Author: [email protected] Eshtiaghi (Canada)
Co-authors: Arjan Dhoot, Marko Popovic, Prem Nichani, Charles Wykoff, Peter Kertes, Rajeev Muni
To compare the efficacy and safety of pars plana vitrectomy (PPV) relative to PPV with scleral buckling (PPV+SB) for rhegmatogenous retinal detachment (RRD) repair.
Systematic review and meta-analysis.
Ovid MEDLINE, EMBASE and Cochrane CENTRAL were systematically searched from January 2000 to June 2020 to identify comparative randomized controlled trials (RCTs) and observational studies reporting on efficacy and safety outcomes in PPV and PPV+SB for RRD repair. Four reviewers independently assessed study eligibility and evaluated risk of bias. The primary outcome was final best corrected visual acuity (BCVA). Secondary outcomes were primary and final reattachment rates, and intraoperative and postoperative complications. Meta-analysis was performed using a random-effects model if at least three studies reported on an outcome of interest. Weighted mean differences (WMD) and risk ratios (RR) were calculated alongside 95% confidence intervals (CI). Number needed to treat (NNT) and number needed to harm (NNH) were calculated.
Across 31 studies (6 RCTs, 25 observational studies), 13,802 eyes (9027 PPV, 4775 PPV+SB) were included. Median final follow-up was 9 months (range: 3–36 months). In comparing PPV and PPV+SB, final logMAR BCVA was similar between both procedures (0.20 ± 0.45 vs. 0.57 ± 0.62; WMD, –0.10; 95%CI, –0.24 to 0.04]; P=0.16). There were no significant differences in primary (85.7% vs. 86.6%, respectively; P=0.11) or final (96.9% vs. 96.4%, respectively; P=0.66) reattachment rates, or the number of operations required to achieve final anatomic success (1.87 ± 2.61 vs. 1.25 ± 0.59; WMD, 0.30; 95%CI, –0.04 to 0.65]; P=0.09). In terms of complications, PPV was significantly less likely to cause macular edema (6.0% vs. 19.0%; RR, 0.47; 95%CI, 0.25 to 0.88]; P=0.02; NNH 17) or epiretinal membrane formation (7.9% vs. 8.6%; RR, 0.68; 95%CI, 0.52 to 0.88; P=0.003; NNT, 50). However, no significant differences were found in the incidence of epithelial defect (P=0.08), elevated intraocular pressure (P=0.13), hyphema (P=0.78), cataracts (P=0.41), proliferative vitreoretinopathy (P=0.73), macular hole (P=0.32), and subretinal and choroidal hemorrhage (P=0.57).
Visual and surgical outcomes were similar between PPV and PPV+SB in RRD. PPV+SB was significantly more likely to cause macular edema and epiretinal membrane compared with PPV alone; however, the incidence of other ocular adverse events were similar between the two procedures.
None on my behalf: In terms of the other co-authors: ASD: None, MMP: Financial support (to institution) - PSI Foundation, APS: None, PN: None, HY: None, CWW: Consulting: Adverum, Allergan, Apellis, Bayer, Genentech, Gyroscope, IVERIC Bio, Chengdu Kanghong Biotechnologies, Kodiak Sciences, NGM Biopharmaceuticals, Novartis, ONL Therapeutics, Opthea, Regeneron, RegenXBio, Roche. Research: Adverum, Aldeyra, Apellis, Bayer, Chengdu Kanghong Biotechnologies, Clearside Biomedical, Gemini Therapeutics, Genentech, Gyroscope, IONIS Pharmaceutical, IVERIC Bio, Kodiak Sciences, NGM Biopharmaceuticals, Novartis, Opthea, Regeneron, RegenXBio, Roche. PJK: Consultant – Novartis, Alcon, Bayer, Novelty Nobility; Financial support (to institution) – Allergan, Bayer, Roche, Novartis; Financial support – Novartis, Bayer; Equity owner – ArcticDx RHM: Consultant – Bayer, Novartis, Allergan, Roche; Financial Support (to institution)- Bayer, Novartis.