Surgery for post‐vitrectomy cataract
Abstract
Background
Cataract formation or acceleration can occur after intraocular surgery, especially following vitrectomy, a surgical technique for removing the vitreous which is used in the treatment of disorders that affect the posterior segment of the eye. The underlying problem that led to vitrectomy may limit the benefit from cataract surgery.
Objectives
The objective of this review was to evaluate the effectiveness and safety of surgery for post‐vitrectomy cataract with respect to visual acuity, quality of life, and other outcomes.
Search methods
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 4), Ovid MEDLINE, Ovid MEDLINE in‐Process and Other Non‐Indexed Citations, Ovid MEDLINE Daily Update, Ovid OLDMEDLINE (January 1946 to May 2013), EMBASE (January 1980 to May 2013, Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2013), PubMed (January 1946 to May 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled‐trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 22 May 2013.
Selection criteria
We planned to include randomized and quasi‐randomized controlled trials comparing cataract surgery with no surgery in adult patients who developed cataract following vitrectomy.
Data collection and analysis
Two authors screened the search results independently according to the standard methodological procedures expected by The Cochrane Collaboration.
Main results
We found no randomized or quasi‐randomized controlled trials comparing cataract surgery with no cataract surgery for patients who developed cataracts following vitrectomy surgery.
Authors' conclusions
There is no evidence from randomized or quasi‐randomized controlled trials on which to base clinical recommendations for surgery for post‐vitrectomy cataract. There is a clear need for randomized controlled trials to address this evidence gap. Such trials should stratify participants by their age, the retinal disorder leading to vitrectomy, and the status of the underlying disease process in the contralateral eye. Outcomes assessed in such trials may include gain of vision on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, quality of life, and adverse events such as posterior capsular rupture. Both short‐term (six‐month) and long‐term (one‐year or two‐year) outcomes should be examined.
PICOs
Plain language summary
Surgery to remove cataracts after vitrectomy
Review question
We reviewed the evidence about the effect of surgery to remove cataracts (cloudy lens in front of the eye) in people who develop cataracts after vitrectomy, a surgery to remove the vitreous (the clear gel) in the center of the eye.
Background
Vitrectomy, a procedure performed for disorders that affect the back part of the eye, can result in the formation or acceleration of cataract. The underlying problem that led to vitrectomy may limit the benefits from cataract surgery.
Results
We found no randomized controlled trials (trials in which participants are randomly assigned to one treatment group or another) that evaluated the benefits or risks (or both) of cataract surgery following vitrectomy. Since cataract surgery may lead to loss of vision due to worsening or recurrence of the condition that prompted the vitrectomy, its role in these patients remains uncertain. Future trials to address this review question should separate participants by age, the disorder leading to vitrectomy, and the status of the underlying disease process in the opposite eye. Outcomes relevant to patients such as improvement of vision and quality of life, and harms should be examined both in the short term (six months after surgery) and in the long term (one to two years after surgery).
