Vitrectomy Timing for Retained Lens Fragments After Surgery for Age-Related Cataracts: A Systematic Review and Meta-Analysis

Vanner, Elizabeth A.; Stewart, Michael W.

doi:10.1016/j.ajo.2011.02.010

Cited by 39 publications

(45 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Vitreusa disloke olan büyük lens parçaları ve GİL'lerin, komplikasyonların önlenmesi açısından en kısa sürede cerrahi olarak çıkarılması önerilmektedir [8]. Ancak çok küçük nükleus parçaları için konservatif medikal tedavi düşünülebilir.…”

Section: Discussionunclassified

Katarakt cerrahisi sırasında ve travmaya bağlı vitreusa disloke olan göz içi lens ve nükleuslarda pars plana vitrektomi

Öner¹,

Kılıç²,

Polat³

et al. 2013

CMJ

View full text Add to dashboard Cite

Amaç. Katarakt cerrahisi sırasında ve travmaya bağlı vitreusa disloke olan göz içi lens (GİL) ve nükleuslarda pars plana vitrektomi sonuçlarını değerlendirmektir. Yöntem. Ocak 2009-Ocak 2010 tarihleri arasında katarakt cerrahisi esnasında ve travmaya bağlı olarak vitreusa disloke olan GİL ve nükleuslara pars plana vitrektomi uygulanan olguların dosya bilgileri retrospektif olarak değerlendirilmiştir. Bulgular. Dokuz olgu katarakt cerrahisi sırasında, 3 olgu travmaya bağlı olarak nükleus dislokasyonu, 5 olgu katarakt cerrahisi esnasında GİL dislokasyonu, 1 olgu ise katarakt cerrahisi sırasında hem nükleus hem de GİL dislokasyonu olmak üzere 18 hasta çalışma kapsamında değerlendirildi. Hastaların ameliyat öncesinde görme keskinliği ortanca değeri 0.0025 (0,0025-0,002) seviyesindeyken, ameliyat sonrasında görme keskinliği ortanca değeri 0,1 (0,0025-0,8) olarak bulundu. 17 olgunun (%94,4) ameliyat sonrası görme keskinliğinde, ameliyat öncesi değere göre artış olduğu görüldü. PPV ile aynı seansta 11 olguda sulkusa, 3 olguda ön kamaraya, 4 olguda ise skleraya fikse edilen GİL implantayonu yapıldı. GİL dislokasyonu olan bir olguda ise korneal kesafet nedeni ile görme değişmemiştir. Bir olguda ise ameliyat sonrası 1,5 ay sonra retina dekolmanı görülmüş ve skleral çökertme ameliyatı yapılmıştır. Sonuç. Katarakt cerrahisi ve travmaya bağlı olarak vitreusa disloke olan nükleuslar ve GİL'lerde kötü görsel prognoz, pars plana vitrektomi ve sekonder GİL implantasyonu ile etkili olarak engellenebilmektedir.Anahtar sözcükler: Göz içi lens dislokasyonu, katarakt, nükleus dislokasyonu, pars plana vitrektomi Abstract Aim. Evaluating results of pars plana vitrectomy surgeries for dislocated intraocular lenses and nucleuses during cataract surgeries and related to trauma. Method. Records of cases who underwent pars plana vitrectomy surgeries for vitreus dislocation of intraocular lenses and nucleuses during cataract surgeries and related to trauma between January 2009-January 2010 evaluated retrospectively. Results. 9 cases of nuclues dislocation during cataract surgery and 3 cases of nucleus dislocation after trauma and 5 cases of intraocular lens disloaction during cataract surgery and 1 case of both nucleus and intraocular lens dislocation during cataract surgery totally 18 cases included in the study. Preoperative median of visual acuity values of patients was 0.0025 (0.0025-0.002), postoperative median of visual acuity values was 0.1 (0.0025-0.8). Increased postoperative visual acuity values in comparison to preoperative values were found in 17 cases (94.4 %). In addition to PPV in same surgery intraocular lens implantation in sulcus for 11 cases, in anterior chamber for 3 cases and scleral fixation for 4 cases were performed. Visual acuity didn't improve for 1 case with intraouclar lens dislocation as a result of corneal opacity. 1 case had retinal detachment 1.5 month after the initial surgery and underwent scleral buckling surgery. Conlusion. For cases with dislocated nucleus and intraocular lenses related to cataract surger...

show abstract

Section: Discussionunclassified

Katarakt cerrahisi sırasında ve travmaya bağlı vitreusa disloke olan göz içi lens ve nükleuslarda pars plana vitrektomi

Öner¹,

Kılıç²,

Polat³

et al. 2013

CMJ

View full text Add to dashboard Cite

show abstract

“…The timing of pars plana vitrectomy (PPV) to remove retained lens fragments is controversial, especially concerning whether, and under what circumstances, a “same day” (SD) (as the cataract surgery) vitrectomy (SD-PPV) might be performed. Optimal management of retained lens fragments has not been determined, but cataract surgeons have been urged to avoid attempting to retrieve retained lens fragments by manipulating the vitreous,5,6 to prevent complications such as retinal detachment,7 and to refer patients to a vitreoretinal surgeon promptly 8–13…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis comparing same-day versus delayedvitrectomy clinical outcomes for intravitreal retained lens fragments after age-relatedcataract surgery

Vanner¹,

Stewart²

2014

OPTH

View full text Add to dashboard Cite

Purpose/designWe aimed to perform a systematic review and meta-analysis comparing the risk difference of clinical outcomes for same-day (SD) vs delayed (DEL) pars plana vitrectomy (PPV).MethodsWe searched MEDLINE (English; January 1, 1985 to July 16, 2013) and article reference lists, for patients with crystalline retained lens fragments and discussion of SD-PPV vs DEL-PPV. For the meta-analysis, articles needed the number of patients receiving SD-PPV and DEL-PPV, and the number, in each group, who experienced one or more of the outcomes: not good visual acuity (VA) (<20/40), bad VA (≤20/200), retinal detachment, increased intraocular pressure/glaucoma, intraocular infection/inflammation, cystoid macular edema, and corneal edema.ResultsOf 304 articles identified, 23 provided data for the meta-analysis. Results were mixed, indicating 1) neither vitrectomy time produced better outcomes in all studies (not good VA risk difference =10.3% [positive numbers favored SD-PPV; negative numbers favored DEL-PPV], 95% confidence interval [CI] = [−0.4% to 21.0%], P=0.059; and bad VA risk difference =−0.3%, 95% CI = [−10.7% to 10.1%], P=0.953); 2) better outcomes with immediate SD-PPV compared with all DEL-PPV (not good VA risk difference =16.2%, 95% CI = [0.8% to 31.5%], P=0.039; and bad VA risk difference =8.5%; 95% CI = [0.8% to 16.2%], P=0.030); and 3) immediate SD-PPV and prompt DEL-PPV (3 to 14 days after cataract surgery) had no significant differences and so may produce similar outcomes (not good VA risk differences range = [−19.9% to 6.5%], 95% CI = [−59.9% to 36.4%]; and bad VA risk differences range = [−6.9% to 7.4%], 95% CI = [−33.1% to 31.8%]).ConclusionPerhaps SD-PPV should be limited to facilities at which a vitreoretinal surgeon is immediately available. Otherwise, these results support referring a patient with retained lens fragments promptly to a vitreoretinal surgeon but do not support interfacility transport for SD-PPV.

show abstract

“…20 Estimates of the occurrence of lost lens fragments vary from 0.1% to 1.6% in the international literature. 70 The rate of lost lens fragments reported by the UK Cataract National Dataset 20 was 0.45%, and this value was included in our model (see Table 16). …”

Section: Post-surgical Complications and Consequencesmentioning

confidence: 99%

“…70,71 These complications are relatively uncommon, affecting fewer than 2% of cataract operations. 1,20,68,[72][73][74] However, the occurrence of PCR during surgery increases the risk of cystoid macular oedema, endophthalmitis and retinal detachment.…”

mentioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of second-eye cataract surgery: a systematic review and economic evaluation

Frampton

Harris

Cooper

et al. 2014

Health Technology Assessment

View full text Add to dashboard Cite

BackgroundElective cataract surgery is the most commonly performed surgical procedure in the NHS. In bilateral cataracts, the eye with greatest vision impairment from cataract is operated on first. First-eye surgery can improve vision and quality of life. However, it is unclear whether or not cataract surgery on the second eye provides enough incremental benefit to be considered clinically effective and cost-effective.ObjectiveTo conduct a systematic review of clinical effectiveness and analysis of cost-effectiveness of second-eye cataract surgery in England and Wales, based on an economic model informed by systematic reviews of cost-effectiveness and quality of life.Data sourcesTwelve electronic bibliographic databases, including MEDLINE, EMBASE, Web of Science, The Cochrane Library and the Centre for Reviews and Dissemination databases were searched from database inception to April 2013, with searches updated in July 2013. Reference lists of relevant publications were also checked and experts consulted.Review methodsTwo reviewers independently screened references, extracted and checked data from the included studies and appraised their risk of bias. Based on the review of cost-effectiveness, a de novo economic model was developed to estimate the cost-effectiveness of second-eye surgery in bilateral cataract patients. The model is based on changes in quality of life following second-eye surgery and includes post-surgical complications.ResultsThree randomised controlled trials (RCTs) of clinical effectiveness, three studies of cost-effectiveness and 10 studies of health-related quality of life (HRQoL) met the inclusion criteria for the systematic reviews and, where possible, were used to inform the economic analysis. Heterogeneity of studies precluded meta-analyses, and instead data were synthesised narratively. The RCTs assessed visual acuity, contrast sensitivity, stereopsis and several measures of HRQoL. Improvements in binocular visual acuity and contrast sensitivity were small and unlikely to be of clinical significance, but stereopsis was improved to a clinically meaningful extent following second-eye surgery. Studies did not provide evidence that second-eye surgery significantly affected HRQoL, apart from an improvement in the mental health component of HRQoL in one RCT. In the model, second-eye surgery generated 0.68 incremental quality-adjusted life-years with an incremental cost-effectiveness ratio of £1964. Model results were most sensitive to changes in the utility gain associated with second-eye surgery, but otherwise robust to changes in parameter values. The probability that second-eye surgery is cost-effective at willingness-to-pay thresholds of £10,000 and £20,000 is 100%.LimitationsClinical effectiveness studies were all conducted more than 9 years ago. Patients had good vision pre surgery which may not represent all patients eligible for second-eye surgery. For some vision-related patient-reported outcomes and HRQoL measures, thresholds for determining important clinical effects are either unclear or have not been determined.ConclusionsSecond-eye cataract surgery is generally cost-effective based on the best available data and under most assumptions. However, more up-to-date data are needed. A well-conducted RCT that reflects current populations and enables the estimation of health state utility values would be appropriate. Guidance is required on which vision-related, patient-reported outcomes are suitable for assessing effects of cataract surgery in the NHS and how these measures should be interpreted clinically.Study registrationThis project is registered as PROSPERO CRD42013004211.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme.

show abstract

Vitrectomy Timing for Retained Lens Fragments After Surgery for Age-Related Cataracts: A Systematic Review and Meta-Analysis

Cited by 39 publications

References 50 publications

Katarakt cerrahisi sırasında ve travmaya bağlı vitreusa disloke olan göz içi lens ve nükleuslarda pars plana vitrektomi

Katarakt cerrahisi sırasında ve travmaya bağlı vitreusa disloke olan göz içi lens ve nükleuslarda pars plana vitrektomi

Meta-analysis comparing same-day versus delayedvitrectomy clinical outcomes for intravitreal retained lens fragments after age-relatedcataract surgery

The clinical effectiveness and cost-effectiveness of second-eye cataract surgery: a systematic review and economic evaluation

Contact Info

Product

Resources

About

Vitrectomy Timing for Retained Lens Fragments After Surgery for Age-Related Cataracts: A Systematic Review and Meta-Analysis

Cited by 39 publications

References 50 publications

Katarakt cerrahisi sırasında ve travmaya bağlı vitreusa disloke olan göz içi lens ve nükleuslarda pars plana vitrektomi

Katarakt cerrahisi sırasında ve travmaya bağlı vitreusa disloke olan göz içi lens ve nükleuslarda pars plana vitrektomi

Meta-analysis comparing same-day versus delayedvitrectomy clinical outcomes for&nbsp;intravitreal retained lens fragments after age-relatedcataract surgery

The clinical effectiveness and cost-effectiveness of second-eye cataract surgery: a systematic review and economic evaluation

Contact Info

Product

Resources

About

Meta-analysis comparing same-day versus delayedvitrectomy clinical outcomes for intravitreal retained lens fragments after age-relatedcataract surgery