Elucidating postoperative dynamics in tractional retinal detachment: a systematic review and meta-analysis of structural and functional outcomes following diabetic vitrectomy, including an analysis of postoperative complications.

Abstract

This meta-analysis aims to evaluate the efficacy and safety of diabetic vitrectomy for treating tractional retinal detachment (TRD) by assessing visual acuity improvements, retinal reattachment success rates, and the frequency of postoperative complications. A comprehensive literature search identified 1,211 studies, 30 of which met the inclusion criteria and were analyzed. The meta-analyses were conducted via random effects models to account for heterogeneity. The primary outcomes were visual acuity improvement and retinal reattachment success, whereas postoperative complications were analyzed as secondary outcomes. Funnel plots, trim-and-fill methods, and Egger's regression tests were employed to assess and adjust for publication bias. The meta-analysis included data from 1,844 eyes across 30 studies. The pooled mean difference (MD) in visual acuity following diabetic vitrectomy was 0.80 logMAR (95% CI: 0.58-1.01, p < 0.0001), with significant heterogeneity (I² = 95%). The trim-and-fill method adjusted the MD to 1.15 (95% CI: 0.85-1.45), indicating potential publication bias. The pooled proportion of retinal reattachment success was 94.63% (95% CI: 90.88-96.89%), with substantial heterogeneity (I² = 82.2%). Egger's regression test confirmed publication bias in the retinal reattachment data (t = 6.07, df = 25, p < 0.0001). The most common postoperative complications were vitreous hemorrhage (8.2%, 0-41%), elevated intraocular pressure (7.3%, 0-25%), and cataract formation (10.3%, 0-43%). Diabetic vitrectomy significantly improves visual acuity and achieves high retinal reattachment success rates in patients with TRD despite considerable heterogeneity across studies. However, a critical limitation of the current literature is the lack of comprehensive reporting of essential markers of perfusion, such as the choroidal vascularity index and choriocapillaris flow area, which are crucial for a thorough understanding of the impact of vitrectomy on ocular perfusion and its correlation with structural and functional outcomes. These findings also highlight the need for vigilant postoperative management to mitigate common complications. Adjustments for publication bias via the trim-and-fill method suggest that the initial estimates of efficacy may be optimistic, but the overall benefits of the procedure remain substantial. Further research is warranted to standardize surgical techniques, include detailed perfusion outcomes, and enhance the reliability of future meta-analyses. Trial registration: Retrospectively registered.