Efficacy and safety of vitrectomy for congenital cataract surgery: a systematic review and meta‐analysis based on randomized and controlled trials

Abstract

Purpose To explore the effectiveness and safety of vitrectomy for congenital cataract surgery. Methods We searched PubMed, Science Direct, The Cochrane Library, China National Knowledge Infrastructure and the Wanfang Database. Two researchers extracted data and assessed paper quality independently. Posterior capsule opacification (PCO) or visual axis opacification (VAO), reoperation rate, visual acuity, intraocular lenses (IOL) deposit, synechias, uveitis, secondary glaucoma, low‐contrast sensitivity and IOL decentration were compared. Results We included 11 randomized controlled trials (RCTs) with 634 congenital cataract eyes. Cases of posterior capsule opacification in vitrectomy group were significantly less than that of control group, with risk ratio (RR) of 0.15 [95% confidence interval (CI): 0.09, 0.26], and there was no heterogeneity (I2 = 0%, p = 0.94). Reoperation rate in vitrectomy group was lower than that of control group either (RR = 0.40, 95%CI: 0.17, 0.94), and there was no heterogeneity (I2 = 0%, p = 0.85). Best‐corrected visual acuity (BCVA) measured in LogMAR unit of vitrectomy group was smaller, with a mean difference (MD) of −0.17 (95%CI: −0.28, −0.05), and I2 was only 22%, indicating of a small heterogeneity. No statistical difference was found between two groups on IOL deposit (RR = 1.23, 95%CI: 0.70, 2.17), and the heterogeneity was small (I2 = 16%, p = 0.31). No statistical difference was found between two groups on synechias (RR = 1.08, 95%CI: 0.60, 1.94), with a quite small heterogeneity (I2 = 3%, p = 0.38). No statistical difference was found between two groups on uveitis (RR = 0.55, 95%CI: 0.15, 2.01), and there was no heterogeneity (I2 = 0%, p = 0.94). There was no statistical difference on IOP either, with a MD of 0.25 (95%CI: −1.56, 2.07), and there was no heterogeneity (I2 = 0%). Egger's test showed that there was no publication bias for all assessed outcomes. Low‐contrast sensitivity was better in the vitrectomy group. And no evidence indicated vitrectomy could lead to a higher risk on secondary glaucoma or IOL decentration. Conclusion Vitrectomy helps lower the PCO risk and reoperation risk after congenital cataract surgery, and also, vitrectomy helps patients gain a better BCVA and achieve a better low‐contrast sensitivity, with no trade‐off on IOP control, IOL deposit, synechias, uveitis and secondary glaucoma. We recommend performing vitrectomy during congenital cataract surgery.

Outcomes of paediatric cataract surgery with and without the use of trypan blue

“…Older children also exhibit this response resulting in need for reinterventions to clear the visual axis. Thus, many paediatric ophthalmologists perform a primary posterior capsulorhexis and anterior vitrectomy in both younger and older children [16, 18, 19]. This may explain the reports of similar findings in the included RCTs despite the differences in age ranges.…”

Bag‐in‐the‐lens intraocular lens in paediatric cataract surgery: intraoperative and postoperative outcomes

“…In this way, the natural barrier between the anterior and posterior segments of the eye is preserved. In the conventional lens‐in‐the‐bag paediatric cataract surgery, anterior vitrectomy is regarded a necessary and important part of the operation, in order to minimize the frequency of VAO (Cao et al 2019). Although only a hypothesis, we find it likely to assume that an intact vitreous membrane may contribute to the low frequency of postoperative complications, especial secondary glaucoma and postoperative inflammation.…”

Posterior continuous curvilinear capsulorhexis with anterior vitrectomy vs optic capture buttonholing without anterior vitrectomy in pediatric cataract surgery

“…17 To further decrease the risk for posterior capsule opacification (PCO), a PCCC combined with anterior vitrectomy or optic capture without anterior vitrectomy can be performed. 2,15,[23][24][25][26][27][28][29][30] The general principle behind optic capture is the fusion of the anterior and posterior capsular leaflets to prevent migration of the peripheral lens epithelial cells (LECs) into the visual zone. 7 In posterior optic buttonholing, the IOL is first implanted between the anterior and posterior capsular flap and the IOL optic then pushed posteriorly, allowing the leaflets to fuse.…”

“…23,27,[33][34][35] However, anterior vitrectomy implicates another controversy since there is no generally valid guideline in which age groups anterior vitrectomy is obligatory to ensure a clear visual axis. 4,6,27,29,35 The purpose of this study was to compare the long-term outcomes of PCCC and anterior vitrectomy or PCCC with optic capture buttonholing without anterior vitrectomy. A heparin-coated, 1-piece polymethyl methacrylate (PMMA) IOL was implanted.…”

“…To further decrease the risk for posterior capsule opacification (PCO), a PCCC combined with anterior vitrectomy or optic capture without anterior vitrectomy can be performed. 2,15,23–30…”