Ahmed Bakr, Marwan Tahoun, Maher Nassor, Usman Muhammad
Vitreoretinal surgery for XLRS-related complications can achieve favorable final anatomical outcomes in most cases, although multiple procedures are frequently required and visual recovery is variable and often modest. Anatomical success does not guarantee functional recovery, underscoring the importance of realistic prognostic counseling. These findings should be interpreted with caution, given that all included studies are small, observational case series with significant clinical heterogeneity. Standardized, prospective, multicenter studies are needed to optimize surgical strategies in this population.
PURPOSE: To systematically review and meta-analyze the outcomes of vitreoretinal surgery for X-linked retinoschisis (XLRS)-related complications.
METHODS: A systematic search of PubMed, Cochrane Library, CINAHL, Web of Science, and OVID was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Studies reporting surgical outcomes in patients with XLRS-associated retinal detachment or schisis were included. Primary outcomes were anatomic success (primary and final reattachment rates) and best-corrected visual acuity (BCVA). Random-effects meta-analysis was performed using RevMan. Subgroup analyses by surgical approach and age group were prespecified, and their feasibility was assessed according to the number of contributing studies.
RESULTS: Fourteen studies comprising over 200 eyes were included. The pooled primary reattachment rate was 0.73 (95% confidence interval [CI]: 0.46-0.99; I 2 = 83%), reflecting substantial heterogeneity across cohorts; formal subgroup analyses were not feasible given the small number of contributing studies. The pooled final reattachment rate was 0.89 (95% CI: 0.84-0.94; I 2 = 0%). Reoperation was frequently required, with rates of 20%-40% across series, predominantly due to proliferative vitreoretinopathy. Visual outcomes are reported narratively; approximately 50%-80% of eyes demonstrated BCVA improvement, although recovery was often limited by preexisting macular pathology, chronic disease, and amblyopia.
CONCLUSIONS: Vitreoretinal surgery for XLRS-related complications can achieve favorable final anatomical outcomes in most cases, although multiple procedures are frequently required and visual recovery is variable and often modest. Anatomical success does not guarantee functional recovery, underscoring the importance of realistic prognostic counseling. These findings should be interpreted with caution, given that all included studies are small, observational case series with significant clinical heterogeneity. Standardized, prospective, multicenter studies are needed to optimize surgical strategies in this population.