It is unclear whether there are differences in efficacy and safety between combined phacoemulsification and pars plana vitrectomy (phaco-PPV), and sequentially performed phaco-PPV.
This meta-analysis aims to compare the efficacy and incidence of complications between these surgical modalities.
Ovid MEDLINE, EMBASE and Cochrane CENTRAL were searched for relevant articles reporting the efficacy and safety of combined versus sequential phaco-PPV for any indication. The primary outcomes were postoperative best corrected visual acuity (BCVA) and mean absolute refractive error from target (RET). Secondary outcomes included efficacy outcomes like the incidence of myopia and postoperative complications. Meta-analysis was conducted using a random effects model in all cases. Risk of bias assessment was performed using the Cochrane risk of bias assessment tool for randomized trials and the ROBINS-I tool for observational studies.
Of the 5410 articles identified, 1 randomized controlled trial and 14 comparative studies were included, with 1407 and 951 eyes in the combined and sequential surgery groups, respectively. There was a mean age of 62.71±6.16 years and 44% (range: 32.1%-70%) of eyes were from male patients. The mean baseline BCVA was 0.88±0.59 logMAR units (20/152 Snellen). The meta-analysis showed no significant difference in postoperative mean BCVA (P=0.56), mean absolute RET (P=0.44) and incidence of myopia (P=0.06) between combined and sequential surgery. Overall, the risks of synechiae formation (risk ratio [RR]: 2.74, 95% confidence interval [CI]: [1.83,4.11], P<0.001), fibrin formation (RR: 2.81, 95% CI: [1.84,4.30], P<0.001), and intraoperative or postoperative retinal detachment (RR: 2.65, 95% CI: [1.08,6.47], P=0.03) were significantly higher following combined surgery relative to sequential surgery. However, the risks of posterior capsular tear (RR: 0.43, 95% CI: [0.25,0.73], P=0.002) and macular hole non-closure or reopening (RR: 0.18, 95% CI: [0.03,0.93], P=0.04) were significantly lower in the combined group.
There were no significant differences in visual and refractive outcomes between combined versus sequential phaco-PPV, while differences existed in certain safety outcomes. These conclusions remain preliminary, as most evidence is derived from low-moderate quality retrospective studies. Given the variability in outcome reporting and associated heterogeneity, future randomized controlled trials are needed to compare combined and sequential phaco-PPV.