Optical aberrations following implantation of multifocal intraocular lenses: a systematic review and meta-analysis protocol

INTRODUCTION: Multifocal intraocular lens (IOLs) are used to restore vision at different focal distances. The technology of multifocal IOLs is continually advancing. Optical aberrations a property of lenses that causes spreading of light over a region resulting in a blurred or distorted image. This study aims to systematically review investigator measured and patient reported optical aberrations following implantation of multifocal IOLs during phacoemulsification surgery to treat presbyopia in adults. METHODS AND ANALYSIS: We will conduct an electronic database search for randomised controlled trials, prospective non-randomised studies, observational studies in Ovid MEDLINE, Ovid EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus and ClinicalTrials.gov in March 2021. Eligibility criteria will include quantitative articles written in English and containing data on optical aberrations. Two independent reviewers will screen titles and abstracts and extract data from full texts, reporting outcomes according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extraction of key characteristics will be completed using customised forms. Methodological quality will be assessed using Cochrane Handbook 6.2. ETHICS AND DISSEMINATION: Ethics approval is not required for this review, as it will only include published data. Findings will be published in a peer-reviewed journal and disseminated across ophthalmic networks. We anticipate that the findings of this work will be of interest to multiple stakeholders: people who have undergone cataract surgery, eye health professionals, ophthalmic surgeons, device manufacturers and policy-makers. It will also inform researchers to where there are gaps in evidence and identify areas for future research. PROSPERO REGISTRATION NUMBER: CRD42021271050

Elementary education in Eritrea: how mother tongue education policy affects pupils and their access to education

Eritrea, a country in the Horn of Africa with a population of over four million, has nine languages and a mother tongue education policy for its elementary schools. This paper investigates the impact of the policy on the design and implementation of elementary education in this developing country, and on the dissemination of information to pupils. A survey was conducted of fifty-eight interviewees drawn from the nine ethnic groups: the heads of the language panels in the National Department of Curriculum; elementary school teachers, trainee teachers, school directors; and parents. The research reveals the issues a multilingual society with minority ethnic groups faces in opting for mother tongue education at elementary level. There are not enough qualified and experienced educators to prepare the curriculum, and there are the challenges of translating and of turning spoken into written language. There is a lack of literature other than textbooks to refer to, and there are virtually no libraries in elementary schools. However, when elementary pupils learn and read through the medium of their first language it grounds their education in the real world. The curriculum is also an important tool in preserving, using and developing the languages of Eritrea

Use of hyaluronidase as an adjunct to local anaesthetic eye blocks to reduce intraoperative pain in adults

BACKGROUND: Hyaluronidase has been used over many decades as an adjunct to local anaesthetic solution to improve the speed of onset of eye blocks and to provide better akinesia and analgesia. With the evolution of modern eye surgery techniques, fast onset and akinesia are not essential requirements anymore. The assumption that the addition of hyaluronidase to local anaesthetic injections confers better analgesia for the patient needs to be examined. There has been no recent systematic review to provide evidence that hyaluronidase actually improves analgesia. OBJECTIVES: To ascertain if adding hyaluronidase to local anaesthetic solutions for use in ophthalmic anaesthesia in adults results in a reduction of perceived pain during the operation and to assess harms, participant and surgical satisfaction, and economic impact. SEARCH METHODS: We carried out systematic searches in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and four other databases in June 2017. We searched the trial registers at www.ISRCTN.com, ClinicalTrials.gov and www.clinicaltrialsregister.eu for relevant trials. We imposed no language restrictions. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that evaluated the effect of hyaluronidase on pain experienced by adults during intraocular surgery using a rating scale. DATA COLLECTION AND ANALYSIS: Two review authors (HR and KA) independently extracted data and assessed methodological quality using standard procedures as expected by Cochrane. MAIN RESULTS: We included seven trials involving 500 participants that studied the effect of hyaluronidase on intraoperative pain. Four of the seven trials with 289 participants reported the primary outcome in a dichotomous manner, and we proceeded to meta-analyse the findings which showed a moderate heterogeneity that could not be explained (I² = 41% ). The pooled risk ratio (RR) for these four trials was 0.83 with the 95% confidence interval ranging from 0.48 to 1.42. The reduction in intraoperative pain scores in the hyaluronidase group were not statistically significant. Among the three trials that reported the primary outcome in a continuous manner, the presence of missing data made it difficult to conduct a meta-analysis. To further explore the data, we imputed standard deviations for the other studies from another included RCT (Sedghipour 2012). However, this resulted in substantial heterogeneity between study estimates (I² = 76% ). The lack of reported relevant data in two of the three remaining trials made it difficult to assess the direction of effect in a clinical setting. Overall, there was no statistical difference regarding the intraoperative reduction of pain scores between the hyaluronidase and control group. All seven included trials had a low risk of bias. According to GRADE, we found the quality of evidence was low and downgraded the trials for serious risk of inconsistency and imprecision. Therefore, the results should be analysed with caution. Participant satisfaction scores were significantly higher in the hyaluronidase group in two high quality trials with 122 participants. Surgical satisfaction was also superior in two of three high quality trials involving 141 participants. According to GRADE, the quality of evidence was moderate for participant and surgical satisfaction as the trials were downgraded for imprecision due to the small sample sizes. The risk of bias in these trials was low. There was no reported harm due to the addition of hyaluronidase in any of the studies. No study reported on the cost of hyaluronidase in the context of eye surgery. AUTHOR'S CONCLUSIONS: The effects of adding hyaluronidase to local anaesthetic fluid on pain outcomes in people undergoing eye surgery are uncertain due to the low quality of evidence available. A well designed RCT is required to address inconsistency and imprecision among the studies and to determine the benefit of hyaluronidase to improve analgesia during eye surgery. Participant and surgical satisfaction is higher with hyaluronidase compared to the control groups, as demonstrated in moderate quality studies. There was no harm attributed to the use of hyaluronidase in any of the studies. Considering that harm was only rarely defined as an outcome measure, and the overall small number of participants, conclusions cannot be drawn about the incidence of harmful effects of hyaluronidase. None of the studies undertook cost calculations with regards to use of hyaluronidase in local anaesthetic eye blocks

Invasive Dental Treatment and Acute Vascular Events: A Systematic Review and Meta-Analysis

BACKGROUND: Acute infection/inflammation increases the risk of acute vascular events. Invasive dental treatments (IDT) trigger short-term acute inflammation. PURPOSE: To critically appraise the evidence linking IDT and acute vascular events. DATA SOURCES: Six bibliographical databases were searched up to 31st August 2021. A systematic review following PRISMA guidelines was performed. STUDY SELECTION: Intervention and observational studies reporting any acute vascular events following IDT. DATA EXTRACTION: Two reviewers independently extracted data and rated the quality of studies. Data was pooled using fixed effect, inverse variance weights analysis. RISK OF BIAS: Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Handbook -Rob 2.0 for randomised controlled trials. DATA SYNTHESIS: Three out of 16 clinical studies, a total of 533,175 participants, 124,344 myocardial infarctions and of 327,804 ischemic strokes were reported. Meta-analysis confirmed that IDT did not increase incidence ratios (IR) for combined vascular events either at 1-4 weeks (IR of 1.02, 95% CIs: 0.92, 1.13) and at 5-8 weeks (IR of 1.04, 95% CIs-0.97;1.10) after treatment. LIMITATIONS: High level of heterogeneity (study designs and timepoint assessments). CONCLUSIONS: Patients who received IDT exhibited no substantial increase in vascular risk over 8 weeks post treatment