Pars Plana Vitrectomy Versus Anterior Vitrectomy in Scleral‐Fixated Intraocular Lenses Implantation: A Systematic Review and Meta‐Analysis

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BACKGROUND: To compare complication risks and visual outcomes between pars plana vitrectomy (PPV) and anterior vitrectomy (AV) in scleral-fixated intraocular lens (SFIOL) implantation. METHODS: We searched PubMed, MEDLINE, Scopus, EMBASE, the Cochrane Library and Google Scholar. Primary outcomes included postoperative complications-retinal detachment (RD), vitreous prolapse, cystoid macular edema (CME), elevated intraocular pressure (IOP), vitreous Haemorrhage and intraocular lens (IOL) capture-and changes in best-corrected visual acuity (BCVA). We performed random-effects meta-analyses and assessed certainty of evidence using the GRADE framework. RESULTS: We included five studies comprising 522 eyes. PPV was associated with lower odds of retinal detachment (RD) (OR = 0.11, 95% CI: 0.02-0.57, p < 0.01) and vitreous prolapse (OR = 0.10, 95% CI: 0.02-0.60, p < 0.01) compared with AV; however, no events occurred in the PPV arm for both outcomes. The two groups did not differ significantly in the risks of CME, elevated IOP, or vitreous haemorrhage. PPV was associated with a higher risk of IOL capture (OR = 3.12, 95% CI: 1.30-7.46, p < 0.01) and postoperative BCVA improvement was comparable (MD = -0.05, 95% CI: -0.12 to 0.02). GRADE certainty was very low to low. CONCLUSIONS: PPV may be associated with a reduced risk of retinal detachment and vitreous prolapse, but increased risk of IOL capture compared with AV in SFIOL implantation, with comparable visual outcomes. Given the lower certainty of evidence for most outcomes, surgeons should interpret these findings in the context of their surgical expertise and individual patient characteristics.

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