Abstract
BackgroundProliferative vitreoretinopathy (PVR) is a known complication of retinal detachment surgery. It has been postulated that the establishment of PVR involves inflammatory and ischaemic processes. Surgical and clinical risk factors contribute to making certain patients more vulnerable to developing PVR.The objective of this systematic review is to identify and appraise the evidence on clinical and surgical risk factors and their utility in predicting the occurrence or worsening of PVR post-surgery.MethodsElectronic databases and grey literature will be searched dating from 1980. Studies will be eligible if they include patients that underwent retinal reattachment surgery for rhegmatogenous retinal detachment (RRD), with and without PVR, and where risk factors were measured before or during surgery. Screening, data extraction and quality assessment will be performed independently by two reviewers using pre-defined criteria. Should any models be identified, we will liaise with the Cochrane prognostic group to help define the most appropriate quality assessment criteria based on the PROBLAST tool which is in development. All findings will be tabulated and narratively synthesised. Studies presenting models or adjusted data will likely be more informative than studies reporting unadjusted results for a single risk factor. When clinically and methodologically appropriate, random effects meta-analysis will be performed.DiscussionThis review will systematically and comprehensively retrieve evidence to evaluate the clinical and surgical risk factors associated with PVR. The identified evidence may aid standardisation of clinical practice and more effective management for improving patient outcomes following RRD surgery and will provide a clear reference point for vitreoretinal surgeons.Systematic review registrationPROSPERO CRD42016035848Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0284-7) contains supplementary material, which is available to authorized users.
Highlights
MethodsElectronic databases and grey literature will be searched dating from 1980
Proliferative vitreoretinopathy (PVR) is a known complication of retinal detachment surgery
Retinal pigment epithelial (RPE) cells go through the epithelial-mesenchymal transition to form fibroblast-like cells that significantly contribute to scar formation by extracellular matrix (ECM) production in the retina and PVR
Summary
Study criteria Type Any studies are included where the prognostic factor is measured in advance of the outcome. Studies are eligible if they include patients that underwent retinal reattachment surgery for RRD, with and without PVR. Studies reporting any prognostic models including relevant risk factors will be included. Participants In all included studies, the population will consist of a cohort of patients that underwent retinal reattachment surgery for RRD and were followed up to determine whether PVR developed post-operatively or whether established PVR worsened. Studies are eligible if risk factors were recorded using clinical information collected before and during the surgical intervention. Exclusion criteria for the study Patient characteristics and features of retinal detachments Method of retinal reattachment surgery and related procedures Clinical risk factors investigated and method of detection/quantification Ascertainment of post-surgical PVR and length of follow-up Methods of analysis, including statistical tests and methods of variable selection, resultant regression equations and adjusted versus unadjusted results.
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