Título

SURGICAL MANAGEMENT OF RETINAL DETACHMENT AND MACULAR HOLES SECONDARY TO OCULAR TOXOPLASMOSIS: A META-ANALYSIS

Objetivo

Toxoplasma gondii causes ocular toxoplasmosis (OT), involving retinal complications. Limited understanding exists of the safety and efficacy of surgical management of Retinal Detachment (RD)/Retinal Breakes (RB) secondary to OT, and toxoplasmosis-related macular holes (tMH). Surgical interventions like scleral buckling (SB) and vitrectomy are common. This meta-analysis aims to clarify clinical characteristics, and surgical results, and enhance understanding of RD, RB, and MH secondary to OT.

Método

PubMed, Cochrane, Embase and Web of Science database were queried for retrospective studies, case series and case reports that provided information on RD, RB and MH associated with OT and reported the outcomes of: (1) Retinal reattachment of RD/RB and tMH closure; (2) Best-corrected visual acuity (BCVA) improvement; and (3) Complications. Heterogeneity was examined with I 2 statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was performed using the software R (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria).

Resultado

Fourteen final studies, comprising a total of 96 patients were analyzed, 81 with RD or RB and 15 with tMH. Overall, surgical management was associated with several advantages: a high rate of retinal reattachment of RD/ RB of 97% (95% Confidence Interval [CI] 92–100%; I 2=0%), retinal reattachment of just RD of 96% (95% CI 89–100%; I 2=30%) and tMH closure 97% (95% CI 87–100; I 2=12%). There were significant differences in BCVA after surgeries in studies of RD/RB (MD 0.60; 95% CI 0.35–0.65; I 2=20%) and MH (MD 0.67; 95% CI 0.50–0.84; I 2=0%). The overall complication rate associated with surgical procedures in RD/RB secondary to OT was confirmed to be 25%.

Conclusão

The meta-analysis showed that the treatment approaches currently in use are effective, with a a remarkable rate of retinal reattachment of RD/RB, tMH closure, and substancial improvements in visual accuity.