Early versus Delayed Vitrectomy for Open Globe Injuries: A Systematic Review and Meta-Analysis

Figures & data

Table 1 PICO Criteria for the Inclusion of Studies

Parameter	Study selection criteria
Population	People of all ages with OGIs who underwent PPV.
Intervention	Early vitrectomy (within 7 days).
Comparator	Delayed vitrectomy (8–14 days).
Outcomes	Primary outcome (s): Anatomic outcome (retinal reattachment) and functional outcome (postoperative VA ≥ 5/200). Secondary outcome (s): Incidence of traumatic PVR and number of PPV surgeries needed.

Abbreviations: PICO, population, intervention, comparator, outcomes; OGIs, open globe injuries; PPV, pars plana vitrectomy; PVR, proliferative vitreoretinopathy; VA, visual acuity.

Figure 1 PRISMA flow chart outlining the article selection process.

Table 2 Characteristics of the Included Non Controlled Studies

S.N.	Author/Year	Country	Study design	Mean age ± SD (age range) years	No. of eyes analyzed early/delayed group	Type of Injury	Outcome measures
1	Coleman 1982^Citation7	US	Retrospective observational	NA	37/22	Traumatized open globe injuries	Improvement in VA
2	De Juan et al 1984^Citation8	US	Retrospective observational	NA	49/54	Penetrating	Visual outcome (Final VA)
3	Ramsay 1985^Citation16	US	Retrospective observational	5–13	6/4	Double penetrating (Perforating)	Anatomical, functional, and visual outcomes
4	Petrovic et al 2004^Citation22	Slovenia	Retrospective observational	29.5 (5–67)	29/14	Rupture Penetrating Perforating IOFB	BCVA, RD and PVR at final follow-up
5	Colyer et al 2008^Citation17	US	Retrospective observational	29 ± 10	3/4	Perforating	Final VA and rates of PVR
6	Ferreira et al 2015^Citation19	Portugal	Retrospective observational	42 (7–74)	12/6	Perforating	BCVA, rates of global survival and PVR and anatomical success
7	Lin et al 2016^Citation20	US	Retrospective observational	46.1 (18.3–90.7)	4/4	Rupture IOFB	Visual outcome (BCVA)
8	Yu et al 2019^Citation10	China	Retrospective observational	36.6±12.8 (10–69)	20/25	Rupture Penetrating Perforating	Functional success, anatomical success, and surgical failure
9	Chauhan et al 2022^Citation21	US	Retrospective observational	45.2 ± 19.1 (10–92)	39/35	Blunt Sharp IOFB Projectile	Functional and anatomical outcome

Abbreviations: BCVA, best-corrected visual acuity; IOFB, intraocular foreign body; NA, not applicable; PVR, proliferative vitreoretinopathy; RD, retinal detachment; SD, standard deviation; US, United States; VA, visual acuity.

Table 3 Characteristics of the Included Controlled Studies

S.N.	Author/Year	Country	Study design	Mean age ± SD (age range) years	No. of eyes analyzed early/delayed group	Type of Injury	Outcome measures
10	Zhang et al 2014^Citation18	China	Prospective cohort	NA	15/18	Open globe	Retinal reattachment, incidence of PVR, visual recovery and complications
11	He et al 2020^Citation9	China	Randomized comparative	46.7±11.4 (early group) 42.3±10.3 (delayed group)	21/25	Perforating Rupture	Development of PVR, rates of retinal reattachment, and eye enucleation

Abbreviations: NA, not applicable; PVR, proliferative vitreoretinopathy.

Table 4 Summary of the Results from the Included Studies

Study/Year	Outcome Measure	N1	Early (Within 7 Days)	N2	Delayed (8–14 Days)
Zhang et al 2014^Citation18	PVR development	15	1/15	18	12/18
	Retinal reattachment		14/15		12/18
	BCVA 5/200 or better
He et al 2020^Citation9	PVR development	21	3/21	25	10/25
	Retinal reattachment		17/21		15/25
	BCVA 5/200 or better		13		4
	> 1 vitrectomy		3		15
Coleman 1982^Citation7	PVR development	37		22
	Retinal reattachment
	BCVA 5/200 or better		30/37		14/22
De Juan et al 1984^Citation8	PVR development	43		21
	Retinal reattachment
	BCVA 5/200 or better		22/43		9/21
Ramsay et al 1985^Citation16	PVR development	6		4
	Retinal reattachment		5/6		1/4
	BCVA 5/200 or better
Petrovic et al 2004^Citation22	PVR development	29		14
	Retinal reattachment		27/29		12/14
	BCVA 5/200 or better
Colyer et al 2008^Citation17	PVR development	3	1/3	4	3/4
	Retinal reattachment
	BCVA 5/200 or better		2/3		2/4
	Final BCVA (mean SD)
Zhang et al 2014^Citation18	PVR development	15	1/15	18	12/18
	Retinal reattachment		14/15		12/18
	BCVA 5/200 or better
Ferreira et al 2015^Citation19	PVR development	12	1/12	6	1/6
	Retinal reattachment		11/12		4/6
	BCVA 5/200 or better		10/12		4/6
	> 1 vitrectomy		8/12		4/6
Lin et al 2016^Citation20	PVR development	4		4
	Retinal reattachment
	BCVA 5/200 or better		3/4		0/4
	> 1 vitrectomy		2		4
He et al 2020^Citation9	PVR development	21	3/21	25	10/25
	Retinal reattachment		17/21		15/25
	BCVA 5/200 or better		13		4
	> 1 vitrectomy		3		15
Yu et al 2019^Citation10	PVR development	20		25
	Retinal reattachment		20/20		25/25
	BCVA 5/200 or better		16/20		22/25
	> 1 vitrectomy		2		1
Chauhan et al 2022^Citation21	PVR development	39	2/39	35	10/35
	Retinal reattachment
	BCVA 5/200 or better

Abbreviations: BCVA, best-corrected visual acuity; PVR, proliferative vitreoretinopathy; SD, standard deviation.

Figure 2 The odds of retinal reattachment postvitrectomy were significantly greater in the early group than in the delayed group; ra+, retina reattached; ra-, retina not attached.

Figure 3 The odds of a visual acuity of 5/200 or better were 2.4x greater in the early group than in the delayed vitrectomy group.

Figure 4 Forest plots comparing the odds of proliferative vitreoretinopathy (PVR) in early and delayed intervention after ocular injury. The incidence of PVR was significantly greater in the delayed group.

Figure 5 Forest plots comparing the odds of more than one vitrectomy in patients who underwent early or delayed intervention after ocular injury. Patients who underwent delayed vitrectomy were more likely to require more than those who underwent vitrectomy only once.

Figure 6 (A) Risk of bias assessment of randomized controlled trials. Green indicates a low risk of bias, red indicates a high risk of bias, and yellow indicates an unknown risk of bias. (B). Risk of bias assessment of nonrandomized controlled trials. Green indicates a low risk of bias, red indicates a high risk of bias, and yellow indicates an unknown risk of bias.

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Data Sharing Statement

The datasets used in this study have been included in the main text. Photographs and figures from this study may be released via a written application to the Photographic Laboratory and Clinical Archives Retina Department at the Oftalmologia Integral ABC Medical and Surgical Assistance Institution (Nonprofit Organization), Av. Paseo de las Palmas 735 suite 303, Lomas de Chapultepec, Mexico City 11000, Mexico and the corresponding author upon request.