Combined phacovitrectomy versus sequential surgery for idiopathic macular holes: systematic review and meta-analysis

Kai-Hsiang Liang; Hou-Ren Tsai; Po-Lin Peng; Chih-Hao Chen; Yu-Ting Huang; Jing-Wun Lu; Tai-Li Chen

doi:10.1016/j.jcjo.2023.05.005

Combined phacovitrectomy versus sequential surgery for idiopathic macular holes: systematic review and meta-analysis

Can J Ophthalmol. 2023 May 27:S0008-4182(23)00165-5. doi: 10.1016/j.jcjo.2023.05.005. Online ahead of print.

Authors

Kai-Hsiang Liang¹, Hou-Ren Tsai², Po-Lin Peng¹, Chih-Hao Chen³, Yu-Ting Huang¹, Jing-Wun Lu⁴, Tai-Li Chen⁵

Affiliations

¹ Department of Medical Education, Medical Administration Office, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
² Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Medical Education, Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
³ Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
⁵ Department of Medical Education, Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. Electronic address: terrychen.a@gmail.com.

PMID: 37253430
DOI: 10.1016/j.jcjo.2023.05.005

Abstract

Objective: To compare the best-corrected visual acuity (BCVA) change, idiopathic macular (IMH) closure, and complications in IMH patients receiving combined phacovitrectomy and sequential surgery (vitrectomy followed by phacoemulsification).

Design: Systematic review and meta-analysis.

Methods: PubMed, Ovid EMBASE, and Cochrane Library databases were searched from their inception through February 2022. Randomized, controlled trials and observational studies that presented results of BCVA change, IMH closure, and surgery-related complications were included. A random-effects meta-analysis was conducted to calculate effect estimates with 95% CIs.

Results: One randomized, controlled trials and 7 cohort studies with 585 patients were included. Overall, the meta-analyses of BCVA change (mean difference, -0.03; 95% CI, -0.10-0.04) and IMH closure (risk ratio = 1.04; 95% CI, 0.96-1.13) revealed no significant differences between combined phacovitrectomy and sequential surgery. The pooled risk ratios for various surgical complications such as postoperative retinal detachment, inflammation, and intraocular pressure elevation showed no significant differences between the 2 groups.

Conclusions: Similar visual gain and IMH closure rates were achieved after both combined phacovitrectomy and sequential surgery, with similar complication risks. The anatomic and functional outcomes of combined surgery were not better than those of sequential surgery. These results could serve as a reference for future trials.