Efficacy and Safety of Pars Plana Vitrectomy for Primary Symptomatic Floaters: A Systematic Review with Meta-Analyses

Abstract

Introduction: This study aimed to determine the efficacy and safety of pars plana vitrectomy (PPV) as treatment for patients with primary symptomatic vitreous floaters. Methods: We searched 12 databases for studies performing PPV for primary symptomatic vitreous floaters with at least 3 months follow-up. Two authors reviewed the studies and extracted data. Our main outcome of interest was patient satisfaction/reduction of symptoms/quality of life, but other measures of efficacy and safety were also extracted. Where possible, metaanalyses were performed to provide summary estimates. Results: We identified 18 eligible studies, which included 2077 eyes of 1789 patients. Studies reported that at least 90% of the patients were satisfied or had relief of symptoms. Best corrected visual acuity improved -0.08 logMAR (95% CI -0.10 to -0.06 logMAR, P \ 0.0001). Contrast sensitivity improved -2.26% (95% CI -3.26 to -1.26%, P \ 0.0001). After surgery, cataract occurred in 31.7% (95% CI 21.7-42.7%), retinal tears/breaks in 2.92% (95% CI 1.38-4.97%), vitreous hemorrhage in 1.97% (95% CI 0.83-3.54%), macular edema in 1.70% (95% CI 0.84-2.83%), retinal detachment in 1.54% (95% CI 0.62-2.82%), glaucoma in 1.04% (95% CI 0.53-1.73%), and endophthalmitis in 0.18% (95% CI 0.02-0.45%). Conclusions: Postoperative patient satisfaction is high after PPV for primary symptomatic vitreous floaters. However, the patient should be carefully counselled as what to expect from the treatment and understand the risks associated with PPV.

Scientific Literature Database Coverage of Randomized Clinical Trials for Central Serous Chorioretinopathy

“…Conducting a systematic review requires a substantial amount of work, of which screening of records constitutes an important proportion of that work. In our personal experiences, screening of records from 10+ databases can take days and even weeks [ 2 , 3 , 4 ]. This work is typically performed by clinicians outside of their routine hours, pro bono, which further stresses the need to optimize the workload and avoid unnecessary tasks.…”

Dynamic Infrared Imaging of Vitreous Floaters

“…Historically, floaters have not been considered a significant problem meriting therapeutic intervention, primarily due to limited therapeutic options and because the diagnosis has been based on subjective patient self-evaluation. 2 However, advances in surgical techniques and instruments for pars plana vitrectomy have opened a therapeutic option for these patients 3 , and recent studies using different imaging tools to document vitreous opacities and quantitatively show their visual significance have been published. Schwartz et al 4 recognized a characteristic shadowing artifact on spectral-domain optical coherence tomography that was caused by prominent vitreous opacities, which they termed to a "floater scotoma".…”