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Pars plana vitrectomy for diabetic macular edema: a systematic review, meta-analysis, and synthesis of safety literature

Jackson, Timothy L. and Nicod, Elena and Angelis, Aris and Grimaccia, Federico and Pringle, Edward and Kanavos, Panos (2017) Pars plana vitrectomy for diabetic macular edema: a systematic review, meta-analysis, and synthesis of safety literature. Retina, 37 (5). pp. 886-895. ISSN 1539-2864

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Identification Number: 10.1097/IAE.0000000000001280

Abstract

Purpose. To assess the risk and benefit of pars plana vitrectomy for diabetic macular edema (DME). Methods. We conducted a systematic literature review using PubMed, EMBASE, Web of Science, and Cochrane Central Database of Controlled Trials until September 2014. The population was patients with DME, intervention vitrectomy, comparator macular laser or observation, and efficacy outcome visual acuity and central retinal thickness (CRT). Safety outcomes were intra- and postoperative surgical complications. The efficacy meta-analysis included only randomized controlled trials. The safety analysis included prospective, retrospective, controlled and uncontrolled studies. Results. Five studies were eligible for the efficacy meta-analysis (n = 127 eyes) and 40 for the safety analysis (n = 1,562 eyes). Combining follow up intervals from 6 to 12 months, the meta-analysis found a non-significant 2 letter visual acuity difference favoring vitrectomy, and a significant 102 micron greater reduction in CRT favoring vitrectomy, but a post-hoc subgroup analysis found that a 6 month CRT benefit reversed by 12 months. The most frequent complications were retinal break (7.1%), elevated intraocular pressure (5.2%), epiretinal membrane (3.3%), and vitreous hemorrhage (2.4%). Cataract developed in 68.6% of 121 phakic eyes. Conclusions. Vitrectomy produces structural and functional improvements in select eyes with DME, but the visual gains are not significantly better than with laser or observation. No major safety concerns were identified.

Item Type: Article
Official URL: http://journals.lww.com/retinajournal/Pages/defaul...
Additional Information: © 2016 Ophthalmic Communications Society, Inc.
Subjects: R Medicine > RE Ophthalmology
Sets: Research centres and groups > LSE Health
Date Deposited: 22 Jun 2016 11:47
Last Modified: 14 Sep 2017 23:00
URI: http://eprints.lse.ac.uk/id/eprint/66975

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