE: very low) and day 43 to month 18 (MD: -0.35%; 95% CI: -1.48 to 0.78%; CoE: very low), and CCT at postoperative day 1 (MD: -16.37 μm; 95% CI: -56.91 to 24.17 μm; CoE: very low), days 2-14 (MD: -10.92 μm; 95% CI: -30.00 to 8.16 μm; CoE: very low) and days 15-42 (MD: -2.76 μm; 95% CI: -5.75 to 0.24 μm; CoE: low). By contrast, low-flow phacoemulsification showed less increase in CMT at postoperative days 15-42 (MD, -4.58 μm; 95% CI: -6.3 to -2.86 μm; CoE: low).

Conclusions: We found similar anatomical outcomes, except in CMT, for both high-flow and low-flow phacoemulsification cataract surgery. Future head-to-head RCTs on visual outcomes should confirm our findings.

Systematic review registration: PROSPERO, identifier: CRD42022297036.

Keywords: cataract surgery; central corneal thickness; central macular thickness; endothelial cell loss; fluidics; meta-analysis; phacoemulsification; systematic review.

Publication types

Systematic Review