Transconjunctival sutureless vitrectomy versus 20-gauge vitrectomy for vitreoretinal surgery: a meta-analysis of randomized controlled trials.

摘要

Transconjunctival sutureless vitrectomy is appealing to vitreoretinal surgeons around the world. However, its use versus 20-gauge vitreoretinal surgery is still controversial. The aim of this meta-analysis was to compare the safety and functional outcomes of transconjunctival sutureless vitrectomy versus 20-gauge vitrectomy for vitreoretinal surgery.Data sources, including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register, were searched to identify potentially relevant randomized controlled trials. A meta-analysis was performed using RevMan 5.0 software. The primary factors included patients' discomfort, operating time and early postoperative complications. Visual acuity and surgically induced astigmatism were chosen as secondary outcomes.A total of 471 participants with 479 eyes in eight trials between 2005 and 2011 were analyzed. Transconjunctival sutureless vitrectomy was associated with significantly fewer patients suffering from postoperative discomfort at 1 day (odds ratio [OR] 0.07; 95 % confidence interval [CI] 0.01 to 0.49; p = 0.007) and 7 days (OR 0.14; 95 % CI 0.03 to 0.73; p = 0.02) follow-up, and was more effective in reducing surgically induced astigmatism (mean difference -0.23D; 95 % CI -0.31 to -0.15; p < 0.00001) compared to 20-gauge vitrectomy. The sutureless group achieved shorter wound opening (mean difference -1.97 minutes; 95 % CI -2.69 to -1.25; p < 0.00001) as well as wound closure time (mean difference -4.55 minutes; 95 % CI -5.43 to -3.66; p < 0.00001), but the overall surgery time was comparable (mean difference -0.14 minutes; 95 % CI -3.52 to 3.24; p = 0.93). There were no significant differences in the complication rates between the two groups with the exception of postoperative hypotony, which was more likely with the sutureless group (OR 3.73; 95 % CI 1.43 to 9.76; p = 0.007).According to the present data, transconjunctival sutureless vitrectomy offered significantly less postoperative discomfort and decreased surgically induced astigmatism without increasing the risk of vision-threatening complications. Further trials with contemporary equipment and larger sample size are suggested to confirm this conclusion.