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Evidence-based Guidelines for Keratorefractive Lenticule Extraction Surgery

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资源类型：
Pubmed体系：
作者：
Wang Yan[1,2,3,*1] * ; Xie Lixin[4] ; Yao Ke[5,6] ; Sekundo Walter[7] ; Jorge L. Alió[8] ; Mehta Jod S[9] ; Goel Sanjay[10] ; Elmassry Ahmed[11] ; Schallhorn Julie[12] ; Shilova Tatiana[13] ; Cao Huazheng[14] ; Xu Lulu[1] ; Chen Xuan[14] ; Zhang Fengju[15] ; Bai Ji[16] ; Zhang Wenfang[17] ; Liu Qin[18] ; Zhou Xingtao[19] ; Chen Yueguo[20] ; Wang Zheng[21] ; Jhanji Vishal[22] ; Yang Kehu[23,24,25] ;
机构： [1]Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology andVisual Science, Nankai University Affiliated Eye Hospital, Tianjin, China [2]Nankai University Eye Institute, Nankai University, Tianjin, China [3]Clinical College ofOphthalmology, Tianjin Medical University, Tianjin, China [4]Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao China [5]Eye Center, The Second Afiliated Hospital, Zhejiang University School of Medicine.Hangzhou, China [6]Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China [7]Department of Ophthalmology, Philipps University, Marburg, Germany [8]Division of Ophthalmology, School of Medicine, Universidad Miguel Hernandez, Alicante.Spain [9]Singapore National Eye Centre, Singapore, Singapore [10]Goel vision, Maryland, USA [11]Roayah vision center, Faculty of Medicine, Alexandria University, Alexandria, Egypt [12]University of California, San Francisco, USA [13]Moscow State University of Medicine and Dentistry, SMILE EYES Moscow, Moscow,Russia [14]School of Medicine, Nankai University, Tianjin, China [15]Beijing Tongren Hospital of Capital Medical University, Beijing, China [16]Chongqing Baiji Eye Hospital, Chongqing, China [17]Lanzhou University Second Hospital, Lanzhou, China [18]Department of Ophthalmology, Gansu Provincial Hospital, Lanzhou, China 33 [19]Eye & ENT Hospital, Fudan University, Shanghai, China [20]Peking University Third Hospital, Beijing, China [21]Guangzhou Aier Eye Hospital, Guangzhou, China [22]Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, USA [23]Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China [24]WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China [25]Lanzhou University GRADE Center, Lanzhou, China
出处：
DOI： 10.1016/j.ophtha.2024.11.016
ISSN：

摘要：
Development of evidence-based guidelines for keratorefractive lenticule extraction (KLEx).KLEx refers to various corneal refractive procedures involving removal of refractive lenticules of intrastromal corneal tissue, typically through a small incision, thereby eliminating creation of a corneal flap. This technique has rapidly gained popularity as a possible alternative to flap-based procedures; however, no clinical practice guidelines exist for KLEx.These evidence-based guidelines were developed following the WHO guidebook, utilizing the AGREE II tool, and adhering to the RIGHT statement. The body of evidence was drawn from eight literature databases, five clinical guideline databases, and two academic organizations. Recommendations were developed via a Delphi consensus of 44 global experts in refractive surgery, corneal diseases, retinal diseases, glaucoma, and optometry. The certainty of evidence, balance of benefits and harms, patient preferences and values, and economic evaluations were fully considered. The GRADE approach was employed to assess evidence quality and recommendation strengths.From 385 initial clinical questions, 15 were identified, prompting a review of 250,717 studies, with 609 included for conducting and updating 26 and 2 systematic reviews, respectively. Subsequently, consensus was reached on 38 recommendations for preoperative screening, candidate selection, intraoperative quality control, operating principles, postoperative monitoring, and complication management. For KLEx, an effective and accurate refractive correction is attributed to various factors such as corneal thickness, degree of myopia, treatment nomogram, and optical zone. For KLEx-related complications that could affect vision, comprehensive and effective management strategies were proposed, particularly for wrong-plane dissection and difficult lenticule removal, suction loss, and perioperative infection. Customized surgical planning protocols and operative techniques were analyzed. Among all recommendations, 29 (76%) were labelled as "strong", each externally reviewed. The assessment of corneal biomechanical properties may help improve safety and predictability, though needing further validation. The development process also revealed several research gaps for enhancing KLEx safety.These guidelines provide evidence-based recommendations for KLEx in clinical practice, such as on preoperative screening for keratoconus, surgical planning, managements and prevention of complications and infection. The guidelines are expected to improve the safe and effective application of KLEx procedures and achieve more satisfactory visual correction.Copyright © 2024. Published by Elsevier Inc.

基金：
This study was supported by the National Natural Science Foundation ofChina (82271118), National Program on Key Research Project of China (2022YFC2404502)and Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-016A)The funding organizations had no role in the design or conduct ofthis research
语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2023]版：
大类 | 1 区 医学
小类 | 1 区 眼科学
最新[2023]版：
大类 | 1 区 医学
小类 | 1 区 眼科学
第一作者：
第一作者机构： [1]Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology andVisual Science, Nankai University Affiliated Eye Hospital, Tianjin, China [2]Nankai University Eye Institute, Nankai University, Tianjin, China [3]Clinical College ofOphthalmology, Tianjin Medical University, Tianjin, China [*1]Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin EyeHospital, Nankai University Affiliated Eye Hospital, Nankai University Eye Institute, NankaiUniversity, Clinical College of Ophthalmology, Tianjin Medical UniversityNo 4. Gansu Road, He-ping District, Tianjin 300020, China
通讯作者：
通讯机构： [1]Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology andVisual Science, Nankai University Affiliated Eye Hospital, Tianjin, China [2]Nankai University Eye Institute, Nankai University, Tianjin, China [3]Clinical College ofOphthalmology, Tianjin Medical University, Tianjin, China [*1]Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin EyeHospital, Nankai University Affiliated Eye Hospital, Nankai University Eye Institute, NankaiUniversity, Clinical College of Ophthalmology, Tianjin Medical UniversityNo 4. Gansu Road, He-ping District, Tianjin 300020, China
推荐引用方式(GB/T 7714)：
Wang Yan,Xie Lixin,Yao Ke,et al.Evidence-based Guidelines for Keratorefractive Lenticule Extraction Surgery[J].Ophthalmology.2024,doi:10.1016/j.ophtha.2024.11.016.
APA：
Wang Yan,Xie Lixin,Yao Ke,Sekundo Walter,Jorge L. Alió...&Yang Kehu.(2024).Evidence-based Guidelines for Keratorefractive Lenticule Extraction Surgery.Ophthalmology,,
MLA：
Wang Yan,et al."Evidence-based Guidelines for Keratorefractive Lenticule Extraction Surgery".Ophthalmology .(2024)

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