Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
Quality of life with anophthalmia: a systematic review.
PURPOSE: Anophthalmia due to enucleation, evisceration, or exenteration, results in permanent vision loss that may have profound functional, psychological, and social consequences. The purpose of this study is to evaluate health-related quality of life, vision-related quality of life, and psychosocial outcomes among adults with anophthalmia. METHODS: This systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered on PROSPERO (ID: CRD420251274476). MEDLINE, Embase, and CENTRAL were searched from inception to September 9, 2025. Eligible studies included participants with congenital or acquired anophthalmia and reported outcomes related to quality of life or psychosocial health. Risk of bias was assessed using the Cochrane RoB-2 tool for randomized trials and Joanna Briggs Institute critical appraisal tools for observational studies and results were synthesized narratively. RESULTS: Forty-two studies (1999-2025) including 4544 patients (56.0% male; mean age 49.9 years) were included. Enucleation was the most common procedure (55.1%), and most cases were unilateral (59.6%). Health-related quality of life was commonly assessed using the SF-36 and vision-related quality of life using the NEI VFQ-25. Early postoperative reductions in health-related quality of life were frequently observed, with partial recovery over time. Vision-related quality of life remained persistently impaired, particularly for depth perception, peripheral vision, and driving. While mean anxiety and depression scores were often within normal ranges, a substantial subset of patients experienced ongoing psychological distress and appearance-related concerns. CONCLUSIONS: Acquired anophthalmia is associated with enduring vision-specific and psychosocial challenges, supporting the need for anticipatory counseling and integrated multidisciplinary rehabilitation in clinical practice.
25 July 2026
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Incidental ocular surface squamous neoplasia in pterygia: a systematic review and meta-analysis
AIMS: Differentiating pterygium from ocular surface squamous neoplasia (OSSN) is important for guiding management. This meta-analysis evaluates the prevalence and risk factors for incidental OSSN in clinically diagnosed pterygia. METHODS: Ovid Embase, MEDLINE, Cochrane Library and Web of Science were systematically searched from January 2000 to February 2025. Included studies analysed ≥100 clinically diagnosed pterygia via histopathology. Random-effects meta-analysis assessed the prevalence of incidental OSSN among pterygia. Risk factors were evaluated using the Mantel-Haenszel and inverse variance methods, and meta-regression analysed the influence of publication year, geographic proximity to the equator, and country-level ultraviolet (UV) radiation exposure. RESULTS: 12 studies, comprising 8688 specimens, identified 202 cases of incidental OSSN (pooled prevalence=1.32%, 95% CI 0.41% to 4.21%, I2=95.3%). Meta-regression revealed that lower OSSN prevalence was associated with greater distance from the equator (OR 0.49, 95% CI 0.28 to 0.83, p<0.01), while higher prevalence was associated with greater UV exposure (OR 2.20, 95% CI 1.17 to 4.14, p=0.01). Publication year had no effect (p=0.98). Age (p=0.18), sex (p=0.45) and lesion location (p=0.60-0.82) did not differ between incidental OSSN cases and benign pterygia. Incidental OSSN prevalence also did not differ between primary and recurrent pterygia (p=0.23). Regional analyses revealed variation in prevalence: Europe (0.29%), Asia (0.76%), North America (1.03%), Oceania (8.57%) and South America (14.97%). CONCLUSIONS: This meta-analysis, based on low- to very low-certainty evidence, identified a 1.32% pooled prevalence of incidental OSSN in clinically diagnosed pterygia, highlighting the potential influence of UV exposure and equatorial proximity. The overlap in demographic and lesion characteristics between benign pterygia and OSSN underscores diagnostic challenges.
25 Apr 2026
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