Descriptions of Studies
The strategy of this Meta-analysis followed the literature research (Figure 1). 5 randomized controlled trials[6-10] and 6 comparative prospective clinical trials[4, 11-15] were included. 4 articles implanted Toric lens, 1 article implanted Chiron Vision IOL, 1 article implanted AcrySof IOL, 1 article implanted Acri.Lisa 366D IOL, 1 article implanted multifocal Lentis Mplus LS-312 IOL, 1 article implanted Tecnis ZCB00, 1 article implanted acrylic IOL, 1 article implanted POD FT lens,
Table 1 shows the characteristics of optical outcomes in selected trials
Table 1 characteristics of optical outcomes in selected trials(M±SD)[1]
|
Author/deadline
|
UDVA(logMAR)
|
CDVA(logMAR)
|
sphere(D[2])
|
cylinder(D)
|
SE(D)
|
|
CTR[3]+IOL[4]
|
IOL
|
CTR+IOL
|
IOL
|
CTR+IOL
|
IOL
|
CTR+IOL
|
IOL
|
CTR+IOL
|
IOL
|
park/1st month
|
0.11±0.02
|
0.10±0.02
|
0.05±0.01
|
0.03±0.01
|
0.01±0.10
|
-0.07±0.10
|
-0.45±0.11
|
-0.40±0.11
|
-0.21±0.11
|
-0.29±0.11
|
park/3rd month
|
0.09±0.02
|
0.10±0.02
|
0.03±0.01
|
0.02±0.01
|
0.07±0.10
|
-0.07±0.10
|
-0.48±0.10
|
-0.42±0.10
|
-0.17±0.10
|
-0.27±0.10
|
Rastogi/1st month
|
0.25±0.08
|
0.20±0.09
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
Rastogi/3rd month
|
0.20±0.11
|
0.21±0.10
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
Alió /3rd month
|
0.19±0.28
|
0.15±0.21
|
0.02±0.06
|
0.05±0.1
|
-0.16±1.01
|
-0.01±0.64
|
0.53±0.46
|
0.45±0.71
|
-0.1±1.06
|
-0.23±0.75
|
Hahn/3rd month
|
unclear
|
unclear
|
0.02±0.04
|
0.03±0.07
|
unclear
|
unclear
|
0.59±0.49
|
0.64±0.48
|
unclear
|
unclear
|
Nistad /3rd month
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
0.331±0.461
|
0.123±0.442
|
Nistad /3rd month
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
-0.016±0.037
|
-0.09±0.39
|
Weber/3rd month
|
unclear
|
unclear
|
unclear
|
unclear
|
-1.11±0.76
|
-1.24±0.75
|
0.82 ±0.76
|
0.89 ±0.65
|
-0.70 ±0.58
|
-0.81 ±0.81
|
Zhao/6th month
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
unclear
|
–0.50±0.25
|
–1.25±0.33
|
unclear
|
unclear
|
Alio ́ /6th month
|
0.13±0.02
|
0.11±0.02
|
0.01±0.08
|
0.02±0.01
|
0.12±0.55
|
0.53±0.58
|
-0.59±0.52
|
-0.53±0.51
|
-0.18± 0.6
|
-0.31 ± 0.45
|
Vokrojová /6th month
|
0.09±0.14
|
0.11±0.13
|
0.04±0.07
|
0.04±0.07
|
0.38±0.80
|
0.23±0.57
|
-0.45±0.77
|
-0.36±0.40
|
0.15 ± 0.57
|
0.05 ± 0.52
|
[1] mean standard deviation
[3] Capsular Tension Ring group
[4] Intraocular lens group
Table 2 shows the characteristics of the lens position in the selected trials.
Table 2 characteristics of the lens position in the selected trials
|
author/deadline
|
decentration(mm)
|
tilt(degree)
|
rotation(degree)
|
|
CTR+IOL
|
IOL
|
CTR+IOL
|
IOL
|
CTR+IOL
|
IOL
|
Lee/1 week
|
0.38±0.16
|
0.49±0.11
|
2.22±0.46
|
3.14±0.65
|
unclear
|
unclear
|
Lee/1 month
|
0.43±0.15
|
0.53±0.14
|
2.36±0.50
|
2.91±0.67
|
unclear
|
unclear
|
Cheon/1week
|
0.26±0.18
|
0.25±0.11
|
2.30±1.34
|
2.99±1.89
|
unclear
|
unclear
|
Cheon/1month
|
0.28±0.18
|
0.24±0.13
|
2.1±1.63
|
2.91±1.54
|
unclear
|
unclear
|
Hahn/3 month
|
unclear
|
unclear
|
unclear
|
unclear
|
2.07±2.09
|
1.92±1.82
|
Rastogi/3month
|
unclear
|
unclear
|
unclear
|
unclear
|
1.85±1.72
|
4.02±2.04
|
Table 3 shows the quality of randomized controlled trials by Cochrane Collaboration Risk of BiasTool.
Table 3 quality assessment of randomized controlled trials
|
author
|
published year
|
region
|
Sequence Generation
|
Allocation Concealment
|
Blindness of Participants
|
Imcomplete Outcome Data
|
Selective Outcome Reporting
|
Other Bias
|
Alió
|
2012
|
Sapin
|
yes
|
yes
|
unkonwn
|
yes
|
no
|
yes
|
Weber
|
2015
|
Austria
|
yes
|
yes
|
yes
|
yes
|
no
|
no
|
Rastogi
|
2020
|
India
|
unkonwn
|
unkonwn
|
unkonwn
|
yes
|
no
|
no
|
Hahn
|
2019
|
Germany
|
unkonwn
|
unkonwn
|
unkonwn
|
unkonwn
|
no
|
unkonwn
|
Park
|
2016
|
Korea
|
yes
|
yes
|
yes
|
yes
|
no
|
no
|
Table 4 shows the Newcastle-Ottawa Scale score of prospective comparative of clinical trials.
Table 4 quality assessment of prospective comparative of clinical trials
|
author
|
region
|
published year
|
type of trial
|
Newcastle-Ottawa-Scale
|
|
|
|
|
selection
|
comparability
|
outcome
|
Zhao
|
China
|
2016
|
PCCT[5]
|
★★
|
★★
|
★★
|
Lee
|
Korea
|
2002
|
PCCT
|
★★★
|
★★
|
★★
|
Alio ́
|
Spain
|
2008
|
PCCT
|
★★★
|
★★
|
★★
|
Vokrojová
|
Czeck
|
2020
|
PCCT
|
★★★
|
★★
|
★★
|
Nistad
|
Sweden
|
2017
|
PCCT
|
★★
|
★★
|
★★
|
Cheon
|
Korea
|
2000
|
PCCT
|
★★★
|
★★
|
★★
|
[5] prospective comparative of clinical trials
Postoperative Optical Outcomes
Un-corrected distance visual acuity
Four trials[8, 10, 13, 14] were pooled. We analysis the subgroup data by follow-up time with a random-effect model. In the 1st month, capsular tension ring group have better performance (SMD: 0.54, 95%CI = 0.15 to 0.94, P = 0.829); 3rd month (SMD: –0.30, 95%CI = –0.70 to –0.10, P = 0.311) and 6th month (SMD: 0.43, 95%CI = –0.69 to 1.56, P = 0.001) show do difference in two groups.(Figure2)
Corrected distance visual acuity
Five trials[6, 9, 10, 13, 14] were pooled. Analysis mode is random-effect model, define subgroup by follow-up time. Only one trial recorded the data of 1st month so we cannot get the synthesis result. No significant difference of two groups in 3rd month (SMD: 0.02, 95%CI = –0.78 to 0.81,P<0.001) and 6th month (SMD: –0.11, 95%CI = –0.43 to 0.20, P = 0.56). (Figure 3)
Sphere
Five studies[6, 7, 10, 13, 14] were pooled, and just one trial record the outcomes in 1st month, so we failure to analysis. Analysis mode is a random-effect model, define subgroup by follow-up time. Experiment group show no positive effect in 3rd month (SMD: 0.44, 95%CI = –0.43 to 1.31, P<0.001) and 6th month (SMD: –0.26, 95%CI = –1.18 to 0.66, P = 0.005). (Figure 4)
Cylinder
Analysis mode is a random-effect model, define subgroup by follow-up time. Seven trials[6, 7, 9–11, 13, 14] were included. We just analysis the 3rd month and 6th month statistics because of only one trial record the data, which this trial shows no benefit in the capsular tension ring group. No difference found between two groups in 3rd month (SMD: –0.12, 95%CI = –0.36 to 0.13, P = 0.262) and 6th month (SMD: 0.10, 95%CI = –0.39 to 0.59, P = 0.075). (Figure 5)
Sphere equivalent
Five trials[4, 6, 10, 13, 14] were analysis with the random-effect model by the subgroup of follow-up time. We analysis outcomes of 3rd and 6th month, just because of only one trial record the sphere equivalent data. In 3rd month (SMD: 0.41, 95%CI = 0.13 to 0.69, P = 0.084), experimental group show positive effect, but no benefit in 6th month (SMD: 0.22, 95%CI = –0.10 to 0.54, P = 0.849). (Figure6)
Position of lens
Just two trials[12, 15] were pooled to analysis with lens de-centration and tilt. We only synthesis statistics of 1st week and 1st month. Analysis mode is the random-effect model, define subgroup by follow-up time.
In de-centration of lens, capsular tension rings group show low relationship compare to control group in 1st week (SMD: –0.34, 95%CI = –1.19 to 0.51, P = 0.038) and 1st month (SMD: –0.20, 95%CI = –1.12 to 0.73, P = 0.023). (Figure 7) In lens tilt analysis, 1st week (SMD: –1.00, 95%CI = –2.19 to 0.19, P = 0.007) show capsular tension ring is useless to prevent lens tilt, but in 1st month (SMD: –0.67, 95%CI = –1.08 to 0.27, P = 0.323), the capsular tension ring is helpful. Because of a small sample and short range of follow-up, the result should assess carefully. (Figure 8) Only two randomized controlled trials[8, 9] of small sample size reported the data of lens rotation in 3rd month. The result is no significant difference between two groups, the result should assess carefully. (SMD: –0.51, 95%CI = –1.71 to 0.69, P<0.001). (Figure 9)
Publication Bias
Egger’s test showed no significant difference in optical outcomes (P = 0.084), (Figure10) but indicated significant publication bias in lens position (P = 0.005). (Figure 11)