Adjunctive dexamethasone implant during vitrectomy with silicone oil for diabetic tractional retinal detachment: a systematic review and exploratory meta-analysis
6 affiliations
- 1CMH Multan Institute of Medical Sciences
- 2Jinnah Sindh Medical University
- 3Services Institute of Medical Sciences
- 4Liaquat University of Medical and Health Sciences
- 5Sargodha Medical College
- 6Department of Curative Medicine, Faculty of Medicine, Kateb University
Abstract
Background Diabetic tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy is a vision-threatening complication that may require pars plana vitrectomy in selected cases, particularly when the macula is threatened or detached. Silicone oil tamponade is commonly used in complex cases, although tamponade choice varies according to surgical findings and surgeon preference. Objectives To evaluate surgical outcomes associated with adjunctive dexamethasone implant during pars plana vitrectomy with silicone oil or heavy silicone oil tamponade for diabetic tractional retinal detachment. Methods A comprehensive literature search of PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed from inception through 2025. Randomized and non-randomized comparative studies assessing PPV with silicone oil with or without adjunctive dexamethasone implant were considered. Definitions of postoperative PVR and retinal redetachment were accepted as reported by the original studies; no individual-level imaging or independent photographic regrading was available. The anatomical outcome was an exploratory composite of study-reported postoperative proliferative vitreoretinopathy (PVR) and/or retinal redetachment outcomes. Because definitions and follow-up time points differed across studies, this outcome was not treated as a uniformly graded PVR endpoint. Randomized and non-randomized comparative studies were identified; randomized trials were prioritized for the main analysis, while the non-randomized study was considered separately because of serious risk of bias. Secondary outcomes included best-corrected visual acuity (BCVA), central subfield thickness (CST), ocular hypertension, and postoperative complications. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD420261283105) prior to the commencement of the review. Results Four studies involving 305 eyes were included. In the main randomized-trial analysis, two studies comprising 123 eyes contributed to the exploratory study-reported postoperative proliferative/redetachment composite. The pooled estimate was highly imprecise (RR 0.20, 95% CI 0.00 to 16.06; I² = 0%) and did not provide conclusive evidence of benefit. In an exploratory sensitivity analysis including the non-randomized study, the estimate favored dexamethasone implant, but this analysis was subject to serious risk of bias. BCVA and CST findings were limited by small sample sizes, heterogeneity, and inconsistent reporting. Intraocular-pressure outcomes were not pooled because definitions and assessment time points differed across studies. Conclusion Current evidence is insufficient to support routine adjunctive dexamethasone implant use during vitrectomy with silicone oil for diabetic tractional retinal detachment. The available studies provide only a hypothesis-generating signal of fewer study-reported postoperative proliferative or redetachment events. Use should remain selective and individualized until adequately powered randomized trials with standardized anatomical outcomes are available. Clinical trials number Not applicable.
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BibTeX
@article{qureshi2026adjunctive,
title = {{Adjunctive dexamethasone implant during vitrectomy with silicone oil for diabetic tractional retinal detachment: a systematic review and exploratory meta-analysis}},
author = {Ahmar Jan Qureshi and Ali Shan Hafeez and Hamna Hassan Siddiqui and Ahsab Zaka and Muhammad Riyyan Tariq Tagga and Tooba Munir and Eashel Farooq and Muhammad Bilal and Atiqullah Sadaqat},
journal = {International Journal of Retina and Vitreous},
year = {2026},
month = jul,
doi = {10.1186/s40942-026-00903-5},
url = {https://doi.org/10.1186/s40942-026-00903-5},
note = {CC BY},
}
RIS
TY - JOUR
TI - Adjunctive dexamethasone implant during vitrectomy with silicone oil for diabetic tractional retinal detachment: a systematic review and exploratory meta-analysis
AU - Ahmar Jan Qureshi
AU - Ali Shan Hafeez
AU - Hamna Hassan Siddiqui
AU - Ahsab Zaka
AU - Muhammad Riyyan Tariq Tagga
AU - Tooba Munir
AU - Eashel Farooq
AU - Muhammad Bilal
AU - Atiqullah Sadaqat
PY - 2026
DA - 2026/07/01
JO - International Journal of Retina and Vitreous
DO - 10.1186/s40942-026-00903-5
UR - https://doi.org/10.1186/s40942-026-00903-5
AB - Background Diabetic tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy is a vision-threatening complication that may require pars plana vitrectomy in selected cases, particularly when the macula is threatened or detached. Silicone oil tamponade is commonly used in complex cases, although tamponade choice varies according to surgical findings and surgeon preference. Objectives To evaluate surgical outcomes associated with adjunctive dexamethasone implant during pars plana vitrectomy with silicone oil or heavy silicone oil tamponade for diabetic tractional retinal detachment. Methods A comprehensive literature search of PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed from inception through 2025. Randomized and non-randomized comparative studies assessing PPV with silicone oil with or without adjunctive dexamethasone implant were considered. Definitions of postoperative PVR and retinal redetachment were accepted as reported by the original studies; no individual-level imaging or independent photographic regrading was available. The anatomical outcome was an exploratory composite of study-reported postoperative proliferative vitreoretinopathy (PVR) and/or retinal redetachment outcomes. Because definitions and follow-up time points differed across studies, this outcome was not treated as a uniformly graded PVR endpoint. Randomized and non-randomized comparative studies were identified; randomized trials were prioritized for the main analysis, while the non-randomized study was considered separately because of serious risk of bias. Secondary outcomes included best-corrected visual acuity (BCVA), central subfield thickness (CST), ocular hypertension, and postoperative complications. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD420261283105) prior to the commencement of the review. Results Four studies involving 305 eyes were included. In the main randomized-trial analysis, two studies comprising 123 eyes contributed to the exploratory study-reported postoperative proliferative/redetachment composite. The pooled estimate was highly imprecise (RR 0.20, 95% CI 0.00 to 16.06; I² = 0%) and did not provide conclusive evidence of benefit. In an exploratory sensitivity analysis including the non-randomized study, the estimate favored dexamethasone implant, but this analysis was subject to serious risk of bias. BCVA and CST findings were limited by small sample sizes, heterogeneity, and inconsistent reporting. Intraocular-pressure outcomes were not pooled because definitions and assessment time points differed across studies. Conclusion Current evidence is insufficient to support routine adjunctive dexamethasone implant use during vitrectomy with silicone oil for diabetic tractional retinal detachment. The available studies provide only a hypothesis-generating signal of fewer study-reported postoperative proliferative or redetachment events. Use should remain selective and individualized until adequately powered randomized trials with standardized anatomical outcomes are available. Clinical trials number Not applicable.
SN - 2056-9920
ER -