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The Cochrane Database of Systematic... Nov 2021Lamellar macular holes (LMHs) are small, partial-thickness defects of the macula defined by characteristic features on optical coherence tomography (OCT), including a... (Review)
Review
BACKGROUND
Lamellar macular holes (LMHs) are small, partial-thickness defects of the macula defined by characteristic features on optical coherence tomography (OCT), including a newly recognised type of epiretinal membrane termed 'epiretinal proliferation'. There may be a rationale to recommend surgery for individuals with LMHs, particularly those with functional or anatomical deterioration, or poor baseline vision causing significant disability, to stabilise the LMH and prevent further visual deterioration; however, there is currently no evidence-based consensus.
OBJECTIVES
To assess the effect of surgical interventions on post-operative visual and anatomical outcomes in people with a confirmed LMH.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, Scopus SciVerse, ISRCTN registry, US National Institutes of Health Ongoing Trials Register, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We also searched reference lists of included trials to identify other eligible trials which our search strategy may have missed. The date of the search was 20 July 2021.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) involving participants with a confirmed LMH diagnosis which reported one or more surgical intervention(s), alone or in combination, in at least one arm of the RCT.
DATA COLLECTION AND ANALYSIS
We used standard methods as expected by Cochrane. Two study authors independently extracted data and assessed the risk of bias for included trials. Trial authors were contacted for further information and clarification.
MAIN RESULTS
A single RCT was eligible for inclusion. Thirty-six participants were randomised in a 2:1 ratio; 24 were allocated to undergo surgery (pars plana vitrectomy, peeling of the epiretial proliferation followed by fovea-sparing removal of the internal limiting membrane) and 12 (10 following two participant dropouts) to observation. Overall, the certainty of the evidence was low for all outcomes due to selection and detection bias, and the low number of participants enrolled in the study which may affect the accuracy of results and reliability of conclusions. At six-month follow-up, change in vision was better in the surgery group (-0.27 logMAR improvement) than observation (0.02 worsening) (mean difference (MD): -0.29 logMAR, 95% confidence intervals (CI): -0.33 to -0.25). Central retinal thickness increased in the surgery group over 6 months 126 μm increase) compared with observation group (decrease by 11μm) (MD: 137 μm, 95% CI: 125.87 μm to 148.13 μm). Finally, at six-month follow-up, retinal sensitivity was better in the surgery group (3.03 dB increase) compared with the observation group (0.06 dB decrease) (MD: 3.09 dB, 95% CI: 2.07 to 4.11 dB). Vision-related quality of life and metamorphopsia were not reported. No adverse outcomes or complications were reported in the study, however, authors could not provide information on whether any individuals developed deterioration in vision of 0.2 logMAR or worse.
AUTHORS' CONCLUSIONS
The included single trial demonstrated improvements in visual and anatomical outcome measures for participants with a LMH who underwent surgery compared with observation only. Therefore, we can conclude that participants who undergo surgery may achieve superior post-operative best corrected visual acuity and anatomical outcomes compared with observation only. However, the results of a single and small RCT provides limited evidence to support or refute surgery as an effective management option for LMHs. Future RCTs with a larger number of participants and with fewer methodological limitations and biases are necessary to inform future clinical practice.
Topics: Humans; Macula Lutea; Randomized Controlled Trials as Topic; Retina; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 34748208
DOI: 10.1002/14651858.CD013678.pub2 -
Ophthalmic Research 2021Myopic traction maculopathy (MTM) is a major cause of impaired vision in eyes with high myopia, which is characterized by retinal thickening, retinoschisis, lamellar... (Comparative Study)
Comparative Study Meta-Analysis
INTRODUCTION
Myopic traction maculopathy (MTM) is a major cause of impaired vision in eyes with high myopia, which is characterized by retinal thickening, retinoschisis, lamellar macular hole (MH), and foveal retinal detachment. Pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane peeling (ILMP) has been developed to theoretically prevent postoperative MH formation and improve best-corrected visual acuity (BCVA) gain for MTM compared with the complete ILMP. However, in previous studies, the anatomic and visual outcomes still remain uncertain and controversial.
OBJECTIVES
The aim of this study was to evaluate the anatomic and visual outcomes of vitrectomy with fovea-sparing ILMP for the treatment of MTM compared with complete ILMP.
METHODS
Articles from PubMed, EMBASE, Web of Science, and Cochrane Library were systematically retrieved. The main outcomes were the rate of a postoperative MH and visual improvement of BCVA (converted to logarithm of the minimum angle of resolution [logMAR]). The secondary outcomes were the proportion of patients with visual improvement, the proportion of anatomic success, preoperative and postoperative BCVA, preoperative and postoperative central fovea thickness, and time to anatomic resolution.
RESULTS
There was a higher rate of postoperative MH formation (odds ratio [OR] 5.64; 95% confidence interval [CI]: 1.72-18.44; p = 0.004) and less improvement of BCVA in logMAR (mean difference [MD] -0.09; 95% CI: -0.18 to 0.00; p = 0.04) in the complete ILMP group. However, postoperative BCVA (MD 0.14; 95% CI: 0.00-0.27; p = 0.05), the proportion of patients with visual improvement (OR 0.39; 95% CI: 0.15-1.02; p = 0.05), postoperative central foveal thickness (MD -10.02; 95% CI: -24.4 to 4.36; p = 0.17), the rate of anatomic success (MD 0.39; 95% CI: 0.15-1.03; p = 0.06), and time to resolution (MD -1.65; 95% CI: -3.66 to 0.36; p = 0.11) showed no significant differences.
CONCLUSION
PPV combined with the fovea-sparing ILMP could contribute to a lower MH formation rate and more improvement of BCVA in logMAR than PPV combined with complete ILMP.
Topics: Basement Membrane; Humans; Macular Degeneration; Myopia, Degenerative; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Traction; Visual Acuity; Vitrectomy
PubMed: 34425571
DOI: 10.1159/000519021 -
Annals of Palliative Medicine May 2021To compare the therapeutic effects of vitrectomy (PPV) combined with the internal limiting membrane (ILM) flap coverage and PPV in combination with ILM peeling on the... (Meta-Analysis)
Meta-Analysis
Comparative study of vitrectomy combined with internal limiting membrane peeling and vitrectomy combined with internal limiting membrane flap covering in idiopathic macular hole treatment: a meta-analysis and systematic review.
BACKGROUND
To compare the therapeutic effects of vitrectomy (PPV) combined with the internal limiting membrane (ILM) flap coverage and PPV in combination with ILM peeling on the idiopathic large macular hole (MH), in order to better guide the treatment of large MH.
METHODS
Searching was conducted within PubMed, Web of Science, Embase, CNKI, and Wanfang databases, and relevant pieces of literature between 2010 and 2020 published in English or Chinese were included.
RESULTS
A total of 11 studies including 667 patients and 667 affected eyes were included; the effective rate of hole closure between the 2 groups were compared in 11 studies. Results exhibited 94.4% (286/303 eyes) in the test group (PPV combined with ILM flap coverage) and 85.8% (313/364 eyes) in the control group (PPV combined with ILM peeling) were closed. MH closure rates in the test group was superior to the control group [odds ratio (OR) =3.36, 95% confidence interval (CI): 1.88-6.01, P<0.001]. All 11 studies compared the preoperative and postoperative best corrected visual acuity (BCVA), with no significant difference in the preoperative test control group [standardized mean difference (SMD) =-0.18, 95% CI: -0.42 to 0.06, P=0.149]. The BCVA after surgery was better in the test group compared with the control group (SMD =-0.91, 95% CI: -1.43 to -0.40), P=0.001).
DISCUSSION
Compared with PPV combined with ILM peeling, PPV combined with ILM flap coverage can significantly improve the MH closure rate and postoperative BCVA.
Topics: Basement Membrane; Humans; Retinal Perforations; Retrospective Studies; Visual Acuity; Vitrectomy
PubMed: 34107705
DOI: 10.21037/apm-21-871 -
Indian Journal of Ophthalmology May 2021The incidence of leishmaniasis is reported to be up to 1 million per year. To date, there has been no comprehensive review describing the diversity of clinical... (Review)
Review
The incidence of leishmaniasis is reported to be up to 1 million per year. To date, there has been no comprehensive review describing the diversity of clinical presentations of ocular leishmaniasis (OL) and its treatment. This systematic review aims to address this knowledge gap and provide a summary of the clinical presentation, natural course, and treatment options for OL. Our study identified a total of 57 published articles as describing cases of OL involving: adnexa (n = 26), orbit (n = 1), retina (n = 7), uvea (n = 18) and cornea (n = 6). Though well described and easily treated, palpebral leishmaniasis is often misdiagnosed and may lead to chronic issues if untreated. The retinal manifestations of Leishmaniasis consist of self-resolving hemorrhages secondary to thrombocytopenia. Two main uveitis etiologies have been identified: uveitis in the context of active Leishmanial infection (associated with immunosuppression) and uveitis occurring as an immune reconstitution syndrome. Corneal involvement in most geographic areas generally follows an aggressive course, most often ending in corneal perforation if left untreated. In the Americas, a chronic indolent interstitial keratitis may also occur. Topical steroids are of little use in keratitis (systemic antileishmanials being the cornerstone of treatment). However, these are essential in cases of uveitis, with or without concomitant systemic antileishmanial therapy. In conclusion, though ocular involvement in Leishmaniasis is rare, severe sight-threatening consequences follow if left untreated. Early diagnosis, enthusiastic follow-up and aggressive treatment are essential for good outcomes.
Topics: Cornea; Corneal Perforation; Humans; Keratitis; Leishmaniasis; Uveitis
PubMed: 33913831
DOI: 10.4103/ijo.IJO_2232_20 -
PloS One 2021To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies. (Meta-Analysis)
Meta-Analysis
PURPOSE
To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies.
METHODS
PubMed, Medline and Embase databases were searched up to May 2020. Included cohorts were divided into three groups: degenerative LMH group, lamellar hole associated epiretinal proliferation (LHEP) group and tractional LMH group. LHEP is likely to be associated with degenerative LMHs, but less commonly could be associated with mixed LMHs. To reduce risk of possible misclassification bias, eyes with LHEP which could not have been precisely classified by the authors, were included into the LHEP group. The primary outcome was to investigate the visual change following primary vitrectomy in the degenerative LMH and LHEP group versus the tractional LMH group. A sensitivity analysis excluding the LHEP group was also performed on the primary outcome. Mean difference (MD) in best corrected visual acuity between baseline and post-treatment was calculated, along with 95% confidence interval (CI). Rate of incidence of post-operative full-thickness macular hole (FTMH) was assessed as secondary outcome.
RESULTS
Thirteen studies were included. Pooled analyses including all groups showed a significant visual improvement following vitrectomy (pre-post MD = -0.17;95%CI = -0.22,-0.12;p<0.001), with no difference in visual improvement between the degenerative LMH and LHEP group and the tractional LMH group. The sensitivity analysis excluding LHEP group confirmed no difference in visual change between the degenerative LMH group (pre-post MD = -0.18;95%CI = -0.24,-0.12;p<0.001) and the tractional LMH group (MD = -0.16;95%CI = -0.26,-0.07;p<0.001). The incidence rate of post-operative FTMH was higher in the degenerative LMH and LHEP group than in the tractional LMH group (p = 0.002).
CONCLUSION
Primary vitrectomy for LMH ensured a favorable visual outcome, with no difference in visual gain between degenerative and tractional LMHs. However, a higher incidence of post-operative FTMHs was found in eyes with the degenerative LMH subtype.
Topics: Humans; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 33667237
DOI: 10.1371/journal.pone.0246667 -
BMC Ophthalmology Jan 2020The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane... (Comparative Study)
Comparative Study Meta-Analysis
Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis.
BACKGROUND
The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH).
METHODS
Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power.
RESULTS
This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = - 0.16, 95% CI = - 0.23 to 0.09; P < 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = - 0.12 to 0.15; P = 0.86).
CONCLUSION
Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.
Topics: Basement Membrane; Epiretinal Membrane; Humans; Retinal Perforations; Retrospective Studies; Surgical Flaps; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 31914954
DOI: 10.1186/s12886-019-1271-2 -
The Cochrane Database of Systematic... Dec 2019A giant retinal tear (GRT) is a full-thickness neurosensory retinal break extending for 90° or more in the presence of a posterior vitreous detachment. (Meta-Analysis)
Meta-Analysis
BACKGROUND
A giant retinal tear (GRT) is a full-thickness neurosensory retinal break extending for 90° or more in the presence of a posterior vitreous detachment.
OBJECTIVES
To evaluate the effectiveness and safety of pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy alone for eyes with giant retinal tear.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 8), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Literature on Health Sciences (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in our electronic search. We last searched the electronic databases on 16 August 2018.
SELECTION CRITERIA
We included only randomized controlled trials (RCTs) comparing pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy alone for giant retinal tear regardless of age, gender, lens status (e.g. phakic or pseudophakic eyes) of the affected eye(s), or etiology of GRT among participants enrolled in these trials.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed titles and abstracts, then full-text articles, using Covidence. Any differences in classification between the two review authors were resolved through discussion. Two review authors independently abstracted data and assessed risk of bias of included trials.
MAIN RESULTS
We found two RCTs in abstract format (105 participants randomized). Neither RCT was published in full. Based on the data presented in the abstracts, scleral buckling might be beneficial (relative risk of re-attachement ranged from 3.0 to 4.4), but the findings are inconclusive due to a lack of peer reviewed publication and insufficient information for assessing risk of bias.
AUTHORS' CONCLUSIONS
We found no conclusive evidence from RCTs on which to base clinical recommendations for scleral buckle combined with pars plana vitrectomy for giant retinal tear. RCTs are clearly needed to address this evidence gap. Such trials should be randomized, and patients should be classified by giant retinal tear characteristics (extension (90º, 90º to 180º, > 180º), location (oral, anterior, posterior to equator)), proliferative vitreoretinopathy stage, and endotamponade. Analysis should include both short-term (three months and six months) and long-term (one year to two years) outcomes for primary retinal reattachment, mean change in best corrected visual acuity, study eyes that required second surgery for retinal reattachment, and adverse events such as elevation of intraocular pressure above 21 mmHg, choroidal detachment, cystoid macular edema, macular pucker, proliferative vitreoretinopathy, and progression of cataract in initially phakic eyes.
Topics: Humans; Randomized Controlled Trials as Topic; Retinal Detachment; Retinal Perforations; Scleral Buckling; Treatment Outcome; Vitrectomy
PubMed: 31840810
DOI: 10.1002/14651858.CD012646.pub2 -
Retina (Philadelphia, Pa.) Jan 2020To evaluate repeated surgery for idiopathic full-thickness macular hole that failed to close (FTC) after first surgery or reopened (RO) once originally closed. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate repeated surgery for idiopathic full-thickness macular hole that failed to close (FTC) after first surgery or reopened (RO) once originally closed.
METHODS
Systematic review and meta-analysis. Pubmed.gov and Cochrane Library were searched for studies in English presenting outcomes of idiopathic full-thickness macular hole that FTC or RO (case reports/series of <5 cases excluded).
OUTCOME MEASURES
Anatomical closure, postoperative best-corrected visual acuity, intraoperative/postoperative complications, and patient-reported outcomes. Meta-analysis was performed on aggregate and available individual participant data sets using the metafor package in R.
RESULTS
Twenty-eight eligible studies were identified. After reoperation, pooled estimates for anatomical closure were 78% (95% confidence interval 71-84%) and 80% (95% confidence interval 66-89%) for FTC and RO groups, respectively. On average, best-corrected visual acuity improved in both groups. However, only 15% (28 of 189 eyes) of FTC eyes achieved best-corrected visual acuity of ≥6/12. The pooled estimated probability of ≥2-line best-corrected visual acuity improvement was 58% in the FTC group (95% confidence interval 45-71%); meta-analysis was not possible in the RO group. The most common complication was cataract.
CONCLUSION
Reoperation for FTC or RO idiopathic full-thickness macular hole achieved a clinically meaningful visual acuity improvement in more than half of patients; high levels of vision (≥6/12), however, were uncommon.
Topics: Basement Membrane; Humans; Intraoperative Complications; Postoperative Complications; Reoperation; Retinal Perforations; Treatment Failure; Visual Acuity; Vitrectomy; Vitreoretinal Surgery
PubMed: 31335482
DOI: 10.1097/IAE.0000000000002564 -
Eye (London, England) Oct 2019To evaluate the effect of vitrectomy with inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD) in high myopia... (Meta-Analysis)
Meta-Analysis
Vitrectomy with inverted internal limiting membrane flap versus internal limiting membrane peeling for macular hole retinal detachment in high myopia: a systematic review of literature and meta-analysis.
PURPOSE
To evaluate the effect of vitrectomy with inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD) in high myopia compared with that of ILM peeling.
METHODS
PubMed, EMBASE, Web of Science, MEDLINE, Ovid, Wan Fang and CNKI were systematically reviewed. The primary outcome parameters were the MH closure rate, retinal reattachment rate and postoperative BCVA. Secondary outcome parameters, included intraoperative or postoperative complications.
RESULTS
Seven retrospective comparative studies including 228 eyes were selected. No significant difference was detected in either postoperative BCVA (MD -0.07; 95% CI: -0.17 to 0.03; p = 0.16) or the improvement in postoperative BCVA (MD -0.17; 95% CI: -0.50 to 0.16; p = 0.32) between the ILM flap group and ILM peeling group. The retinal reattachment rate using inverted ILM flap was not significantly different from that using ILM peeling (odds ratio (OR) 2.24; 95% CI: 0.75-6.73; p = 0.15). The MH closure rate was higher with inverted ILM flap than with ILM peeling (OR 11.86; 95% CI: 5.65 to 24.92; p < 0.00001). There was no significant difference in intraoperative or postoperative complications, including concomitant cataract rate (OR 1.22; 95% CI: 0.42-3.58; p = 0.71).
CONCLUSION
The inverted ILM flap technique could contribute to a higher MH closure rate than ILM peeling, but visual improvement was similar. Both surgical methods could obtain a high-retinal reattachment rate with fewer intraoperative and postoperative complications.
Topics: Basement Membrane; Female; Humans; Male; Myopia, Degenerative; Retinal Detachment; Retinal Perforations; Retrospective Studies; Surgical Flaps; Vitrectomy
PubMed: 31073163
DOI: 10.1038/s41433-019-0458-3 -
The Cochrane Database of Systematic... Mar 2019Rhegmatogenous retinal detachment (RRD) is a separation of neurosensory retina from the underlying retinal pigment epithelium. It is caused by retinal tears, which let... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Rhegmatogenous retinal detachment (RRD) is a separation of neurosensory retina from the underlying retinal pigment epithelium. It is caused by retinal tears, which let fluid pass from the vitreous cavity to the subretinal space. Pars plana vitrectomy (PPV), scleral buckling surgery and pneumatic retinopexy are three accepted management strategies whose efficacy remains controversial. Pneumatic retinopexy is considered in a separate Cochrane Review.
OBJECTIVES
The primary objective of this review was to assess the efficacy of PPV versus scleral buckling for the treatment of simple RRD (primary RRD of any extension with up to two clock hours large break(s) regardless of their anterior/posterior localisation) in people with (phakia) or without (aphakia) a natural lens in the eye, or with an artificial lens (pseudophakia). A secondary objective was to assess any data on economic and quality-of-life measures.
SEARCH METHODS
We searched CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; MEDLINE; Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 5 December 2018.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing PPV versus scleral buckling surgery with at least three months of follow-up.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodology. Two review authors independently extracted the data and study characteristics from the studies identified as eligible after initial screening. We considered the following outcomes: primary retinal reattachment, postoperative visual acuity, final anatomical success, recurrence of retinal detachment, number of interventions needed to achieve final anatomical success, quality of life and adverse effects. We assessed the certainty of evidence using GRADE.
MAIN RESULTS
This review included 10 RCTs (1307 eyes of 1307 participants) from Europe, India, Iran, Japan and Mexico, which compared PPV and scleral buckling for RRD repair. Two of these 10 studies compared PPV combined with scleral buckling with scleral buckling alone (54 participants). All studies were high or unclear risk of bias on at least one domain. Five studies were funded by non-commercial sources, while the other five studies did not report source of funding.There was little or no difference in the proportion of participants who achieved retinal reattachment at least 3 months after the operation in the PPV group compared to those in the scleral buckling group (risk ratio (RR) 1.07, 95% confidence intervals (CI) 0.98 to 1.16; 9 RCTs, 1261 participants, low-certainty evidence). Approximately 67 in every 100 people treated with scleral buckling had retinal reattachment by 3 to 12 months. Treatment with PPV may result in 4 more people with retinal reattachment in every 100 people treated (95% confidence interval (CI) 2 fewer to 11 more).There was no evidence of any important difference in postoperative visual acuity between participants in the PPV group compared to those in the scleral buckling group (mean difference (MD) 0.00 logMAR, 95% CI -0.09 to 0.10, 6 RCTs, 1138 participants, low-certainty evidence).There was little or no difference in final anatomical success between participants in the PPV group and scleral buckling group (RR 1.01, 95% CI 0.99 to 1.04, 9 RCTs, 1235 participants, low-certainty evidence). There were 94 out of 100 people treated with control (scleral buckling) that achieved final anatomical success compared to 96 out of 100 in the PPV group.Retinal redetachment was reported in fewer participants in the PPV group compared to the scleral buckling group (RR 0.75 (95% CI 0.59 to 0.96, 9 RCTs, 1320 participants, low-certainty evidence). Approximately 28 in every 100 people treated with scleral buckling had retinal detachment by 3 to 36 months. Treatment with PPV may result in seven fewer people with retinal detachment in every 100 people treated (95% CI 1 to 11 fewer).Participants treated with PPV on average needed fewer interventions to achieve final anatomical success but the difference was small and data were skewed (MD -0.20, 95% CI -0.34 to -0.06, 2 RCTs, 682 participants, very low-certainty evidence).Very low-certainty evidence on quality of life suggested that more people in the PPV group were "satisfied with vision" compared with the scleral buckling group (RR 6.22, 95% CI 0.88 to 44.09, 1 RCT, 32 participants).All included studies reported adverse effects, however, it was not always clear whether they were reported as number of participants or number of adverse effects. Cataract development or progression was more prevalent in the PPV group (RR 1.71, 95% CI 1.45 to 2.01), choroidal detachment was more prevalent in the scleral buckling group (RR 0.19, 95% CI 0.06 to 0.65) and new/iatrogenic breaks were observed only in the PPV group (RR 8.21, 95% CI 1.91 to 35.21). Estimates of the relative frequency of other adverse effects, including postoperative proliferative vitreoretinopathy, postoperative increase in intraocular pressure, development of cystoid macular oedema, macular pucker and strabismus were imprecise. Evidence for adverse effects was low-certainty evidence.
AUTHORS' CONCLUSIONS
Low- or very low-certainty evidence indicates that there may be little or no difference between PPV and scleral buckling in terms of primary success rate, visual acuity gain and final anatomical success in treating primary RRD. Low-certainty evidence suggests that there may be less retinal redetachment in the PPV group. Some adverse events appeared to be more common in the PPV group, such as cataract progression and new iatrogenic breaks, whereas others were more commonly seen in the scleral buckling group such as choroidal detachment.
Topics: Humans; Postoperative Complications; Quality of Life; Randomized Controlled Trials as Topic; Recurrence; Retinal Detachment; Retinal Perforations; Scleral Buckling; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 30848830
DOI: 10.1002/14651858.CD009562.pub2