Current Evidence Research Articles

TELEREHABILITATION INTERVENTION PROTOCOLS FOR COVID-19 PATIENTS: A SCOPING REVIEW

Introduction: Since the start of the pandemic, it became clear to physical therapists through emerging studies that there are better outcomes in managing the symptoms of COVID-19 patients if they undergo physical therapy; however, face-to-face rehabilitation of COVID-19 patients placed physical therapists at risk of cross-infection. To address this issue, the use of telerehabilitation as a mode of delivery of instruction and patient monitoring was considered. Recent studies have expressed its effectiveness; however, there are still no available standardized protocols for the telerehabilitation of COVID-19 patients. Thus, this study seeks to conduct a comprehensive search of the published literature regarding COVID-19 physical therapy interventions and to map out the current evidence and knowledge gaps surrounding telerehabilitation protocols for COVID-19 patients. Methods: The study has a Scoping Review Design in accordance with the PRISMA-ScR guidelines. In this study, 939 articles were found through searching in the following databases with specific MeSH Terms: PEDRO, PubMed, BioMed Central, & Cochrane Central. These 939 articles were then screened and assessed for their eligibility, specifically, to match the inclusion criteria of the study. Specific details of each of the studies included the following: Title, Author & Country, Digital Technology Used, Research Design, Methodology, Intervention/Program, and Key Findings/Results. Similar details between studies were tallied and were then compared to their existing forms of literature. Results: A total of 9 studies were reviewed after the 939 articles were screened and similar details were tallied as well. A majority of the studies were RCTs followed by Systematic Reviews/Meta-Analysis. The most common interventions used in order were (1) Strengthening Exercises, (2) Deep Breathing Exercises, and (3) Aerobic Exercises. The most used telerehabilitation technology was any internet-connected device that had access to video conferencing. Four of the studies have shown better outcomes as a result of telerehabilitation. Gaps in literature, specifically the lack of studies conducted in developing nations and unevidenced claims of better cost-effectiveness, were consistent in all studies. Discussion: This study was able to map out the available research and the surrounding protocols conducted through telerehabilitation for COVID-19 patients. The current literature shows the most common interventions and outcome measures used during telerehabilitation and that some patients have become better as a result of telerehabilitation. The findings can be used as a basis for creating a telerehabilitation treatment plan and may be used to systematically compare said studies in turn would create a standardized protocol for COVID-19 telerehabilitation.

TELEREHABILITATION INTERVENTION PROTOCOLS FOR COVID-19 PATIENTS: A SCOPING REVIEW

Introduction: Since the start of the pandemic, it became clear to physical therapists through emerging studies that there are better outcomes in managing the symptoms of COVID-19 patients if they undergo physical therapy; however, face-to-face rehabilitation of COVID-19 patients placed physical therapists at risk of cross-infection. To address this issue, the use of telerehabilitation as a mode of delivery of instruction and patient monitoring was considered. Recent studies have expressed its effectiveness; however, there are still no available standardized protocols for the telerehabilitation of COVID-19 patients. Thus, this study seeks to conduct a comprehensive search of the published literature regarding COVID-19 physical therapy interventions and to map out the current evidence and knowledge gaps surrounding telerehabilitation protocols for COVID-19 patients. Methods: The study has a Scoping Review Design in accordance with the PRISMA-ScR guidelines. In this study, 939 articles were found through searching in the following databases with specific MeSH Terms: PEDRO, PubMed, BioMed Central, & Cochrane Central. These 939 articles were then screened and assessed for their eligibility, specifically, to match the inclusion criteria of the study. Specific details of each of the studies included the following: Title, Author & Country, Digital Technology Used, Research Design, Methodology, Intervention/Program, and Key Findings/Results. Similar details between studies were tallied and were then compared to their existing forms of literature. Results: A total of 9 studies were reviewed after the 939 articles were screened and similar details were tallied as well. A majority of the studies were RCTs followed by Systematic Reviews/Meta- Analysis. The most common interventions used in order were (1) Strengthening Exercises, (2) Deep Breathing Exercises, and (3) Aerobic Exercises. The most used telerehabilitation technology was any internet-connected device that had access to video conferencing. Four of the studies have shown better outcomes as a result of telerehabilitation. Gaps in literature, specifically the lack of studies conducted in developing nations and unevidenced claims of better cost-effectiveness, were consistent in all studies. Discussion: This study was able to map out the available research and the surrounding protocols conducted through telerehabilitation for COVID-19 patients. The current literature shows the most common interventions and outcome measures used during telerehabilitation and that some patients have become better as a result of telerehabilitation. The findings can be used as a basis for creating a telerehabilitation treatment plan and may be used to systematically compare said studies in turn would create a standardized protocol for COVID-19 telerehabilitation.

Improvement of thrombosis management in patients with cancer: a practical consensus document of recommendations for cancer-associated thrombosis patients' healthcare in Spain.

Cancer patients are at risk of venous thromboembolism (VTE), its recurrence, but also at risk of bleeding while anticoagulated. In addition, cancer therapies have been associated to increased VTE risk. Guidelines for VTE treatment in cancer patients recommend low molecular weight heparins (LMWH) or direct oral anticoagulants (DOAC) for the initial treatment, DOAC for VTE short-term treatment, and LMWH or DOAC for VTE long-term treatment. This consensus article arises from a collaboration between different Spanish experts on cancer-associated thrombosis. It aims to reach an agreement on a practical document of recommendations for action allowing the healthcare homogenization of cancer-associated thrombosis (CAT) patients in Spain considering not only what is known about VTE management in cancer patients but also what is done in Spanish hospitals in the clinical practice. The text summarizes the current knowledge and available evidence on the subject in Spain and provides a series of practical recommendations for CAT management and treatment algorithms to help clinicians to manage CAT over time.

Remdesivir and the Liver: A Concise Narrative Review of Remdesivir-Associated Hepatotoxicity in Patients Hospitalized Due to COVID-19

Severe acute respiratory syndrome coronavirus 2 has infected millions of people, but about 20% of infected individuals do not develop symptoms. COVID-19 is an inflammatory disease that affects a portion of individuals infected with the virus and it is associated with liver injury and other complications, leading to hospitalization, critical illness, and death. Remdesivir is an antiviral agent used for the treatment of hospitalized patients with COVID-19 to improve the time to recovery, reduce the duration of mechanical ventilation, decrease the need for supplemental oxygen, and decrease the risk of mortality. Remdesivir-associated hepatotoxicity has been observed as increased transaminases more than five times the upper limit of normal in hospitalized patients with COVID-19, but causality has not been proven. It is generally difficult to distinguish between remdesivir-associated hepatotoxicity and COVID-19-induced hepatotoxicity. The purpose of this review is to evaluate the evidence for remdesivir-associated hepatotoxicity. Current evidence suggests that elevated liver enzymes in hospitalized COVID-19 patients are more likely to be due to the infection than remdesivir, and a 5-day course of remdesivir seems to be safe in regard to hepatotoxicity.

Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association.

Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.

Redevelopment of mental health first aid guidelines for substance use problems: a Delphi study

BackgroundSubstance use problems have a major impact on the physical and mental health of individuals, families and communities. Early intervention may have a positive effect on recovery and treatment outcomes for those with substance use problems, reducing related risk and harm. Separate mental health first aid guidelines on how a member of the public could assist someone experiencing or developing alcohol use and drug use problems in high income Western countries were developed using Delphi expert consensus in 2009 and 2011, respectively. This study aimed to synthesise and update these two original guidelines to reflect current evidence and best practice.MethodsThe Delphi expert consensus method was used to determine the inclusion of statements in the redeveloped guidelines. A questionnaire was developed using previously endorsed helping statements from the original guidelines on alcohol and drug use problems, as well as relevant content identified in systematic searches of academic and grey literature. Three panels of experts (people with lived experience, support people and professionals) rated statements over three consecutive online survey rounds to determine the importance of their inclusion in the guidelines. Statements endorsed by at least 80% of each panel were included.Results103 panellists completed all three survey rounds. They rated 469 statements and endorsed 300 of these for inclusion in the redeveloped guidelines.ConclusionsThis study has developed a broader and more comprehensive set of guidelines for how to support a person experiencing or developing a substance use problem. The redeveloped guidelines provide more detail on knowledge about and recognition of substance use problems, approaching and assisting people who want to change or are not ready to change, harm reduction, community-based supports and professional help, but have less on physical first aid actions. Mental Health First Aid International will use these guidelines in future updates of their training courses.

The effects of vitamin D and omega-3 co-supplementation on lipid profile in adults: a systematic review and meta-analysis

PurposePrevious research indicates that vitamin D and omega-3 co-supplementation may benefit overall health, but current evidence regarding its effects on lipid profile remains unclear. The present systematic review and meta-analysis aimed to examine the effects of vitamin D and omega-3 co-supplementation on lipid profile (total cholesterol [TC], low-density lipoprotein [LDL], triglyceride [TG] and high-density lipoprotein [HDL]) in adults.Design/methodology/approachIn this systematic review and meta-analysis, relevant studies were obtained by searching the PubMed, Scopus and Web of Science databases (from inception to January 2022). Weighted mean differences and 95% confidence intervals were estimated via a random-effects model. Heterogeneity, sensitivity analysis and publication bias were reported using standard methods.FindingsPooled analysis of six randomized controlled trials (RCTs) revealed that vitamin D and omega-3 co-supplementation yielded significant reductions in TG (p = 0.631). A pooled analysis of five trials indicated a significant association between omega-3 and vitamin D treatment and reductions in TC (p = 0.001) and LDL (p = 0.001). Although, pooled analyses of omega-3 and vitamin D did not significantly affect HDL.Originality/valueThe findings suggest that vitamin D and omega-3 co-supplementation lowers TG, TC and LDL in adults. Future, large-scale, RCTs on various populations are needed to elucidate further beneficial effects of vitamin D and omega-3 co-supplementation on lipid profile and establish guidelines for clinical practice.

Arteriovenous malformation presenting as complex regional pain syndrome: illustrative case.

Complex regional pain syndrome (CRPS) is typically described as a peripheral nerve disorder in which exaggerated allodynia and hyperalgesia follow a minor injury. Some researchers propose a central mechanism, although current evidence is lacking. A 14-year-old female presented with classic CRPS symptoms of left upper-extremity weakness and hyperalgesia after a bout of sharp pain in her thumb while shoveling snow. A possible seizure prompted magnetic resonance imaging, revealing a right frontal Spetzler-Martin grade II arteriovenous malformation (AVM) adjacent to the primary motor cortex. Brodmann areas 1, 3a, and 3b, which are responsible for localizing and processing burning and painful sensations, were also involved. The patient underwent transarterial Onyx embolization in two sessions and microsurgical resection, after which her CRPS symptoms completely resolved. To our knowledge, this is the first reported case of a cerebral AVM presenting as CRPS, which supports a central mechanism. The authors propose that rapid growth of the AVM led to a vascular steal phenomenon of surrounding parenchyma, which disrupted the patient's normal motor function and nociceptive processing. Further validation in other series is needed.

Psychological risk factors of somatic symptom disorder: A systematic review and meta-analysis of cross-sectional and longitudinal studies

ObjectiveCurrent diagnostic concepts of somatic symptom disorder (SSD) in DSM-5 and bodily distress disorder (BDD) in ICD-11 require certain psychological criteria, but researchers have called for further specification. Therefore, in a first step, this systematic review and meta-analysis aimed to summarize the current evidence on psychological factors associated with SSD/BDD and/or disorder-relevant clinical outcomes such as symptom severity and impairment. MethodsPsychological factors were systematically searched using Pubmed, Cochrane Library and Psycinfo via EBSCO. Studies providing original data in English or German, after 2009 were included. Cross-sectional, cohort and case-control studies investigating at least one psychological factor in individuals with SSD/BDD in the context of disorder-relevant outcomes were included. ResultsForty-three eligible studies (n = 3760 patients) in SSD (none in BDD) provided data on at least one psychological factor, 37 in case-control format, 10 cross-sectional and 5 longitudinal. Meta-analyses of the case-control studies found patients with SSD to be more impaired by depression (SMD = 1.80), anxiety (SMD = 1.55), health anxiety (SMD = 1.31) and alexithymia (SMD = 1.39), compared to healthy controls. Longitudinal results are scarce, mixed, and require refining, individual studies suggest self-concept of bodily weakness, anxiety and depression to be predictive for persistent SSD and physical functioning. ConclusionThis review provides a detailed overview of the current evidence of psychological factors in relation to SSD/BDD. Future studies on SSD and BDD should include under-studied psychological factors, such as negative affect, fear avoidance, or emotion regulation. More longitudinal studies are needed to assess the predictive value of these factors.

RNA N6-methyladenosine modifications in urological cancers: from mechanism to application.

The N6-methyladenosine (m6A) modification is the most common modification of messenger RNAs in eukaryotes and has crucial roles in multiple cancers, including in urological malignancies such as renal cell carcinoma, bladder cancer and prostate cancer. The m6A RNA modification is controlled by three types of regulators, including methyltransferases (writers), demethylases (erasers) and RNA-binding proteins (readers), which are responsible for gene regulation at the post-transcriptional level. This Review summarizes the current evidence indicating that aberrant or dysregulated m6A modification is associated with urological cancer development, progression and prognosis. The complex and context-dependent effects of dysregulated m6A modifications in urological cancers are described, along with the potential for aberrantly expressed m6A regulators to provide valuable diagnostic and prognostic biomarkers as well as new therapeutic targets.

Beyond the horizon: Exploring adverse childhood experiences and their lifelong, intergenerational influence on dental caries

The influence of sociodemographic, psychological, and behavioral characteristics on dental caries development, maintenance, and treatment is well-established. Although current evidence shows a direct effect of Adverse Childhood Experiences (ACEs)11ACE(s): Adverse Childhood Experience(s). on oral health-related outcomes, such as dental anxiety and tooth loss, the major impact in dental caries probably occurs through indirect pathways. Even though some evidence observed mediation by variables related to health behavior (e.g., sugar intake and smoking) and mental health in the relationship between ACEs and oral health-related outcomes, there is a significant gap in the understanding of potential causal pathways related to socioeconomic, psychosocial, and behavioral variables. In this way, the main objective of this hypothesis paper was to present and discuss the hypothesis on how ACEs might increase the risk of dental caries in childhood and adulthood, as well as the risk of intergenerational transmission of effect, using a life course approach in a chain-of-risk perspective. The leading hypothesis of this paper was that exposure to ACEs might lead to worse socioeconomic, psychosocial, and behavioral conditions that might increase the risk of dental caries in childhood, adulthood, and intergenerationally. The hypothesis outlined is valuable for the development of further empirical evidence, mainly longitudinal studies. Strengthening the evidence is essential to promote a comprehensive understanding of the short- and long-term effects of ACEs and to establish points for intervention to improve oral health outcomes in both children and adults.

Intravitreous aflibercept or vitrectomy for initial treatment of diabetic vitreous hemorrhage? A Systematic Review of Current Evidence

Introduction & Objectives : To assess the efficacy and safety of intravitreous aflibercept versus vitrectomy in patients with diabetic vitreous hemorrhage (VH)
 Methods : Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE database were searched. No constraints based on language or publication date were applied. Only randomized controlled trials (RCTs) comparing intravitreal aflibercept injection with vitrectomy procedure were included. Search results were screened independently by two authors. Data extraction and synthesis were performed according to The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome measures were best-corrected visual acuity obtained at least 6 months following interventions, rate of recurrent hemorrhage, and periprocedural ocular adverse events. The quality of evidence was assessed using the GRADE tools.
 Results : Two clinical trials that randomized 239 eyes were included in this review. There was no evidence ofa difference in primary outcome of mean visual acuity at six months between randomized groups. However, patients receiving intravitreous aflibercept were more likely to experience recurrent VH than those undergoing vitrectomy (RR 3.12 95% CI 1.95 - 4.99, absolute effect of 32 more people with recurrent VH per 100 people treated with aflibercept). Rates of periprocedural ocular complications were similar in both groups.
 Conclusion : Intravitreous aflibercept safety and efficacy appear to be non-inferior compared to vitrectomy for initial management of diabetic VH. Further well-designed studies are needed to investigate the long- term effects of treatments.

The human factor H protein family - an update.

Complement is an ancient and complex network of the immune system and, as such, it plays vital physiological roles, but it is also involved in numerous pathological processes. The proper regulation of the complement system is important to allow its sufficient and targeted activity without deleterious side-effects. Factor H is a major complement regulator, and together with its splice variant factor H-like protein 1 and the five human factor H-related (FHR) proteins, they have been linked to various diseases. The role of factor H in inhibiting complement activation is well studied, but the function of the FHRs is less characterized. Current evidence supports the main role of the FHRs as enhancers of complement activation and opsonization, i.e., counter-balancing the inhibitory effect of factor H. FHRs emerge as soluble pattern recognition molecules and positive regulators of the complement system. In addition, factor H and some of the FHR proteins were shown to modulate the activity of immune cells, a non-canonical function outside the complement cascade. Recent efforts have intensified to study factor H and the FHRs and develop new tools for the distinction, quantification and functional characterization of members of this protein family. Here, we provide an update and overview on the versatile roles of factor H family proteins, what we know about their biological functions in healthy conditions and in diseases.

Efficacy and Safety of Iris-Claw and Scleral Fixated Intraocular Lens in Pediatric Ectopia Lentis : A Systematic Review

Abstract
 Introduction & Objectives : Ectopia lentis is a condition that involves displacement of the crystalline lens because of weakened or damaged zonules. Surgical intervention is indicated in cases of poor best corrected visual acuity (BCVA) and progressive severity of subluxation. This systematic review aims to elucidate current evidence regarding the efficacy and safety of iris-claw and scleral-fixated intraocular lenses (IOLs) to treat children with ectopia lentis.
 Methods : A comprehensive search from multiple electronic databases such as PubMed, Cochrane Library, ProQuest, Scopus, EBSCO, Wiley, and Embase within the last ten years of publication. All seventeen studies matched with studies’ criteria were included in this review and assessed with eligibility assessment tools. The outcomes extracted and compared were BCVA, endothelial cell density, postoperative complications, IOL stability, and intraocular pressure (IOP).
 Results : Seventeen studies were included in this review; three observational studies, nine retrospective studies and five interventional studies in which majority have a low risk of bias. Significant improvement of post-operative BCVA on both IOLs. The most frequent complications found on ICIOL was pupillary ovalization, while SCIOL was eye infection. Endothelial cell loss was higher in SCIOL, and both IOL showed no significant difference (p > 0,05) in terms of the post-operative IOP. Dislocation of IOL more frequently found on ICIOL. However, ICIOL much more preferred due to less manipulation and duration of surgery.
 Conclusion : ICIOL and SFIOL were both effective and safe for treating pediatric ectopia lentis. There was no superiority in which technique is better, technique varied according to each surgeon's preference.

Effectiveness of occupational therapy interventions on function and satisfaction with occupational performance among adults with conditions of the hand, wrist, and forearm: a protocol for a systematic review.

Functional hand use post injury is important in enabling a person's engagement in daily living tasks. Without proper treatment, there may be difficulties in self-care, engaging in job roles, or leisure pursuits. Occupational therapists are key health care practitioners for people with upper limb conditions. This systematic review aims to appraise and summarise current evidence regarding effectiveness of occupational therapy interventions among adults with conditions of the hand, wrist, and forearm. A systematic review of randomised control trials and quasi randomised controlled trials will be completed. MEDLINE OVID, CINAHL, CENTRAL, COCHRANE, PUBMED and EMBASE databases will be systematically searched. Grey literature will be searched for via Google Scholar. Studies will be included if they include provision of occupational therapy to adults with a hand, wrist, or forearm condition when compared to treatment as usual or an alternative treatment option. The primary outcome will be function. Secondary outcomes will include satisfaction with occupational performance, quality of life, pain experience, and participation. The Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions will be used to categorise outcomes. The Cochrane Risk of Bias 2 (RoB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) framework will be utilised to assess quality. A pooled meta- analysis will be completed using RevMan, depending on the uniformity and availability of data. This review aims to synthesise high quality evidence to identify the effectiveness of occupational therapy interventions with patients with a hand, wrist, or forearm condition, categorising outcomes in relation to the ICF Core Set for Hand Conditions. By synthesising the evidence there is potential for improved evidence base for clinicians; improved outcomes for patients; as well as potential economic benefit.This study is registered with PROSPERO: CRD42022337070.

Carotid intima-media thickness in surgically or conservatively managed patients with primary hyperparathyroidism.

Current evidence of cardiovascular (CV) risk in primary hyperparathyroidism (PHPT) is still inconsistent. To prospectively investigate changes of early atherosclerosis in patients with PHPT undergoing parathyroidectomy (PTx) or conservative management, according to Consensus criteria. Biochemical parameters of PHPT, CV risk factors (systolic and diastolic blood pressure-BP-, total-, HDL- and LDL-cholesterol, triglyceride, glycosilated hemoglobin, and HOMA-IR), and carotid intima-media thickness (IMT) and plaque were assessed in 52 consecutive postmenopausal PHPT patients both at baseline and ≥24 months after surgery (PTx: n = 22) or conservative management (no-PTx: n = 30). At baseline, PTx and no-PTx showed comparable age, BMI, renal function, 25(OH)D levels, and did not differ for CV risk factors, IMT and plaques, nor for the prevalence of smoking, diabetes mellitus, antihypertensive or statin therapy, while differing for all parameters characterizing PHPT. Follow-up length in PTx was longer (p = 0.004) than in no-PTx. Parameters characterizing PHPT significantly improved ≥24 months after surgery, whereas in no-PTx serum phosphate slightly decreased and PTH increased. Systolic and diastolic BP increased at follow-up in both groups, while other CV risk factors did not significantly vary. In PTx IMT did not significantly vary after surgery (0.85 ± 0.14 to 0.89 ± 0.22 mm, p = 0.366), whereas it significantly increased in no-PHPT (0.80 ± 0.18 to 0.93 ± 0.23 mm, p = 0.008), even adjusting for BP values. Plaque prevalence and incidence did not significantly differ in the two groups. Our results suggest that in postmenopausal PHPT patients subclinical atherosclerosis could be halted by PTx, whereas it worsens over time in not operated patients with milder disease.

Binocular therapy for amblyopia in children: a systematic review and meta- analysis of randomized controlled trials

Abstract
 Introduction & Objectives : Concerns for low compliance and mixed outcomes with conventional deprivation therapy prompt the need to explore new modes of amblyopia treatment. Novel binocular therapy using movies or games may offer comparable outcomes with better compliance, theoretically strengthening the amblyopic eye by enhancing stereopsis. This study aims to elucidate current evidence regarding binocular therapy in comparison to conventional therapy in treating amblyopia in children.
 Methods : Comprehensive literature search across five electronic databases was conducted using keywords selected a priori. Randomized controlled trials (RCTs) on binocular therapy in children with amblyopia were included and critically appraised using Cochrane risk of bias tool by three reviewers. Primary outcome was improvement of amblyopic eye VA, and a meta-analysis was conducted for quantitative data analysis.
 Results : We included 16 RCTs eligible for inclusion with a total sample size of 1,520 patients. In comparing binocular therapy to either patching or spectacles, there was no overall significant difference in terms of VA change from baseline. Subgroup analysis suggests binocular therapy may be favorable within 2-4 weeks, although not statistically significant. Albeit subgroup analysis of video-based binocular therapy revealed significant improvement in VA compared to patching (0.39 logMAR, [0.03, 0.74], p = 0.03), yet the same was not found for game-based binocular therapy.
 Conclusion : Efficacy of binocular therapy as a substitute for conventional therapy in treating amblyopia is not yet substantiated. Further exploration to determine most effective treatment protocol is needed, including strategies to increase adherence. Video-based therapy shows potential for improving outcomes and warrants further investigation.

Efficacy and Safety of Iris-Claw and Scleral Fixated Intraocular Lens in Pediatric Ectopia Lentis : A Systematic Review

Introduction & Objectives : Ectopia lentis is a condition that involves displacement of the crystalline lens because of weakened or damaged zonules. Surgical intervention is indicated in cases of poor best corrected visual acuity (BCVA) and progressive severity of subluxation. This systematic review aims to elucidate current evidence regarding the efficacy and safety of iris-claw and scleral-fixated intraocular lenses (IOLs) to treat children with ectopia lentis.
 Methods : A comprehensive search from multiple electronic databases such as PubMed, Cochrane Library, ProQuest, Scopus, EBSCO, Wiley, and Embase within the last ten years of publication. All seventeen studies matched with studies’ criteria were included in this review and assessed with eligibility assessment tools. The outcomes extracted and compared were BCVA, endothelial cell density, postoperative complications, IOL stability, and intraocular pressure (IOP).
 Results : Seventeen studies were included in this review; three observational studies, nine retrospective studies and five interventional studies in which majority have a low risk of bias. Significant improvement of post-operative BCVA on both IOLs. The most frequent complications found on ICIOL was pupillary ovalization, while SCIOL was eye infection. Endothelial cell loss was higher in SCIOL, and both IOL showed no significant difference (p > 0,05) in terms of the post-operative IOP. Dislocation of IOL more frequently found on ICIOL. However, ICIOL much more preferred due to less manipulation and duration of surgery.
 Conclusion : ICIOL and SFIOL were both effective and safe for treating pediatric ectopia lentis. There was no superiority in which technique is better, technique varied according to each surgeon's preference.

MONOVISION VERSUS MULTIFOCAL INTRAOCULAR LENS IMPLANTATION IN CATARACT PATIENTS:A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: With the aim to increase spectacle independence, recent approaches to repair cataracts include the implantation of premium intraocular lenses (IOLs), such as multifocals. Another approach is monovision techniques achieved by monofocal IOL implantation, which is more cost-effective, although it has the same good outcome as multifocal IOLs. This meta-analysis aimed to compare monovision versus multifocal IOL implantation in cataract patients. Method: Systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacles independence, visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) and The Risk Of Bias In Non-randomized Studies – of Interventions (ROBINS-I) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data. Result: Ten studies satisfying the inclusion criteria were included. Pooling analysis for BCVA and BNVA showed no difference between monovision vs multifocal IOL (95% CI at -0,10 to 0,73; I2=79% (p=0,14) and 95% CI at -0,27 to 1,37; I2=94% (p=0,19), respectively). Spectacle independence showed monovision was inferior to multifocal IOL (RR 0,53; 95% CI at 0,34 to 0,82; I² 83% (p=0,004)). Conclusion: Current evidence showed monovision was comparable to multifocal IOL in terms of visual acuity. While multifocal IOL achieved more spectacle-free patients than monovision, many patients in the monovision group also achieved spectacle-free condition. Keywords: cataract, monovision, multifocal intraocular lens, visual acuity, spectacle independence.

Monovision versus multifocal intraocular lens implantation in cataract patients: a systematic review and meta-analysis

Abstract
 Introduction & Objectives : Modern cataract surgery technique entails replacing the crystalline lens with an artificial intraocular lens (IOL). While the standard monofocal IOL implantation with monovision technique has been cost- effective and provided patients with good visual acuity, multifocal IOLs present the prospect of spectacle-free vision despite various adverse outcomes. It remained contentious whether multifocal IOLs were superior to monovision. Our review provide an up-to-date assessment of monovision vs. multifocal IOL implantation's visual acuity and spectacle independence following cataract surgery.
 Methods : A systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacle independence, and visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data.
 Results : Ten studies were identified. Pooling analysis for uncorrected binocular distance visual acuity and binocular uncorrected near visual acuity showed no difference between monovision vs. multifocal IOL (SMD 0,31; 95% CI -0,21 to 0,82 and SMD 0,41; 95% CI -0,58 to 1,40, respectively). Spectacle independence showed monovision was inferior to multifocal IOL (OR 0,22; 95% CI 0,08 to 0,61; heterogeneity I2=75%).
 Conclusion : Current evidence showed that multifocal IOL had comparable visual acuity to monovision with slightly higher likelihood of being spectacle-free. Despite that, monovision can be an efficacious and affordable option to be implemented in countries with high cataract burden.