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Abhinav R Bheemidi, Vivian D Roan, Justin Muste, Rishi P Singh; Examining the Necessity of Day-1 Postoperative Review After Pars Plana Vitrectomy: A Meta-Analysis. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1705.
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The current standard of care following retina surgery, particularly pars plana vitrectomy (PPV), is an in-person evaluation conducted on postoperative day 1 (POD1). Given the inherent difficulty of patients with visual disability attending POD1 visits and the safety concerns raised during the COVID-19 pandemic, a critical examination of this standard of care is needed. This study is a meta-analysis that aims to evaluate the necessity of the POD1 review following PPV.
The analysis included available literature documenting medical and surgical interventions performed on POD1 review following PPV. 2262 patients across 14 eligible studies were included in the analysis. A meta-analysis of proportions was conducted using a binomial-normal model to analyze datasets consisting of all interventions, medical interventions, and surgical interventions. The primary outcome measured was the proportion of patients requiring an intervention on POD1. Heterogeneity and publication bias analyses were performed. Statistical analyses were performed using R (version 3.5.1).
Of the 80 references identified as being of potential relevance, 14 studies met all eligibility criteria. POD1 reviews of 2262 patients were analyzed to yield an intervention rate estimate of 4.7% [95% CI 3.0-13.9]. The proportion of patients requiring medical interventions (4.1% [95% CI 1.4-11.6]) was significantly greater than that of surgical interventions (0.7% [95% CI 0.3-1.3]). Elevated intraocular pressure was the most frequent POD1 complication, accounting for 77.0% and 40.0% of medical and surgical interventions respectively. The heterogeneity analysis revealed significant inter-study variation, with I2 values of 97.93%, 97.80%, and 20.99% for the all intervention, medical intervention and surgical intervention datasets respectively. Attempts to integrate the different indications for surgery into this analysis were unsuccessful due to variability in reporting of indications and interventions.
Given the wide confidence interval of the estimated intervention rate, variability in postoperative practices, and range of interventions performed, the POD1 review cannot be discarded. Future analyses could identify clinical characteristics associated with patients at a higher risk of requiring POD1 intervention.
This is a 2021 ARVO Annual Meeting abstract.
Figure 1: PRISMA Flow Diagram
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