Surgical management of pseudophakic retinal detachments - A meta-analysis

Purpose: To compare the success of pars plana vitrectomy (PPV) versus scleral buckle (SB) in the management of uncomplicated pseudophakic retinal detachments (RDs). Design: Meta-analysis of published studies from 1966 to 2004 regarding surgical treatment of pseudophakic RDs. Participants: Two thousand two hundred thirty eyes: 1579 operated by SIB, 457 by PPV, and 194 by the combined method of PPV and SB. Methods: We compared reattachment and functional success rates after 3 commonly practiced surgical interventions for pseudophakic RDs: PPV, SB, and the combined method. Twelve hundred thirty-two articles were retrieved from Medline and by cross-reference searches. Articles with sufficient data on preoperative evaluation, applied surgical technique, and anatomical and functional success rates were included in this analysis. Articles regarding complex pseudophakic RDs, treatment by laser or pneumatic retinopexy, studies with indistinguishable treatment outcomes from phakic and pseudophakic RDs, or reviews without original data were excluded. Main Outcome Measures: Anatomical success rates after initial surgical intervention and after reoperation(s) for primary failures, and best or final visual outcome at the end of follow-up. Results: Of 1232 papers, 29 matched inclusion criteria. After controlling for variation between study characteristics, PPV and the combined method resulted in higher initial reattachment rates (odds ratio [OR], 1.69; 95% confidence interval [Cl], 1.07-2.68, and OR, 3.54; 95% Cl, 1.57-7.97, respectively) as compared with SIB. The differences between the procedures persisted for final reattachment outcome despite reoperation for primary failures. Final visual outcome also was found to depend on the choice of primary surgical intervention. After controlling for differences in the study characteristics, the probability of visual improvement was higher after PPV (OR, 2.34; 95% Cl, 1.58-3.46) or the combined method (OR, 11.52; 95% Cl, 4.42-30.04) as compared with SB. Conclusions: A meta-analysis of published literature implies that PPV with or without SB is more likely to achieve a favorable anatomical and visual outcome than conventional SB alone in uncomplicated pseudophakic RDs. However, the inherent limitations of differing study protocols, quality of included studies, and publication bias in a pooled analysis should be recognized.