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Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systematic review and meta-analysis.

Abstract：

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.

journal_name

Am J Ophthalmol

journal_title

American journal of ophthalmology

authors

Vanner EA,Stewart MW

doi

10.1016/j.ajo.2011.02.010

subject

Has Abstract

pub_date

2011-09-01 00:00:00

pages

345-357.e3

issue

eissn

0002-9394

issn

1879-1891

pii

S0002-9394(11)00154-1

journal_volume

152

pub_type

杂志文章,meta分析,评审

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Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systematic review and meta-analysis.