Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes

Miguel A Quiroz-Reyes; Erick A Quiroz-Gonzalez; Miguel A Quiroz-Gonzalez; Virgilio Lima-Gomez

doi:10.1186/s40942-023-00472-x

Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes

Int J Retina Vitreous. 2023 May 22;9(1):33. doi: 10.1186/s40942-023-00472-x.

Authors

Miguel A Quiroz-Reyes¹, Erick A Quiroz-Gonzalez^{2

3}, Miguel A Quiroz-Gonzalez², Virgilio Lima-Gomez⁴

Affiliations

¹ Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico. drquiroz@prodigy.net.mx.
² Retina Department of Oftalmologia Integral ABC (Nonprofit Medical and Surgical Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Paseo de las Palmas 735 Suite 303, Lomas de Chapultepec, 11000, Mexico City, Mexico.
³ Institute of Ophthalmology, Fundacion Conde de Valenciana, (Nonprofit Organization), Which is Affiliated with the Postgraduate Studies Division of the National Autonomous University of Mexico, Av. Chimalpopoca 14. Col. Obrera, 06800, Mexico City, Mexico.
⁴ Juarez Hospital, Public Assistance Institution (Nonprofit Organization), Av. Politecnico Nacional 5160, Colonia Magdalena de las Salinas, 07760, Mexico City, Mexico.

Abstract

Background: We conducted a systematic review to compare the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options.

Methods: Databases, including PubMed, ClinicalTrials.gov ( www.

Clinicaltrials: gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies.

Results: Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared with PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively. Adverse events and postoperative complications occurring after treatment have also been documented in these studies.

Conclusion: PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.

Keywords: Macular hole; Ocriplasmin; Pars plana vitrectomy; Pneumatic vitreolysis; Vitreomacular traction syndrome.

Publication types

Review