Anterior vitrectomy incidence in cataract surgery among experienced surgeons and residents: A systematic review and meta-analysis.

Abstract

PurposeCataract surgery is a fundamental procedure in ophthalmology, yet intraoperative complications such as anterior vitrectomy can compromise surgical outcomes. This systematic review and meta-analysis (CRD42025637001) aim to compare the incidence of anterior vitrectomy in cataract surgeries performed by ophthalmology residents versus experienced surgeons and assess factors contributing to surgical complications.MethodsA systematic search was conducted across EMBASE, MEDLINE, CINAHL Plus, Web of Science, ClinicalTrials.gov, PQDT Global, ARVO and AAO for studies published after 2000 that reported on anterior vitrectomy incidence in cataract surgery. Eligible studies included randomized controlled trials and observational studies. Meta-analysis was performed using STATA v. 18.0.ResultsOut of 1,190 screened studies, five studies (four retrospective cohort, one prospective cohort) involving phacoemulsification, extracapsular cataract extraction (ECCE), and femtosecond laser-assisted cataract surgery (FLACS) were included, encompassing a total of 4,918 cataract surgeries, and 208 anterior vitrectomy (AV) cases. The random-effects meta-analysis demonstrated a significant AV incidence for residents (ES = 0.04, 95% CI: [0.01, 0.06]), while the incidence for experienced surgeons was not statistically significant (ES = 0.03, 95% CI: [-0.03, 0.09]). High heterogeneity was observed among the included studies (I² = 92.1% for residents and I² = 96.7% for surgeons).ConclusionResidents may have a higher incidence of AV, highlighting the potential benefits of structured surgical training, early exposure, and mentorship in reducing intraoperative complications. Future research should explore simulation-based training and technology-assisted surgery to improve resident proficiency and patient outcomes.