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PARS PLANA VITRECTOMY FOR VITREOMACULAR TRACTION SYNDROME: A Systematic Review and Metaanalysis of Safety and Efficacy

Jackson, Timothy L. PhD, FRCOphth*; Nicod, Elena MSc; Angelis, Aris MSc; Grimaccia, Federico MD; Prevost, Andrew T. PhD*; Simpson, Andrew R.H. MBBS, MRCOphth*; Kanavos, Panos PhD

doi: 10.1097/IAE.0b013e3182a6b3e2
Original Study

Purpose: To determine the safety and efficacy of pars plana vitrectomy for vitreomacular traction.

Methods: Articles reporting visual acuity change before and after pars plana vitrectomy were selected using a systematic literature review with predefined eligibility criteria. Visual acuities were converted to logarithm of the minimum angle of resolution (logMAR), weighted for study size, and pooled across studies. Safety outcomes were also pooled across studies.

Results: Twenty-one of 460 articles were eligible. Mean (±standard deviation) logMAR visual acuity improved from 0.67 ± 0.55 to 0.42 ± 0.45 (n = 259 eyes) after pars plana vitrectomy (from 20/94 to 20/53 Snellen). In series of at least 20 eyes, mean visual acuity improved in all 5 studies (sign test, P = 0.0625). Of 392 eyes, 9.2% lost visual acuity, 11.7% were unchanged, and 64.3% improved; 32.9% of 217 eyes gained ≥2 Snellen lines. The most common postoperative complications were cataract (34.7% of 304 eyes; 63.2% of 68 phakic eyes), epiretinal membrane (5.7% of 348 eyes), and retinal detachment (4.6% of 348 eyes). Cataract surgery was undertaken in 10.5% of eyes.

Conclusion: The visual acuity gains after pars plana vitrectomy for vitreomacular traction are relatively modest, but visual acuity change may not fully reflect symptomatic relief.

A systematic review found that eyes with vitreomacular traction syndrome have modest visual acuity gains after pars plana vitrectomy: one third of eyes gained at least 2 Snellen lines, but 21% had no change or reduced visual acuity.

*School of Medicine, King's College London, London, United Kingdom; and

London School of Economics and Political Science, London, United Kingdom.

Reprint requests: Timothy L. Jackson, PhD, FRCOphth, King's College Hospital, London SE5 9RS, United Kingdom; e-mail: t.jackson1@nhs.net

Supported by an unrestricted educational grant from Thrombogenics. A. T. Prevost was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London.

Paper presented at the Royal College of Ophthalmologists' Annual Congress, Liverpool, United Kingdom, 21st to 23rd May 2013.

T. L. Jackson is a consultant to Thrombogenics, and has served on advisory boards for Alcon, and Bausch and Lomb. The remaining authors have no financial/conflicting interests to disclose.

Thrombogenics had no role in the design or conduct of this study. Authors have no proprietary interests. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

© 2013 by Ophthalmic Communications Society, Inc.