Risk factors of post-operative optic nerve injury after vitrectomy: a systematic review

Abstract

Background Vitrectomy is a common procedure used to treat various disorders in the back of the eye. Although it is generally considered safe and effective, there is a risk of complications, including optic nerve damage, which can lead to vision problems. The aim of this study is to determine risk factors of optic nerve injury after vitrectomy for various indications. Methods We conducted a systematic review through literature search via Cochrane, PubMed, Scopus, and Embase, as well as a hand search of relevant journals with the keywords: “(postoperative optic nerve injury) AND (vitrectomy) AND (risk factor)”. The inclusion criteria were: (1) patients with postoperative optic nerve injury after vitrectomy, (2) clinical trial, case-control, or cohort study, (3) analyzing risk factors of optic nerve injury after vitrectomy, (4) published in the last 15 years and conducted in English. For risk of bias assessment, we used the risk of bias (RoB) 2.0 for randomized controlled trials and the ROBINS-E tool for observational studies. Results Thirteen eligible studies were included in this study. We found that damage to the optic nerve can happen either during or after a vitrectomy procedure. This is linked to four main risk factors: removing the internal limiting membrane, having a lower average ocular perfusion pressure, using silicone oil as a tamponade agent, and using ICG as an ILM staining agent. Conclusions Removing the internal limiting membrane, having a lower average ocular perfusion pressure, using silicone oil as a tamponade agent, and using ICG as an ILM staining agent were associated with the occurrence of optic nerve injury following vitrectomy. Our study has limitations, including more retrospective studies than prospective ones and difficulties in combining and analyzing information from individual studies. Additionally, merging data from various studies is challenging due to differences in original research. PROSPERO registration CRD42023453533 (22/08/2023).