Low-Level Red-Light (LLRL) Therapy is a safe and natural way to promote healing and reduce inflammation in the body. When it comes to treating myopia in children, LLRL therapy is recent, and its efficacy and safety still are not clear. A systematic review and meta-analysis of the literature for LLRL was conducted in accordance with the PRISMA guidelines on November 5, 2022. Databases, including PUBMED, Cochrane Library, Web of Science, and Embase were queried. A meta-analysis of random effects was conducted. Inclusion criteria included Randomized Controlled Trials (RCTs) or observational studies where LLRL therapy was used in children (3‒15 years old) with myopia. Exclusion criteria were studies with other ocular abnormalities. Efficacy was evaluated through the mean change in Axial Length (AL) and cycloplegic Spherical Equivalent Error (SER), while safety was evaluated by monitoring adverse effects. A total of 5 final studies were included (4 RCTs, and 1 observational), in which 685 total patients were analyzed. The mean age was 9.7 ± 0.66 years, with 48,2% female patients. The number of eyes in the LRLL arm is 714 and, in the control, arm is 656. LLRL showed better results in SER and AL mean change (OR = 0.58; 95% CI 0.33 to 0.83; p < 0.00001, and MD -0.33; 95% CI -0.52 to -0.13; p = 0.001, respectively), in comparison to the control group. There was no significant difference in adverse effects between groups (MD = 5.76; 95% CI 0.66 to 50.14; p = 0.11). LLRL therapy is a non-invasive, effective, and safe short-term treatment option; however, long-term evaluation, particularly in comparison to other therapies, requires additional investigation.

Background: Cataract surgery is one of the most frequently performed eye surgeries worldwide, and among several techniques, phacoemulsification has become the standard of care due to its safety and efficiency. We evaluated the advantages and disadvantages of two phacoemulsification techniques: phaco-chop and divide-and-conquer. Methods: PubMed, Cochrane, Embase, and Web of Science databases were queried for randomized controlled trial (RCT), prospective and retrospective studies that compared the phaco-chop technique over the divide-and-conquer technique and reported the outcomes of (1) Endothelial cell count change (ECC); (2) Ultrasound time (UST); (3) Cumulated dissipated energy (CDE); (4) Surgery time; and (5) Phacoemulsification time (PT). Heterogeneity was examined with I² statistics. A random-effects model was used for outcomes with high heterogeneity. Results: Nine final studies, (6 prospective RCTs and 3 observational), comprising 837 patients undergoing phacoemulsification. 435 (51.9%) underwent the phaco-chop technique, and 405 (48.1%) underwent divide-and-conquer. Overall, the phaco-chop technique was associated with several advantages: a significant difference in ECC change postoperatively (Mean Difference [MD] − 221.67 Cell/mm²; 95% Confidence Interval [CI] − 401.68 to − 41.66; p < 0.02; I2=73%); a shorter UST (MD − 51.16 sec; 95% CI − 99.4 to − 2.79; p = 0.04; I2=98%); reduced CDE (MD − 8.68 units; 95% CI − 12.76 to − 4.60; p < 0.01; I2=84%); a lower PT (MD − 55.09 sec; 95% CI − 99.29 to − 12.90; p = 0.01; I2=100). There were no significant differences in surgery time (MD − 3.86 min; 95% CI − 9.55 to 1.83; p = 0.18; I2=99%). Conclusion: The phaco-chop technique proved to cause fewer hazards to the corneal endothelium, with less delivered intraocular ultrasound energy when compared to the divide-and-conquer technique.

Introduction: Corneal ectasia leads to progressive irregular corneal curvature and reduced visual acuity. Objective: To assess the safety and effectiveness of corneal collagen cross-linking (CXL) for managing corneal ectasia resulting from refractive laser surgery (RSL). Methods: A systematic review and meta-analysis were realized according to PRISMA guidelines. We searched PubMed, EMBASE, Cochrane, and Web of Science databases for studies on CXL in patients with ectasia after RLS. The outcomes of interest included visual acuity, refractive outcomes, topographic parameters (Kmax, index surface variance (ISV), index of Vertical Asymmetry (IVA), keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry (IHA), index of height decentration (IHD) and Rmin (minimum sagittal curvature)), central corneal thickness, endothelial cell count, and possible adverse events. Statistical analysis was performed using the R software (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria). Results: 15 studies encompassing 421 patients (512 eyes) were included. The mean age was 32.03 ± 4.4 years. The pooled results showed a stable uncorrected visual acuity post-CXL, with a significant improvement in corrected distance visual acuity (SMD = 0.09; 95% CI: − 0.07 to 0.26). The spherical equivalent decreased significantly (SMD = − 0.09; 95% CI: − 0.35, − 0.02). The topographic parameter Kmax decreased significantly (SMD = 0.15; 95% CI:0.01 to 0.28); however, the other parameters, ISV, IVA, KI, CKI, IHA, IHD, and Rmin, did not change significantly. Central corneal thickness decreased significantly (SMD = 0.24; 95% CI:0.07 to 0.41), and the endothelial cell count remained stable The complications were rare. Conclusion: CXL is a safe and effective technique for managing corneal ectasia after RLS.

Précis: In this meta-analysis, Kahook dual blade (KDB) goniotomy achieved higher rates of surgical success compared with iStent/iStent inject implantation combined with phacoemulsification. KDB goniotomy demonstrated better intraocular pressure (IOP) reduction at month 6 compared with the stent group. Objective: To compare the outcomes of phacoemulsification combined with either KDB goniotomy (phaco-KDB) or trabecular microbypass stent (iStent and iStent inject) implantation (phaco-Stent). Methods: A literature search was performed on PubMed, Embase, Web of Science, and Cochrane Library from inception to April 2024. Randomized clinical trials and observational studies that compared KDB goniotomy to the first or second-generation iStent combined with phacoemulsification were included. The main outcome measures were surgical success, mean change in IOP and medication number, and complication rates. Mean differences (MDs) and pooled odds ratios were used to analyze continuous and binary outcomes, respectively. Results: Fourteen studies were included with a total of 1959 eyes (958 phaco-KDB, and 1000 phaco-Stent including 753 phaco-iStent and 207 phaco-iStent inject). The combined findings showed significantly higher rates of surgical success in the phaco-KDB group versus the phaco-Stent group (odds ratio: 0.68; 95% CI: 0.50 to 0.92; P = 0.01; I ²= 40%), and greater IOP reduction in the phaco-KDB group versus the phaco-Stent group at month 6 (MD: 1.13 mm Hg; 95% CI: 0.43 to 1.83; P = 0.002; I ²= 51%). By month 12, both groups demonstrated similar IOP reduction. Subgroup analysis at month 12 showed greater IOP reduction in the phaco-KDB group versus the phaco-iStent group (MD: 1.69 mm Hg; 95% CI: 0.44 to 2.95; P = 0.008; I ²= 74%). However, compared with the phaco-iStent inject group, there was no significant difference in IOP reduction (MD: −0.72 mm Hg; 95% CI: −3.69 to 2.24; P = 0.63; I ²= 64%). Medication reduction and the incidence of adverse events were comparable between groups. Conclusion: KDB goniotomy may offer better surgical success compared with Stent implantation when used in combination with phacoemulsification. KDB goniotomy demonstrated better IOP reduction at month 12 compared with iStent. However, iStent inject showed a similar IOP reduction to KDB.

Myopia is a significant public health concern with increased risk of ocular complications. Intense Foveal Red Light (IFRL) therapy has been explored in myopia control, but its efficacy at the pre-myopic stage remains underexplored. The use of this therapy in a population without a myopia diagnosis may offer a new window for the prophylactic application of IFRL therapy. The purpose of this meta-analysis is to determine the effectiveness of IFRL therapy in children with pre-myopia. PubMed, Embase, and the Cochrane Library were systematically searched for studies investigating the effects of IFRL therapy on myopia incidence, changes in axial length (AL), choroidal thickness (CT), and cycloplegic spherical equivalent refraction (SER). Two independent reviewers screened studies, extracted data, and assessed the risk of bias. Meta-analyses were conducted using random-effects models to estimate the pooled effect sizes. Of 365 studies identified, 4 met the criteria, totaling 619 participants (mean age 8.48 years, 51.8% female). At 6 months, IFRL significantly reduced myopia incidence (Risk Difference [RD] - 0.1; 95% CI -0.15 to -0.05; p < 0.01), with benefits persisting at 12 months (RD -0.17; 95% CI -0.26 to 0.09; p < 0.01). IFRL also reduced AL at 6 months (Mean Difference [MD] - 0.12 mm; 95% CI -0.16 to -0.09; p < 0.01) and 12 months (MD -0.18 mm; 95% CI -0.23 to -0.14; p < 0.01), increased CT (MD 22.34 µm; 95% CI 5.45-39.24; p < 0.01), and improved SER at 6 (MD 0.27 D; 95% CI 0.23 to 0.32; p < 0.01) and 12 months (MD 0.36 D; 95% CI 0.27-0.46; p < 0.01). IFRL effectively reduced myopia incidence, AL, and improved SER and CT. These findings support further research on its long-term efficacy and safety, particularly regarding potential adverse effects and durability of outcomes. Overall, IFRL may offer a preventive strategy for pre-myopic children.