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

PURPOSE: To evaluate the effect of vitrectomy timing on outcomes for patients with crystalline retained lens fragments receiving vitrectomy 3+ days after cataract surgery. DESIGN: Systematic review and meta-analysis of retrospective interventional cases series. METHODS: Searches of MEDLINE (English, 1/1/85 through 7/30/2010) and article reference lists. Articles were screened for patients with crystalline retained lens fragments after surgery for age-related cataracts, discussion of vitrectomy timing, and, for the meta-analysis, patient totals for at least 1 outcome and multiple time periods, 10+ patients, and mean follow-up >= 3 months. Outcomes included visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation, cystoid macular edema, and corneal edema. Data extraction was performed twice and quality assessed. Logistic regression estimated study-level odds ratios for each additional 1-week vitrectomy delay. Meta-analysis estimated summary odds ratios using random-effects models. RESULTS: Of 257 articles identified, there were 43 unique studies (53 articles) for the systematic review, including 27 (31 articles) for the meta-analysis. Early vitrectomies were statistically significantly associated with better outcomes for not good visual acuity (odds ratio: 1.13; 95% CI: 1.04-1.22, P = .005); bad visual acuity (odds ratio: 1.05; 95% CI: 1.01-1.09, P = .009); previtrectomy retinal detachment (odds ratio: 1.29; 95% CI: 1.01-1.65, P = .038); postvitrectomy retinal detachment (odds ratio: 1.13; 95% CI: 1.0271.26, P = :024); increased intraocular pressure (odds ratio: 1.23; 95% CI: 1.07-1.41, P = .003); and intraocular infection/inflammation (odds ratio: 1.20; 95% CI: 1.01-1.42, P = .041). Results were robust to sensitivity analyses.