백내장 임상진료지침 개발 사례 및 경험-메타분석과 설문조사 결과 등을 중심으로-

Abstract

Background: By reviewing experiences and lessons from results of main studies such as systematic review of articles and meta- analysis, and the current situation and trend in the field of cataract and refractive surgery, we proposed practical cases about objective and scientifically evident approaches in process of developing cataract clinical practice guideline in Korea. Methods: Development of cataract clinical practice guideline composed of constructing development team, reviewing guideline- associated articles, conducting meta-analysis and survey about practice behaviors, and having workshop and council. Meta-analysis composed of search and collection of article published within current five years, selection of review principles, development of article assessment form, and investigation of practical variation by qualitative and quantitative meta-analysis. Based on Medline, Meta-analysis was conducted about three topics of IOP (Intra-ocular pressure) changes after inserting each healon, and comparison results after cataract surgery by incision point and occurrence patterns of acquired cataract by types of intraocular lens. Questionnaire survey was conducted about practice behaviors focused on main procedures and surgeries related to cataract. For developing and using clinical practice guideline, we developed a draft which was reviewed by each sub-ophthalmology society, opened symposiums and workshop, and developed final draft.

Results: There was no significant difference between IOP (Intra-ocular pressure) changes after inserting each healon. After reviewing article about results after cataract surgery by incision point, we found that we couldn't conduct quantitative meta-analysis because surgeries method, incision lengths, measuring methods, and points at measuring showed different pattern. Occurrences of cataract in 24 months after cataract surgery between 'PMMA', 'Silicone', and 'Acrylic' group showed significant difference. Result of questionnaire survey showed that there was many variations on cataract clinical practice behaviors.

Conclusions: Although we were lacking in articles, we could propose partial objective evidences for development of cataract clinical practice guideline. And we found that systematic researches and surveys should be conducted for more objective evidences.