Retinal Detachment Risk Comparing Anterior Versus Pars Plana Vitrectomy For Scleral-Fixated Intraocular Lenses: A Systematic Review And Dual-Method Meta-Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: FP03.06 | Type: Free paper | DOI: 10.82333/v8h9-7c32
Authors: Dr Carlos Eduardo de Menezes Souza Filho* 1 , Dr GIULIA VALLE 2 , Dr MARIANA ZINHER 3 , Dr MATEUS ARRUDA 4 , Dr LARISSA BARBOSA 5 , Dr ANDRES GONZALEZ 6 , Dr RIAN LIMA 7 , Dr ANDRÉ PEREIRA 1
1Ophthalmology Division,Santa Casa de Misericórdia de Belo Horizonte,Belo Horizonte,Brazil, 2Ophthalmology,Hospital de Olhos do Paraná,Curitiba,Brazil, 3Ophthalmology Division,Hospital de Clínica Universidade Federal do Paraná,Curitiba,Brazil, 4Ophthalmology Division,Universidade Federal de São Paulo,São Paulo,Brazil, 5Health Science Center, Faculdade Santa Marcelina,São Paulo,Brazil, 6Fundación Nacional Oftalmológica,Bogotá,Colombia, 7Health Science Center, Universidade de Fortaleza,Fortaleza,Brazil
Purpose
This systematic review and meta-analysis aims to provide a comprehensive evaluation comparing the post operative complications of retinal detachment (RD) after performing anterior vitrectomy (AV) or pars plana vitrectomy (PPV) during scleral fixation (SF) of intraocular lenses (IOL).
Setting
PRISMA-compliant systematic review and dual-framework (Frequentist and Bayesian) meta-analysis of comparative studies assessing anterior versus pars plana vitrectomy in scleral-fixated IOL surgery.
Methods
A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 1973 and March 2025. Eligible studies included patients undergoing any form of SF-IOL implantation, comparing AV versus PPV. The primary outcome was post operative retinal detachment (RD). A Random-effects meta-analysis using Mantel-Haenszel (MH) under the Frequentist framework was performed (odds ratio [OR] with 95% confidence intervals [CI]). Given the small number of studies and low event rates, Bayesian meta-analysis was also conducted, reporting 95% credible intervals (CrI), posterior distributions probabilities and Bayes Factors (BF). Sensitivity and subgroup analyses were also conducted using R (v4.4.1).
Results
Nine studies (N = 1034 eyes) were included. Mean follow-up was 11.8 months in the PPV group and 13.2 months in the AV group. Yamane’s sutureless flanged haptic scleral fixation (FHSF) was used in 4 studies (N = 429 eyes), and 10-0 Prolene suture fixation (SSF) in 5 studies (N = 605 eyes). No eligible studies using Gore-Tex or Prolene flanged techniques were identified. Eight studies were retrospective; one was prospective. For the outcome of RD, sensitivity analysis yielded an OR of 0.34 (95% CI: 0.10–1.12; p = 0.075; I² = 0%). Bayesian analysis indicated a 93% posterior probability that PPV reduces RD risk compared to AV (OR = 0.40; 95% CrI = 0.12; 1.32). The Bayes Factor (BF₁₀ = 1.27) suggests weak evidence in favor of PPV.
Conclusions
In standard frequentist analysis, PPV did not demonstrate a statistically significant reduction in RD compared with AV. However, the limited number and predominantly retrospective design of available studies weaken the overall strength of evidence. In contrast, Bayesian modelling showed a high posterior probability of benefit, suggesting that PPV may reduce the risk of RD. Unquestionably further high-quality comparative studies are needed to guide clinical decision-making on vitreous management in SF-IOL surgery.