Muhammad Alfatih , Ananda Kukuh Adishabri , Ni Luh Putu Yunia Dewi , Alfiani Zukhruful Fitri Rifa'i , Michaela Kemuning , Dillan Cunha Amaral , Bruno Fortaleza de Aquino Ferreira , Ricardo Noguera Louzada , Ari Djatikusumo , Hashem Abu Serhan
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This study aims to systematically evaluate the proportion of eyes showing the best-corrected visual acuity (BCVA) improvement and final BCVA ≥ 20/200 after vitrectomy for PTE and to investigate potential determinants of outcome using meta-regression.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>We conducted a meta-analysis following the PRISMA guidelines and registered the protocol in PROSPERO (CRD42024606195). Eligible studies included ≥80 % of participants undergoing vitrectomy for PTE. The prespecified primary outcome was the proportion with any BCVA improvement; final BCVA ≥20/200 at last follow-up was assessed as an additional outcome. Random-effects meta-analysis was performed, and subgroup and meta-regression analyses were used to explore outcome modifiers. Certainty of evidence was assessed using GRADE.</div></div><div><h3>Results</h3><div>Nine studies (<em>n</em> = 448 eyes) were included. The pooled proportion of eyes with any BCVA improvement was 0.80 (95 % CI 0.63–0.90; I² = 90 %), significantly higher in adults (≥18 years; 0.91) than in children/adolescents (<18 years; 0.65; <em>p</em> < 0.01). Meta-regression suggested higher silicone-oil use and IOFB proportion correlated with BCVA improvement (<em>p</em> = 0.027; <em>p</em> = 0.017), while corneal-entry and baseline retinal detachment were not associated. The proportion achieving final BCVA ≥20/200 was 0.33 (95 % CI 0.23–0.45; I²=67.9 %) with no age difference (<em>p</em> = 0.45). Certainty was low to very low.</div></div><div><h3>Conclusion</h3><div>Vitrectomy for PTE often yielded visual improvement, particularly in adults, while ambulatory vision (≥20/200) was less common. Given the single-arm meta-analysis, substantial heterogeneity, and low-certainty ratings, these estimates should be interpreted cautiously. Multicenter randomized trials are needed to verify these findings and to evaluate the potential role of silicone-oil tamponade.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100174"},"PeriodicalIF":0.0000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Proportion of eyes with visual-acuity improvement after vitrectomy for post-traumatic endophthalmitis: A meta-analysis\",\"authors\":\"Muhammad Alfatih , Ananda Kukuh Adishabri , Ni Luh Putu Yunia Dewi , Alfiani Zukhruful Fitri Rifa'i , Michaela Kemuning , Dillan Cunha Amaral , Bruno Fortaleza de Aquino Ferreira , Ricardo Noguera Louzada , Ari Djatikusumo , Hashem Abu Serhan\",\"doi\":\"10.1016/j.ajoint.2025.100174\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>Post-traumatic endophthalmitis (PTE) is a leading cause of irreversible vision loss after ocular trauma; despite widespread vitrectomy, outcomes vary and predictors remain unclear. This study aims to systematically evaluate the proportion of eyes showing the best-corrected visual acuity (BCVA) improvement and final BCVA ≥ 20/200 after vitrectomy for PTE and to investigate potential determinants of outcome using meta-regression.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>We conducted a meta-analysis following the PRISMA guidelines and registered the protocol in PROSPERO (CRD42024606195). Eligible studies included ≥80 % of participants undergoing vitrectomy for PTE. The prespecified primary outcome was the proportion with any BCVA improvement; final BCVA ≥20/200 at last follow-up was assessed as an additional outcome. Random-effects meta-analysis was performed, and subgroup and meta-regression analyses were used to explore outcome modifiers. Certainty of evidence was assessed using GRADE.</div></div><div><h3>Results</h3><div>Nine studies (<em>n</em> = 448 eyes) were included. The pooled proportion of eyes with any BCVA improvement was 0.80 (95 % CI 0.63–0.90; I² = 90 %), significantly higher in adults (≥18 years; 0.91) than in children/adolescents (<18 years; 0.65; <em>p</em> < 0.01). Meta-regression suggested higher silicone-oil use and IOFB proportion correlated with BCVA improvement (<em>p</em> = 0.027; <em>p</em> = 0.017), while corneal-entry and baseline retinal detachment were not associated. The proportion achieving final BCVA ≥20/200 was 0.33 (95 % CI 0.23–0.45; I²=67.9 %) with no age difference (<em>p</em> = 0.45). Certainty was low to very low.</div></div><div><h3>Conclusion</h3><div>Vitrectomy for PTE often yielded visual improvement, particularly in adults, while ambulatory vision (≥20/200) was less common. Given the single-arm meta-analysis, substantial heterogeneity, and low-certainty ratings, these estimates should be interpreted cautiously. Multicenter randomized trials are needed to verify these findings and to evaluate the potential role of silicone-oil tamponade.</div></div>\",\"PeriodicalId\":100071,\"journal\":{\"name\":\"AJO International\",\"volume\":\"2 4\",\"pages\":\"Article 100174\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"AJO International\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2950253525000784\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"AJO International","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2950253525000784","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的创伤后眼内炎（PTE）是眼外伤后不可逆性视力丧失的主要原因；尽管玻璃体切除术广泛应用，但结果各不相同，预测因素仍不清楚。本研究旨在系统评估PTE玻璃体切除术后最佳矫正视力（BCVA）改善和最终BCVA≥20/200的眼睛比例，并利用meta回归研究结果的潜在决定因素。设计系统回顾和荟萃分析。方法按照PRISMA指南进行meta分析，并在PROSPERO注册该方案（CRD42024606195）。符合条件的研究包括≥80%因PTE接受玻璃体切除术的参与者。预先指定的主要结局是BCVA改善的比例；最后随访时的最终BCVA≥20/200作为附加结果进行评估。进行随机效应荟萃分析，并使用亚组和荟萃回归分析来探索结果修饰因子。使用GRADE评估证据的确定性。结果纳入9项研究（n = 448只眼）。BCVA改善的眼睛总比例为0.80 (95% CI 0.63-0.90; I²= 90%)，成人（≥18岁；0.91）显著高于儿童/青少年（18岁；0.65;p < 0.01）。meta回归显示，较高的硅油用量和IOFB比例与BCVA改善相关（p = 0.027; p = 0.017），而角膜进入和基线视网膜脱离无关。最终BCVA≥20/200的比例为0.33 (95% CI 0.23-0.45; I²= 67.9%)，无年龄差异（p = 0.45）。确定性从低到非常低。结论玻璃体切除术治疗PTE通常能改善视力，尤其是成人，而移动视力（≥20/200）较少见。考虑到单臂荟萃分析、大量异质性和低确定性评级，这些估计应谨慎解释。需要多中心随机试验来验证这些发现，并评估硅油填塞的潜在作用。
Proportion of eyes with visual-acuity improvement after vitrectomy for post-traumatic endophthalmitis: A meta-analysis
Purpose
Post-traumatic endophthalmitis (PTE) is a leading cause of irreversible vision loss after ocular trauma; despite widespread vitrectomy, outcomes vary and predictors remain unclear. This study aims to systematically evaluate the proportion of eyes showing the best-corrected visual acuity (BCVA) improvement and final BCVA ≥ 20/200 after vitrectomy for PTE and to investigate potential determinants of outcome using meta-regression.
Design
A systematic review and meta-analysis.
Methods
We conducted a meta-analysis following the PRISMA guidelines and registered the protocol in PROSPERO (CRD42024606195). Eligible studies included ≥80 % of participants undergoing vitrectomy for PTE. The prespecified primary outcome was the proportion with any BCVA improvement; final BCVA ≥20/200 at last follow-up was assessed as an additional outcome. Random-effects meta-analysis was performed, and subgroup and meta-regression analyses were used to explore outcome modifiers. Certainty of evidence was assessed using GRADE.
Results
Nine studies (n = 448 eyes) were included. The pooled proportion of eyes with any BCVA improvement was 0.80 (95 % CI 0.63–0.90; I² = 90 %), significantly higher in adults (≥18 years; 0.91) than in children/adolescents (<18 years; 0.65; p < 0.01). Meta-regression suggested higher silicone-oil use and IOFB proportion correlated with BCVA improvement (p = 0.027; p = 0.017), while corneal-entry and baseline retinal detachment were not associated. The proportion achieving final BCVA ≥20/200 was 0.33 (95 % CI 0.23–0.45; I²=67.9 %) with no age difference (p = 0.45). Certainty was low to very low.
Conclusion
Vitrectomy for PTE often yielded visual improvement, particularly in adults, while ambulatory vision (≥20/200) was less common. Given the single-arm meta-analysis, substantial heterogeneity, and low-certainty ratings, these estimates should be interpreted cautiously. Multicenter randomized trials are needed to verify these findings and to evaluate the potential role of silicone-oil tamponade.
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