Combined versus Sequential Pars Plana Vitrectomy and Phacoemulsification for Macular Hole and Epiretinal Membrane: A Systematic Review and Meta-Analysis

Abstract

Topic: Comparing the efficacy and safety between combined and sequential pars plana vitrectomy and phacoemulsification for macular hole (MH) and epiretinal membrane (ERM).

Clinical relevance: The standard of care for MH and ERM is vitrectomy, which increases the risk of developing cataract. Combined phacovitrectomy eliminates the need for a second surgery.

Methods: Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were searched in May 2022 for all articles comparing combined versus sequential phacovitrectomy for MH and ERM. The primary outcome was mean best-corrected visual acuity (BCVA) at 12 months follow-up. Meta-analysis was conducted using a random effects model. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool for randomized controlled trials (RCTs) and Risk of Bias in Nonrandomized Studies of Interventions tool for observational studies (PROSPERO, registration number, CRD42021257452).

Results: Of the 6470 studies found, 2 RCTs and 8 nonrandomized retrospective comparative studies were identified. Total eyes for combined and sequential groups were 435 and 420, respectively. Meta-analysis suggested no significant difference between combined and sequential surgery for 12-month BCVA (combined = 0.38 logarithm of the minimum angle of resolution [logMAR]; sequential = 0.36 logMAR; mean difference = + 0.02 logMAR; 95% confidence interval = -0.04 to 0.08; P = 0.51; I² = 0%; n = 4 studies, 398 participants), as well as absolute refractive error (P = 0.76; I² = 97%; n = 4 studies, 289 participants), risk of myopia (P = 0.15; I² = 66%; n = 2 studies, 148 participants), MH nonclosure (P = 0.57; I² = 48%; n = 4 studies, 321 participants), cystoid macular edema (P = 0.15; I² = 0%; n = 6 studies, 526 participants), high-intraocular pressure (P = 0.09; I² = 0%; n = 2 studies, 161 participants), posterior capsule opacification (P = 0.46; I² = 0%; n = 2 studies, 161 participants), posterior capsule rupture (P = 0.41; I² = 0%; n = 5 studies, 455 participants), and retinal detachment (P = 0.67; I² = 0%; n = 6 studies, 545 participants).

Conclusion: No significant difference was detected between combined and sequential surgeries for visual outcomes, refractive outcomes, or complications. Given that most studies were retrospective and contained a high RoB, future high-quality RCTs are warranted.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Keywords: Cataract; Epiretinal membrane; Macular hole; Phacovitrectomy; Retina.