title: Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the effect of vitrectomy timing on outcomes for patients with crystalline retained lens fragments receiving vitrectomy 3+ days after cataract surgery.
  
  
  METHODS
  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: 1.02-1.26, 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.
  
  
  CONCLUSIONS
  This systematic review and meta-analysis found significantly better outcomes (visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation) with earlier vitrectomy for retained lens fragments. Reduced vitrectomy delays may yield better patient outcomes.
authors.affiliation: Department of Preventive Medicine and Health Care Policy & Management, Health Sciences Center, Stony Brook University, Stony Brook, New York. Electronic address: evanner@notes.cc.sunysb.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Vanner
authors.affiliation: Department of Ophthalmology, Mayo Clinic College of Medicine, Jacksonville, Florida.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Stewart
mesh_terms: D000375:Aging / Q000502:physiology*; D002386:Cataract / Q000503:physiopathology*; D002387:Cataract Extraction / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D007906:Lens Subluxation / Q000209:etiology / Q000601:surgery*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy