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Purpose: To estimate the rate of retinal detachment (RD) after acute retinal necrosis (ARN) and evaluate the efficacies of different interventions.Methods: The databases Medline and EMBASE from inception to March 2020 were searched to identify the relevant studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval were calculated using generalized linear mixed models.Results: Sixty-seven studies involving 1,811 patients were finally included. The pooling results suggested the general RD rate of ARN was 47%. The RD rate increased with the extent of retinitis and was slightly lower when involved Zone III. The RD rate was 37% for herpes simplex virus ARN and 46% for varicella-zoster virus ARN; 52% for immunocompetent patients and 39% for immunocompromised patients. Retinal detachment presented in 2% of eyes at the first visit. Systemic antiviral therapy could lower the RD rate significantly from 67% to 43%, and prophylactic vitrectomy could lower the RD rate significantly from 45% to 22%. Systemic antiviral therapy plus vitrectomy achieved the lowest RD rate to 18%. Although the efficacy of prophylactic laser or intravitreal antiviral therapy was still limited. Prophylactic vitrectomy might significantly increase the incidence of proliferative vitreoretinopathy from 7% to 32%.Conclusion: About half of the eyes might develop RD during the entire course of ARN. Systemic antiviral therapy and prophylactic vitrectomy are effective interventions to prevent RD, whereas the roles of prophylactic laser or adjunctive intravitreal antiviral therapy are still unclear. Varicella-zoster virus ARN and cases with extensive retinitis might need intensified interventions.

Currently, controversies regarding the optimal time-point of anti-vascular endothelial growth factor (VEGF) pretreatment before pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) still exist. To clarify this, we conducted a network meta-analysis, 26 randomized controlled trials including 1806 PDR patients were included. Compared with the sham group, performing anti-VEGF injection at preoperative (Pre-Op) 6 to 14 days could significantly improve post-operative best-corrected visual acuity (BCVA) and decrease the incidence of recurrent vitreous hemorrhage (VH). Meanwhile, it could significantly reduce the duration of surgery. Performing anti-VEGF injection at Pre-Op more than 14 days, 6 to 14 days or 1 to 5 days could significantly reduce the incidence of intra-operative bleeding, while no significant benefit existed at the end of PPV (P > 0.05). No significant difference existed between all those strategies and sham group in reducing the rate of silicone oil tamponade. Based on currently available evidence, performing the anti-VEGF pretreatment at pre-operative 6 to 14 days showed best efficacy in improving post-operative BCVA, reducing the duration of surgery and incidence of recurrent VH, it also achieves satisfactory effect in reducing the incidence of intra-operative bleeding.