Effect of image-guided systems in phacoemulsification with intraocular lens (IOL) implantation: a systematic review and meta-analysis

Purpose To explore the effect of image-guided systems in phacoemulsification with intraocular lens (IOL) implantation.Methods We searched Pubmed, Embase and China National Knowledge Infrastructure (inception to January 20, 2021). Two researchers extracted data and assessed paper quality independently. Uncorrected distance visual acuity (UDVA) before and after surgery, best corrected visual acuity (BCVA) before and after surgery, preoperative cylinder, postoperative residual refractive cylinder, postoperative corneal cylinder, IOL misalignment, and intraocular pressure (IOP) were compared.Results We included 14 studies with 885 cataract eyes. All data were performed using Review Manager 5.3 (RevMan 5.3) (https://revman.cochrane.org/). Cases of all preoperative outcomes showed no significant difference between image-guided group and manual group. There was no significant difference in postoperative UDVA (Standard mean difference (SMD: −0.11, 95% CI: −0.32 to 0.11, I2 = 59%, p = 0.33)), BCVA (SMD: 0.03, 95% CI: −0.12 to 0.18, I2 = 36%, p = 0.72), corneal cylinder (Weighted mean difference WMD: 0.13, 95% CI: −0.06 to −0.32, I2 = 0%, p = 0.17), IOP (WMD: −0.37, 95% CI: −1.36 to −0.62, I2 = 9%, p = 0.46) between two groups. There was less residual refractive cylinder in image-guided group than in manual group (WMD: −0.20, 95% CI: −0.26 to −0.14, I2 = 59%, p＜0.00001). It is more accurate in IOL alignment when combined with image-guided systems (WMD: −1.20, 95% CI: −1.43 to −0.96, I2 = 14%, p