Dados do Trabalho

Título

A COMPREHENSIVE META-ANALYSIS ON THE ROLE OF ANALGESICS AND ANTI-INFLAMMATORIES IN PAN-RETINAL PHOTOCOAGULATION

Introdução

Diabetic retinopathy (DR) arises from diabetes-induced microvascular damage and stands as the leading cause of vision loss in the adult population. Pan-retinal photocoagulation (PRP) has been demonstrated to reduce the risk of vision loss in DR; hence, it remains the mainstay of treatment. Pain poses a potential obstacle to effective laser delivery; thus, pain relief strategies become necessary.

Métodos

We conducted a systematic review and meta-analysis according to PRISMA guidelines. The PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) that enrolled patients undergoing PRP due to DR and compared analgesics or non-steroidal anti-inflammatory drugs (NSAID) to placebo. The version 2 of the Cochrane Collaboration's Risk of Bias in Randomized Controlled Trials tool and its version for crossover trials were used to assess the risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to measure the certainty of evidence.

Resultados

A total of 13 studies were included, comprising 1,404 eyes from RCTs, nine of which were crossover. Patients who were administered analgesia reported a significantly lower pain sensitivity compared to those who received placebo (Standardized mean difference [SMD] -0.38; 95% confidence interval [CI] -0.58, -0.17; P<0.01; I2=69%). Subgroup analysis of systemic administration of analgesics/NSAIDs also showed a statistically significant reduction in pain when compared to placebo (SMD -0.28; 95% CI -0.50, -0.07; P<0.01; I2=43%). Additionally, when exclusively considering eye drops administration, a statistically significance difference was observed between groups regarding pain sensation (SMD -0.46; CI -0.88, -0.05; P=0.03; I2=83%).

Conclusões

The results of this meta-analysis including over 1,400 eyes demonstrated that the use of analgesics significantly reduced pain sensitivity during PRP, especially systemic analgesics/NSAIDs. Also happen during use of topical analgesics/NSAIDs, however, with high heterogeneity. Performing leave one out analysis the heterogeneity remains high. Hence, systemic approach might be preferred.

Palavras Chave

Analgesics. Laser treatment. Meta-analysis. Non-steroidal anti-inflammatory drugs. NSAIDs. Photocoagulation. Systematic Review.

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