Oral mucositis is a common side effect of radiochemotherapy and may adversely affect the patients' quality of life (QoL). Honey application may reduce the mucositis grade in patients. Here, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the prophylactic and therapeutic effects of honey on radiochemotherapy-induced oral mucositis.

Background To figure out the efficacy, effects, safety and patient’s subjective perceptions of phacoemulsification with the active-fluidics system (AFS). Patients and methods This was a prospective, randomized, double-masked, controlled clinical study. Age-related cataract patients were recruited and randomly assigned to the AFS group and gravity-fluidics system (GFS) group in a ratio of 1:1 to have phacoemulsification. Participants were followed up at one day, one week, one month and three months postoperatively (Chinese Clinical Trial Registry, ChiCTR2100044409). Results The overall included participants were 107 finally. The total aspiration time of the AFS group was significantly less than that of the GFS group ( p = .020), while no significant difference existed in cumulative dissipated energy and estimated fluid usage between the two groups. The best corrected visual acuity was significantly better in the AFS group at one day and one week postoperatively ( p = .002, p = .038 respectively). The recovery of central corneal thickening and macular superficial vasculature increase was earlier in the AFS group. The central retinal thickness was significantly higher in the GFS group at one month and three months postoperatively ( p = .029, p = .016 respectively). The incidence of corneal adverse events was higher in GFS group ( p = .035). No serious adverse events occurred in either group. Pain scores and the scores of Cat-PROM5 questionnaire of the AFS group were significantly lower than that of the GFS group ( p = .011, p = .002 respectively). Conclusion AFS improves the efficiency, effects, safety and patients’ subjective perceptions of phacoemulsification compared with GFS. It is worthwhile to promote its application in cataract surgery. KEY MESSAGES The active-fluidics system automatically detects and maintains stable intraocular pressure at the set value. The active-fluidics system improves the efficiency, effects, safety and patients’ subjective perceptions in phacoemulsification.

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IntroductionThe active-fluidics system is a new irrigation system of phacoemulsification that automatically detects and maintains stable intraocular pressure at the set value. This trial is designed to compare the efficacy, visual outcomes, safety and patients’ subjective perceptions of cataract surgery with the active-fluidics system and gravity-fluidics system.Methods and analysisThis trial will recruit 110 patients with age-related cataract at the Chinese People’s Liberation Army (PLA) General Hospital (Beijing, China) and they will be randomly assigned to the active-fluidics group and gravity-fluidics group in a ratio of 1:1 to have phacoemulsification. Patients will be followed up at 1 day, 1 week, 1 month and 3 months postoperatively. The primary outcomes are the cumulative dissipated energy and best corrected visual acuity. Secondary outcomes include: estimated fluid usage, U/S time, total aspiration time, intraocular pressure, corneal endothelium parameters, retinal thickness, macular superficial vessel density, pain scores, scores of the Cataract surgery Patient-Reported Outcome Measures Questionnaire and the complication rates. The data will be independently analysed by the statistical team, who will be masked for the allocation information as participants are.Ethics and disseminationThis study was approved by the Ethics Committee of Chinese PLA General Hospital (approval no. S2021-068-01). Informed consent will be obtained from each participant. All the results will be published in peer-reviewed journals and used for scholarly communication or technical guidance. Protocol version 1.0.Trial registration numberChinese Clinical Trial Registry (ChiCTR2100044409).

Purpose To compare the accuracy of the new-generation intraocular lens power calculation formulae in axial myopic eyes. Methods Four databases, PubMed, Web of Science, EMBASE and Cochrane library, were searched to select relevant studies published between Apr 11, 2011, and Apr 11, 2021. Axial myopic eyes were defined as an axial length more than 24.5 mm. There are 13 formulae to participate in the final comparison (SRK/T, Hoffer Q, Holladay I, Holladay II, Haigis for traditional formulae, Barrett Universal II, Olsen, T2, VRF, EVO, Kane, Hill-RBF, LSF for the new-generation formulae). The primary outcomes were the percentage of eyes with a refractive prediction error in ± 0.5D and ± 1.0D. Results A total of 2273 eyes in 15 studies were enrolled in the final meta-analysis. Overall, the new-generation formulae showed a relatively more accurate outcome in comparison with traditional formulae. The percentage of eyes with a predictive refraction error in ± 0.5D (± 1.0D) of Kane, EVO and LSF was higher than 80% (95%), which was only significantly different from Hoffer Q (all P < 0.05). Moreover, another two new-generation formulae, Barrett Universal II and Olsen, had higher percentages than SRK/T, Hoffer Q, Holladay I and Haigis for eyes with predictive refraction error in ± 0.5D and ± 1.0D (all P < 0.05). In ± 0.5D group, Hill-RBF was better than SRK/T (P = 0.02), and Holladay I was better than EVO (P = 0.03) and LSF (P = 0.009), and Hoffer Q had a lower percentage than EVO, Kane, Hill-RBF and LSF (P = 0.007, 0.004, 0.002, 0.03, respectively). Barrett Universal II was better than T2 (P = 0.02), and Hill-RBF was better than SRK/T (P = 0.009). No significant difference was found in other pairwise comparison. Conclusion The new-generation formula is more accurate in intraocular lens power calculation for axial myopic eyes in comparison with the third- or fourth-generation formula.

The fluidics system is an indispensable and primary component of phacoemulsification. Both the gravity-fluidics system and active-fluidics system are commonly used in practice. The irrigation pressure of the gravity-fluidics system is determined by the bottle height, which is relatively constant, while the active-fluidics system is paired with a cassette that contains pressure sensors to monitor intraocular pressure changes. The active-fluidics system allows surgeons to preset a target intraocular pressure value, and it replenishes the fluids proactively; thus, the intraocular pressure is consistently maintained near the target value. Under such circumstances, stable intraocular pressure and anterior chamber volume values could be acquired. Research on surgical safety, efficiency and results have reported several strengths of the active-fluidics system. It is also advantageous in some complicated cataract surgeries. However, the system is not widely used at present, mainly due to its low penetration rate and high equipment cost. Some of its updates such as the new Active Sentry handpiece showed potential superiority in laboratory studies recently, but there is still further research to be conducted. This article gives an overview of the mechanism and performance of the active-fluidics system, and it is expected to provide clues for future research.

Background: Corneal edema (CE) affects the outcome of phacoemulsification. Effective ways to predict the CE after phacoemulsification are needed. Methods: On the basis of data from patients conforming to the protocol of the AGSPC trial, 17 variables were selected to predict CE after phacoemulsification by constructing a CE nomogram through multivariate logistic regression, which was improved via variable selection with copula entropy. The prediction models were evaluated using predictive accuracy, the area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA). Results: Data from 178 patients were used to construct prediction models. After copula entropy variable selection, which shifted the variables used for prediction in the CE nomogram from diabetes, best corrected visual acuity (BCVA), lens thickness and cumulative dissipated energy (CDE) to CDE and BCVA in the Copula nomogram, there was no significant change in predictive accuracy (0.9039 vs. 0.9098). There was also no significant difference in AUCs between the CE nomogram and the Copula nomogram (0.9637, 95% CI 0.9329–0.9946 vs. 0.9512, 95% CI 0.9075–0.9949; p = 0.2221). DCA suggested that the Copula nomogram has clinical application. Conclusions: This study obtained a nomogram with good performance to predict CE after phacoemulsification, and showed the improvement of copula entropy for nomogram models.