Abstract:
BACKGROUND:Fuchs endothelial dystrophy (FED), first described by Ernst Fuchsis in 1910, is a condition in which there is premature degeneration of corneal endothelial cells. When the number of endothelial cells is reduced to a significant degree fluid begins to accumulate within the cornea. As a result the cornea loses its transparency and the individual suffers a reduction in vision. The only successful surgical treatment for this condition is replacement of part or all of the cornea with healthy tissue from a cadaveric donor. The established procedure, penetrating keratoplasty (PKP), has been used for many years and its safety and efficacy are well known. Endothelial keratoplasty (EK) is a relatively new surgical procedure and the safety and efficacy relative to PKP are unknown. OBJECTIVES:The objective of this review is to collate information on the benefits and complications related to two surgical methods (PKP and EK) of replacing the diseased endothelial layer of the cornea with a healthy layer in people with FED. SEARCH STRATEGY:We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 2), MEDLINE (January 1950 to February 2011), EMBASE (January 1980 to February 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to February 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 February 2011. SELECTION CRITERIA:We included all randomised controlled trials (RCTs) comparing EK versus PKP for people (of any age and gender) who had been clinically diagnosed with FED. When assessing the primary and secondary outcome measures, only RCTs were included in the analysis. As per our protocol a description of data from non-randomised comparative studies is also reported. As RCTs may not detect differences in frequency of adverse events, when assessing these we included data from cohort studies with more than 50 participants and a follow-up of up to five years. DATA COLLECTION AND ANALYSIS:Two authors independently assessed trial quality and extracted data. MAIN RESULTS:The electronic searches identified one RCT, five non-randomised comparative studies and 34 cohort studies with a sample size of over 50 participants for inclusion. The RCT was conducted in the USA and included 28 eyes of 25 participants with FED. Although this is a very good RCT, there may be potential for bias due to lack of masking of assessors and possible selective reporting not being clearly reported. In this RCT, comparing EK versus PKP, best corrected visual acuity (BCVA) was similar at 24 months (PKP 0.20 ± 0.20 logMAR; EK 0.34 ± 0.35 logMAR; P = 0.23) and higher order aberrations (HOAs) (deviations of the performance of an optical system from the predictions of paraxial optics) were lower with EK. No other data were reported by the trial. Based on data obtained from both non-randomised comparative studies and individual cohort studies the endothelial rejection rate was between 5.3% and 23.2% for PKP and 2% and 4% for EK. However the mean follow-up duration in the EK cohort studies was noticeably shorter. The rate of EK graft dislocation requiring repositioning ranged from 3% to 63%, with the majority of studies having a rate of < 10%. AUTHORS' CONCLUSIONS:There is no high quality evidence that EK is superior to PKP in the treatment of FED considering the studies that satisfied our primary and secondary outcome measures. One RCT demonstrated that HOAs are lower following EK and some lower quality evidence suggests that endothelial rejection episodes may be less with EK. These findings should be interpreted with caution as they are based on data with risk of biases. Further RCTs of visual and refractive outcomes needs to be performed in this field, comparing EK to PKP, with a larger sample size and at least five years of follow up. To avoid bias due to a surgeon's learning curve, procedures should be performed by experienced surgeons only. Quality of life and vision should also be evaluated. The risk of endothelial rejection will be difficult to address in the context of a RCT because of power considerations but large non-randomised comparative case series and corneal graft registry outcome data will be useful in this regard.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Nanavaty MA,Shortt AJdoi
10.1002/14651858.CD008420.pub2subject
Has Abstractpub_date
2011-07-06 00:00:00pages
CD008420issue
7issn
1469-493Xpub_type
杂志文章,评审abstract:BACKGROUND:Multiple sclerosis (MS) is an autoimmune, T-cell-dependent, inflammatory, demyelinating disease of the central nervous system, with an unpredictable course. Current MS therapies focus on treating exacerbations, preventing new exacerbations and avoiding the progression of disability. However, at present there...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD011203.pub2
更新日期:2016-04-15 00:00:00
abstract:BACKGROUND:Indomethacin is used as standard therapy to close a patent ductus arteriosus (PDA) but is associated with reduced blood flow to several organs. Ibuprofen, another cyclo-oxygenase inhibitor, may be as effective as indomethacin with fewer side effects. OBJECTIVES:To determine the efficacy and safety of ibupro...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003481.pub5
更新日期:2013-04-30 00:00:00
abstract:BACKGROUND:A wide variety of grafts have been introduced with the aim of improving the outcomes of traditional native tissue repair (colporrhaphy) for vaginal prolapse. OBJECTIVES:To determine the safety and effectiveness of transvaginal mesh or biological grafts compared to native tissue repair for vaginal prolapse. ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD012079
更新日期:2016-02-09 00:00:00
abstract:BACKGROUND:Research on the clinical application of oral naltrexone agrees on several things. From a pharmacological perspective, naltrexone works. From an applied perspective, however, the medication compliance and the retention rates are very poor. OBJECTIVES:To evaluate the effects of naltrexone maintenance treatmen...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD001333.pub3
更新日期:2011-02-16 00:00:00
abstract:BACKGROUND:The operation of insertion of a hemiarthroplasty to the hip refers to replacement of the femoral head with a prosthesis, whilst retaining the natural acetabulum and acetabular cartilage. The main surgical approaches to the hip for insertion of the prosthesis can be broadly categorised as either 'anterior' vi...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001707
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Febrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects of continu...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003031.pub3
更新日期:2017-02-22 00:00:00
abstract:BACKGROUND:Depression is a common and important cause of morbidity and mortality worldwide. Depression is commonly treated with antidepressants and/or psychological therapy, but some people may prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression....
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004366.pub6
更新日期:2013-09-12 00:00:00
abstract:BACKGROUND:Extramedullary fixation of hip fractures refers to the application of a plate and screws to the lateral side of the proximal femur. OBJECTIVES:To compare different types of extramedullary fixation implants for the surgical treatment of extracapsular hip fracture in adults. SEARCH STRATEGY:We searched the C...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000339
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Previous research suggests that increasing dietary intakes of calcium, potassium or magnesium separately may reduce BP to a small degree over the short term. It is unclear whether increasing intakes of a combination of these minerals produces a larger reduction in BP. OBJECTIVES:To evaluate the effects of c...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD004805.pub2
更新日期:2006-07-19 00:00:00
abstract:BACKGROUND:Epilepsy is the most common serious neurological condition after stroke, with a 0.5 per cent prevalence, and a two to three per cent life time risk of being given a diagnosis of epilepsy in the developed world. As a result of the perceived deficiencies and suggestions to improve the quality of care offered t...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001907
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Tetanus is an acute, often fatal, disease caused by an exotoxin produced by Clostridium tetani. It occurs in newborn infants born to mothers who do not have sufficient circulating antibodies to protect the infant passively, by transplacental transfer. Prevention may be possible by the vaccination of pregnant...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD002959.pub3
更新日期:2013-05-31 00:00:00
abstract:BACKGROUND:Propentofylline is a novel therapeutic agent for dementia that readily crosses the blood-brain barrier and acts by blocking the uptake of adenosine and inhibiting the enzyme phosphodiesterase. In vitro and in vivo its mechanism of action appears to be twofold; it inhibits the production of free radicals and ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002853
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:Reduced ankle dorsiflexion range of motion, or ankle equinus, is a common and disabling problem for patients with neuromuscular disease. Clinicians devote considerable time and resources implementing interventions to correct this problem although few of these interventions have been subject to rigorous empir...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006973.pub2
更新日期:2010-02-17 00:00:00
abstract:BACKGROUND:Total knee arthroplasty is a common intervention for patients with arthritis. Post-surgical rehabilitation often includes continuous passive motion. However, it is not clear whether continuous passive motion is effective. OBJECTIVES:To evaluate the effectiveness of continuous passive motion following total ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004260.pub2
更新日期:2010-03-17 00:00:00
abstract:BACKGROUND:Routine monitoring of gastric residuals in preterm infants on gavage feeds is a common practice in many neonatal intensive care units and is used to guide the initiation and advancement of feeds. No guidelines or consensus is available on whether to re-feed or discard the aspirated gastric residuals. Althoug...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章
doi:10.1002/14651858.CD012940.pub2
更新日期:2019-07-08 00:00:00
abstract:BACKGROUND:Geriatric day hospitals provide multi-disciplinary rehabilitation in an outpatient setting. Concern has been expressed that evidence for effectiveness is equivocal and that day hospital care is expensive. OBJECTIVES:To assess the effects of medical day hospitals for elderly people. SEARCH STRATEGY:We searc...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001730
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Antibiotics are frequently prescribed in children. They alter the microbial balance within the gastrointestinal tract, commonly resulting in antibiotic-associated diarrhea (AAD). Probiotics may prevent AAD via restoration of the gut microflora. OBJECTIVES:The primary objectives were to assess the efficacy a...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004827.pub4
更新日期:2015-12-22 00:00:00
abstract:BACKGROUND:Cholecystectomy is not required in up to 64% of patients who adopt a wait-and-see policy after endoscopic clearance of common bile duct stones. Although reports of retrospective cohort series have shown a higher mortality among patients who defer cholecystectomy, it is not known if this is due to the patient...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006233.pub2
更新日期:2007-10-17 00:00:00
abstract:BACKGROUND:Early endoscopic retrograde cholangio-pancreatography with or without endoscopic sphincterotomy (ERCP+/-ES) has been advocated to reduce complications in patients presenting with a severe attack of gallstone-associated acute pancreatitis (GAP). However, a recent trial has reported contradictory results. Impo...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003630.pub2
更新日期:2004-10-18 00:00:00
abstract:OBJECTIVES:To estimate the short-term efficacy and toxicity of sulfasalazine for the treatment of rheumatoid arthritis (RA). SEARCH STRATEGY:We searched the Cochrane Musculoskeletal Group trials register, and Medline, up to July 1997, using the search strategy developed by the Cochrane Collaboration (Dickersin 1994). ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000958
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Chronic kidney disease (CKD) is a major public health issue worldwide. Standard therapies to delay CKD progression include dietary protein restriction and administration of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) to help control blood pressure and confer additi...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD008000.pub2
更新日期:2012-07-11 00:00:00
abstract:BACKGROUND:The health benefits of physical activity and exercise are well documented and these effects could help people with schizophrenia. OBJECTIVES:To determine the mental health effects of exercise/physical activity programmes for people with schizophrenia or schizophrenia-like illnesses. SEARCH STRATEGY:We sear...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004412.pub2
更新日期:2010-05-12 00:00:00
abstract:BACKGROUND:A variety of body positions other than the standard supine position have been used in patients undergoing intensive care with hopes of reducing the incidence of pressure ulcers of the skin, contractures or ankylosis and improving the patients' well being. In patients from different age groups undergoing mech...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003668.pub3
更新日期:2013-03-28 00:00:00
abstract:BACKGROUND:The integration of HIV/AIDS and maternal, neonatal, child health and nutrition services (MNCHN), including family planning (FP) is recognized as a key strategy to reduce maternal and child mortality and control the HIV/AIDS epidemic. However, limited evidence exists on the effectiveness of service integratio...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD010119
更新日期:2012-09-12 00:00:00
abstract:BACKGROUND:Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. OBJECTIVES:To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. SEARCH METHODS:The Information Speciali...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD001088.pub4
更新日期:2019-12-12 00:00:00
abstract:BACKGROUND:Prayer is an ancient and widely used intervention for alleviating illness and promoting good health. This review focuses specifically on intercessory prayer, which is organised, regular and committed, and those who practise it will almost inevitably hold some committed belief that they are praying to God. Wh...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000368
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Pain following brain surgery can compromise recovery. Several pharmacological interventions have been used to prevent pain after craniotomy; however, there is currently a lack of evidence regarding which interventions are most effective. OBJECTIVES:The objectives are to assess the effectiveness of pharmacol...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD011931.pub2
更新日期:2019-11-21 00:00:00
abstract:BACKGROUND:The common cold is a major and recurrent cause of morbidity, on average affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal deconges...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD001953.pub3
更新日期:2007-01-24 00:00:00
abstract:BACKGROUND:The prevalence of sleep problems in adulthood increases with age. While not all sleep changes are pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for carers and increased healthcare costs. The most common tr...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003161
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:Patients with stable angina not controlled by monotherapy with nitrates, beta blockers, or calcium channel blockers are often treated with combinations of these drugs. There may be adverse effects from, or contraindications to, the use of combinations. In low risk groups, medical treatment appears to be as g...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003614.pub2
更新日期:2005-10-19 00:00:00