Vitrectomy Timing for Retained Lens Fragments After Surgery for Age-Related Cataracts: A Systematic Review and Meta-Analysis - 17/08/11

Doi : 10.1016/j.ajo.2011.02.010

Elizabeth A. Vanner ^a,^⁎ , Michael W. Stewart ^b
^a Department of Preventive Medicine and Health Care Policy & Management, Health Sciences Center, Stony Brook University, Stony Brook, New York
^b Department of Ophthalmology, Mayo Clinic College of Medicine, Jacksonville, Florida

Inquiries to Elizabeth A. Vanner, Health Sciences Center Level 2 School of Health Technology and Management, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, 11794-8204

Résumé

Purpose

To evaluate the effect of vitrectomy timing on outcomes for patients with crystalline retained lens fragments receiving vitrectomy 3+ days after cataract surgery.

Design

Systematic review and meta-analysis of retrospective interventional cases series.

Methods

Searches of MEDLINE (English, 1/1/85 through 7/30/2010) and article reference lists. Articles were screened for patients with crystalline retained lens fragments after surgery for age-related cataracts, discussion of vitrectomy timing, and, for the meta-analysis, patient totals for at least 1 outcome and multiple time periods, 10+ patients, and mean follow-up ≥3 months. Outcomes included visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation, cystoid macular edema, and corneal edema. Data extraction was performed twice and quality assessed. Logistic regression estimated study-level odds ratios for each additional 1-week vitrectomy delay. Meta-analysis estimated summary odds ratios using random-effects models.

Results

Of 257 articles identified, there were 43 unique studies (53 articles) for the systematic review, including 27 (31 articles) for the meta-analysis. Early vitrectomies were statistically significantly associated with better outcomes for not good visual acuity (odds ratio: 1.13; 95% CI: 1.04–1.22, P = .005); bad visual acuity (odds ratio: 1.05; 95% CI: 1.01–1.09, P = .009); previtrectomy retinal detachment (odds ratio: 1.29; 95% CI: 1.01–1.65, P = .038); postvitrectomy retinal detachment (odds ratio: 1.13; 95% CI: 1.02–1.26, P = .024); increased intraocular pressure (odds ratio: 1.23; 95% CI: 1.07–1.41, P = .003); and intraocular infection/inflammation (odds ratio: 1.20; 95% CI: 1.01–1.42, P = .041). Results were robust to sensitivity analyses.

Conclusions

This systematic review and meta-analysis found significantly better outcomes (visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation) with earlier vitrectomy for retained lens fragments. Reduced vitrectomy delays may yield better patient outcomes.

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