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Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol). Gutierrez M, Rodriguez JL, Zamora-De la Cruz ...

Cochrane Database of Systematic Reviews

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Gutierrez M, Rodriguez JL, Zamora-De la Cruz D, Flores Pimentel MA, Jimenez-Corona A, Novak LC, Cano Hidalgo R, Graue F

Gutierrez M, Rodriguez JL, Zamora-De la Cruz D, Flores Pimentel MA, Jimenez-Corona A, Novak LC, Cano Hidalgo R, Graue F. Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD012646. DOI: 10.1002/14651858.CD012646.

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Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

TABLE OF CONTENTS HEADER . . . . . . . . . . ABSTRACT . . . . . . . . . BACKGROUND . . . . . . . OBJECTIVES . . . . . . . . METHODS . . . . . . . . . ACKNOWLEDGEMENTS . . . REFERENCES . . . . . . . . APPENDICES . . . . . . . . CONTRIBUTIONS OF AUTHORS DECLARATIONS OF INTEREST . SOURCES OF SUPPORT . . . .

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Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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[Intervention Protocol]

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear Mario Gutierrez1 , Jose L Rodriguez1 , Diego Zamora-De la Cruz2 , Mariana Aracely Flores Pimentel3 , Aida Jimenez-Corona4 , Linda C Novak5 , Rene Cano Hidalgo1 , Federico Graue1 1 Retina and Vitreous Department, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico. 2 Anterior Segment

Department, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico. 3 Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico. 4 Ocular Epidemiology and Visual Sciences Department, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico. 5 Bend, Oregon, USA Contact address: Mario Gutierrez, Retina and Vitreous Department, Instituto de Oftalmología Fundación Conde de Valenciana, Chimalpopoca 14 Obrera, Mexico City, D.F., 6800, Mexico. [email protected] Editorial group: Cochrane Eyes and Vision Group. Publication status and date: New, published in Issue 4, 2017. Citation: Gutierrez M, Rodriguez JL, Zamora-De la Cruz D, Flores Pimentel MA, Jimenez-Corona A, Novak LC, Cano Hidalgo R, Graue F. Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD012646. DOI: 10.1002/14651858.CD012646. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy alone for eyes with giant retinal tear.

BACKGROUND

Description of the condition A giant retinal tear (GRT) is a full-thickness neurosensory retinal break extending for 90° or more in the presence of a posterior vitreous detachment (Freeman 1978; Glasspool 1973; Kanski 1975; Schepens 1967; Scott 1975). The annual incidence of GRT in the general population is estimated to be between 0.094 and 0.15 per 100,000 individuals (Ang 2010; Mitry 2011). The mean age of people with GRT ranges from 30 to 53 years (Ambresin 2003; Freeman 1981; Ghosh 2004; Goezinne 2008; Lee 2009; Norton 1969; Sirimaharaj 2005; Wolfensberger 2003). By gender, men represent more cases of

GRT, up to 91% of all cases (Ang 2010). GRTs are estimated to be the cause of rhegmatogenous retinal detachment in 0.5% to 8.3% of cases (Chou 2007; Freeman 1978; Malbran 1990; Yorston 2002). GRTs can be classified as primary or secondary. Primary GRTs are idiopathic, while secondary GRTs can be caused by trauma, peripheral retinal degeneration (lattice-related and white-without-pressure), hereditary vitreoretinopathies, such as Sticklers (Donoso 2003; Stickler 2001), Ehlers-Danlos and Marfan syndrome (Dotrelova 1997); high myopia (greater than 6 diopters) (Ang 2010); or as a complication of other surgical procedures, such as pars plana vitrectomy (PPV) (Shinoda 2008), refractive surgery (Navarro 2005; Ozdamar 1998; Schipper 2000; Vilaplana 1999), excessive diathermy, or photocoagulation (Schepens 1962).

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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The majority of GRTs are judged to be idiopathic (55% to 66%); next in frequency are trauma (31%) (Ghosh 2004; Goezinne 2008; Holland 1977; Kanski 1975; Leaver 1981; Leaver 1984; Norton 1969; Sirimaharaj 2005; Vidaurri-Leal 1984), high myopia (9%) (Holland 1977; Kanski 1975; Lee 2009), and hereditary vitreoretinopathies (1%) (Donoso 2003; Stickler 2001). Other rare associations have included aniridia, lens coloboma, buphthalmos, microspherophakia, retinitis pigmentosa, endogenous endophthalmitis and acute retinal necrosis (Cahill 1998; Cooling 1980; Dowler 1995; Hovland 1968; Pal 2005). Between 0% and 13% of GRTs present as bilateral, nontraumatic tears (Ambresin 2003; Ang 2012; Freeman 1978; Ghosh 2004; Goezinne 2008; Holland 1977; Kanski 1975; Leaver 1984; Lee 2009; Schepens 1962; Schepens 1967; Sirimaharaj 2005; Vidaurri-Leal 1984). Nearly 10% of cases of GRT have been associated with an earlier GRT in the fellow eye (Ang 2012). GRTs frequently are found just posterior to the ora serrata. In cases of blunt trauma, the GRT usually appears at the superonasal quadrant associated with vitreous base avulsion; secondary to anterior-to-posterior compression followed by transverse distension of the globe (Schepens 1967). When GRTs are presented at the equatorial zone with posterior extensions, the slits at either end of the GRT may extend further posteriorly in a radial fashion (Scott 1976), giving the tear’s edge increased independent mobility that tends to make it invert or fold on itself. At diagnosis, visual acuity varies widely from counting fingers and light perception to, in some cases, visual acuity better than 20/ 40 (Ang 2010). More than 50% of all cases with GRT are associated with retinal detachment in which the fovea is compromised (fovea-off retinal detachment). People with GRT usually present with acute, painless loss of vision, that may be preceded by the perception of lights, floaters, a shadow over the field of vision, or a combination of these symptoms (Ambresin 2003; Ang 2012; Aylward 1993; Ghosh 2004; Goezinne 2008; Leaver 1984). Surgical management of GRT can be extremely challenging because of the high incidence of scarring on both retinal surfaces and in the vitreous cavity following retinal detachment, which may lead to surgical failure even following initially successful surgical repair. Proliferative vitreous retinopathy may be due to retinal pigment epithelium (RPE) cells from the large area of exposed RPE and blood-borne cells from any concurrent clinical or subclinical associated vitreous hemorrhage. RPE cells migrate towards the vitreous cavity and proliferate into the epiretinal and subretinal space with an increase in cytokine production followed by formation of cellular membranes, which may grow and contract (Duquesne 1996; Girard 1994; Kon 1999; Leaver 1984; Malbran 1990; Miller 1986; Ryan 1985; Tseng 2004; Weller 1990; Wiedemann 1988; Yeung 2008; Yoshino 1989). Proliferative vitreous retinopathy has been estimated to cause up to 49% of recurrent retina detachment of GRT cases (Ghosh 2004; Kertes 1997; Malbran 1990; Rofail 2005; Scott 2002). There has been a long-standing debate over the role of the scle-

ral buckle procedure combined with PPV in the surgical management of GRT. Management includes complete vitrectomy, unfolding the retinal flap, sealing the tear with chorioretinal adhesion, and providing long-term intraocular tamponade (Adelman 2013; Chang 1989; Kreiger 1992). The role of scleral buckling is controversial. Some surgeons consider it a beneficial procedure to help attachment of the retina because it reduces early and late vitreoretinal tractions, supports areas where unrecognized retinal breaks developed after surgery and counteracts late tractions on peripheral retina from contracture of residual vitreous gel. There are surgeons who consider it to complicate the closure of GRT by causing a gaping of retinal tissue, redundant retinal folds, being a real cause of posterior retinal slippage due to its role in changing ocular contour and scleral shortening relative to retina. Alternatively, some surgeons consider performing a scleral buckle only for recurrent cases of GRT. This remains an ongoing discussion between experienced surgeons (Al-Khairi 2008; Hoffman 1986; May 1992; Scott 2002).

Description of the intervention Two surgical interventions are used to repair GRTs: PPV combined with scleral buckle or PPV alone. PPV is a surgical procedure that involves removal of the vitreous gel. Perfluorocarbon liquids are then used to unfold the retina and provide countertraction and retinal stabilization during removal of fibrous membranes adherent to the retina (epiretinal and subretinal membranes) (Machemer 1972). Once retina reattachment is complete, the surgeon performs two or three rows of endophotocoagulation under air or a perfluorocarbon liquid bubble at the border of the tear. At the end of the PPV, silicone oil or a gas bubble is usually injected into the eye to provide retinal tamponade while the retina heals and reattaches (Chang 1989; Machemer 1972; Mathis 1992). Scleral buckle procedures involve the use of an explant made of silicon sponge or a solid silicone band sutured to the sclera circumferentially around the equator of the eye (Wilkinson 1999; Williams 2006). Scleral buckle and PPV may be combined for treatment of GRTs (Goezinne 2008; Holland 1977; Weichel 2006).

How the intervention might work In PPV, the vitreous body and the vitreous base are removed; intraoperatively perfluorocarbon liquids (perfluoro n-octano) are used to unfold the retina. Fibrous membranes are removed to relieve the vitreoretinal traction while the retina flattens. Once the retina is flattened, the tear is sealed by chorioretinal adhesion induced by endophotocoagulation. At the end of the procedure, the vitreous cavity is filled with silicone oil or a gas bubble to promote the adhesion between the retina and the RPE (Ambresin

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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2003; Freeman 1981; Leaver 1981; Leaver 1984; Sirimaharaj 2005). The scleral buckle creates an indentation in the wall of the eye, which brings the detached retina closer to the eye wall and relieves the vitreoretinal traction by supporting the vitreous base. Thus, the combined procedure may hasten healing and result in better postsurgery anatomical and visual outcomes (Goezinne 2008; Holland 1977; Weichel 2006).

Why it is important to do this review GRTs are an uncommon cause of retinal detachment. Even though primary and final retinal reattachment rates are achieved in up to 90% of cases (Chang 1989; Goezinne 2008), visual recovery may be limited. Because of the extensive area of RPE exposed, GRTs usually progress rapidly to proliferative vitreous retinopathy leading to surgical failure or reduced vision. The surgical management of a GRT may be challenging; recurrent retinal detachment secondary to proliferative vitreous retinopathy occurs in up to 40% of cases (Ghosh 2004; Kertes 1997; Malbran 1990; Rofail 2005; Scott 2002). GRT currently is managed with PPV; the use of adjunctive scleral buckling is debated because it is unclear whether applying a scleral buckle provides anatomical or visual advantage. Although there is general consensus that favors the combined procedure in cases of GRT with proliferative vitreous retinopathy, some surgeons choose not to use scleral buckling because it may distort the shape of the eye and enhance the risks of slippage of the retina posteriorly, secondary axial lengthening, gaping of retinal tissue, redundant retinal folds and fish mouthing (Chang 1989; Machemer 1972; Mathis 1992). Other surgeons favor the combined procedure because it is thought to reduce early and late traction within the vitreous base, thus decreasing the risk of recurrent retinal detachment (Goezinne 2008; Holland 1977; Weichel 2006). It is therefore important to review the current evidence to compare PPV alone or combined with scleral buckling to determine the better option that results in higher rates of surgery success, while reducing the number of secondary surgeries and adverse events. A separate Cochrane Review has been published about interventions for prevention of GRT in the fellow eye because people with unilateral GRT are at high risk of developing retinal tears and retinal detachment in the other eye (Ang 2012).

METHODS

Criteria for considering studies for this review

Types of studies We will include only randomized controlled trials (RCTs) and exclude quasi-randomized and nonrandomized trials. We will include trials irrespective of their publication status or language.

Types of participants We will include trials that enrolled participants with either unilateral or bilateral GRT. We will define GRT as a full-thickness retinal break extending circumferentially for 90° or greater in the presence of a posterior vitreous detachment, or as defined by eligible trials. We will include trials with more than three months of follow-up, regardless of the age, gender, ethnicity, lens status (e.g. phakic or pseudophakic eyes) of the affected eye(s), or etiology of GRT among participants enrolled in the trials.

Types of interventions We will include trials that compared PPV combined with scleral buckle versus PPV alone for GRT.

Types of outcome measures

Primary outcomes

1. Primary surgical success defined as primary retinal reattachment, or as defined by the trial investigators, after initial surgery. As we anticipate trials will report different postsurgery follow-up, we will consider outcomes reported at different time points: less than six months, six to 12 months and more than 12 months’ follow-up.

Secondary outcomes

OBJECTIVES To assess the effectiveness and safety of pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy alone for eyes with giant retinal tear.

1. Mean change in best corrected visual acuity (BCVA) in logMAR units from baseline to last follow-up visit reported at different time points (less than six months, six to 12 months and more than 12 months’ follow-up). 2. Proportion of study eyes that required a second surgery for retinal reattachment after the initial surgery. We will analyze second surgeries reported from day one up to last reported follow-up visit after surgery.

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Adverse events

We will investigate the proportion of study eyes with adverse events after the surgeries such as retinal detachment recurrence, elevation of intraocular pressure above 21 mmHg, choroidal detachment, cystoid macular edema, macular pucker, vitreoretinal proliferation, progression of cataract in initially phakic eyes and any other adverse events reported from the included trials at any time from day one up to last reported follow-up visit after surgery.

Economic outcomes

We will compare costs between treatment groups when data are available.

author will label the study referenced in each citation as “definitely relevant,” “unsure” or “definitely not relevant.” We will exclude trials classified as “definitely not relevant” from the review. Two authors will independently reassess the full-text of trials labeled as “unsure” and “definitely relevant” according to the inclusion criteria for this review and classify them as “definitely include” or “definitely exclude.” We will assess the trials labeled as “definitely include” for methodological quality. We will resolve any differences in classification between the two authors by discussion at both stages of screening process. We will document excluded trials after review of the full-text report and provide the reasons for exclusion in the ’Characteristics of excluded studies’ table.

Data extraction and management

Search methods for identification of studies

Electronic searches The Cochrane Eyes and Vision Information Specialist will search the following electronic databases for randomised controlled trials and controlled clinical trials. There will be no language or publication year restrictions. • Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) in the Cochrane Library (latest issue) (Appendix 1); • MEDLINE Ovid (1946 to present) (Appendix 2); • Embase.com (1947 to present) (Appendix 3); • LILACS (Latin American and Caribbean Health Science Information Database (1982 to present) (Appendix 4); • PubMed (1948 to present) (Appendix 5); • US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (www.clinicaltrials.gov) (Appendix 6); • World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp) (Appendix 7);

Searching other resources For this review, we will not search conference proceedings because these are handsearched by Cochrane Eyes and Vision (CEV) and included in CENTRAL.

Data collection and analysis

Selection of studies Two authors will independently assess the titles and abstracts of all records identified by the electronic and manual searches. Each

Two authors will extract data independently using online webbased data extraction forms developed by Cochrane Eyes and Vision, using Systematic Review Data Repository (SRDR) or Covidence. Two authors will record the data independently and reach consensus before entering data into Review Manager 5 (RevMan 5) (Review Manager 5 2014). One author will enter the data into Review Manager 5 and a second author will verify the entered data as correct. We will collect the following information from the included trials: study methods, participants, interventions and outcomes. If data on included trials are missing or unclear, we will contact the study authors or organizations involved to obtain clarification. When possible, we will contact trial authors to ask if they are able to provide numeric data when it is only provided in a graphic format.

Assessment of risk of bias in included studies We will assess each included trial for the risks of bias according to the guidelines in Chapter 8 of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). We will consider the following criteria when assessing bias. 1. Random sequence generation: we will assess the method used to generate the allocation sequence generation and allocation concealment method used before randomization. 2. Masking (blinding) of participants and outcome assessors: we will assess the methods used to mask participants and outcome assessors. 3. Incomplete outcome data: we will assess exclusions after randomization, rates of follow-up, reasons for losses to follow-up and deviations from intention-to-treat analysis of outcomes. 4. Selective outcome reporting: we will assess selective outcome reporting by comparing protocols and other design documents with trial reports and note outcomes that were measured but not reported. 5. Other bias: for example, industry funding. We will grade each of the above bias criteria as:

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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1. high risk of bias: when plausible bias seriously weakens the study results; 2. low risk of bias: when plausible bias is unlikely to alter the study results; or 3. unclear risk of bias: when plausible bias raises some doubt about the study results. For all trials assessed graded as “unclear risk of bias” because of the doubt about the study on methods, results or missing data, we will contact the investigators of the RCTs to request additional information. If we are unable to communicate with the study investigators or do not receive a response within two weeks, we will assess the risks of bias of that trial based on the available information and note the lack of response from study investigators. We will resolve any disagreements between the authors regarding bias assessment through discussion until a consensus is reached.

Measures of treatment effect We will estimate the risk ratio (RR) and its 95% confidence interval (CI) after surgery (PPV combined with scleral buckle compared with PPV alone) of the following dichotomous outcomes. 1. Primary surgical success. 2. Second surgery for retinal reattachment. 3. Develop of adverse events such as retinal detachment recurrence, elevation of intraocular pressure above 21 mmHg, choroidal detachment, cystoid macular edema, macular pucker, vitreoretinal proliferation, progression of cataract in initially phakic eyes and any other adverse events reported from the included trials at any time from day one up to last reported follow-up visit after surgery. We will estimate means and standard deviation of absolute and relative change after surgery (PPV combined with scleral buckle compared with PPV alone) of the following outcomes. 1. Absolute and relative change on visual acuity in LogMAR from baseline to follow-up visits in both surgery groups. 2. Absolute and relative change on retinal detachment in GRT from baseline to follow-up visits in both surgery groups. To avoid the phenomenon of regression to the mean for the absolute change, we will perform an analysis of covariance were the change is defined relative to the value of ’y’ at baseline.

tabulation, we will use a paired-sample t-test or a McNemar test to assess the differences between paired eye outcomes.

Dealing with missing data If trials are not analyzed using an intention-to-treat analysis, or where data are unclear or missing, we will contact the trial authors for clarification and further information. We will make two attempts to contact trial authors and allow two weeks for the trial authors to respond, and if we do not receive a response, we will use the available information.

Assessment of heterogeneity We will evaluate the heterogeneity of the trials using the Cochrane Q and I2 tests. The Q value has a Chi2 distribution with the null hypothesis that the likelihood ratio is the same for all studies. The I 2 test evaluates the variability on the effect. We will consider values higher than 50% as evidence of substantial heterogeneity (Deeks 2011). If substantial heterogeneity or inconsistency is present, we will not report the pooled analysis, we will instead report a narrative summary of the results. We expect methodological and clinical sources of heterogeneity from differences in participant characteristics, types or timing of outcome measurement, and intervention characteristics such as surgical methods used like number of surgeons, PPV gauge number, scleral buckle type (silicon band/silicon sponge), preoperative lens status (phakic, pseudophakic, aphakic) and vitreous substitute endotamponade (gas/silicon oil).

Assessment of reporting biases When possible, we will obtain published protocols or methods papers to compare the intended outcomes with reported outcomes. When there are 10 or more RCTs, we will use funnel plots to judge asymmetry that may indicate publication bias in one or more reported studies in a meta-analysis.

Data synthesis Unit of analysis issues For this review, the unit of analysis will be eyes, then all statistical estimations will be including within individual correlation. Among the analyses that we will use are analysis of covariance and lineal regression for repeated measures. For trials that enrolled both eyes of participants with bilateral GRT and used a paired-eye design in which one eye was randomized to receive PPV alone and the fellow eye received the combined procedure, the unit of analysis will be the eye. If enough data are provided on paired-eye design trials such as covariances or paired

We will perform data analysis according to the guidelines set out in Chapter 9 of the Cochrane Handbook for Systematic Reviews of Interventions (Deeks 2011). We will compare PPV combined with scleral buckle versus PPV alone for GRT. When the number of trials is fewer than three, we will use a fixed-effect model, otherwise we plan to use a random-effects model. If there is evidence of substantial heterogeneity, or there is a large amount of diversity in participant characteristics and trial methodology, we may choose to present only a narrative summary of the results. We will perform a meta-analysis for all the outcomes under Types of outcome measures.

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Subgroup analysis and investigation of heterogeneity

’Summary of findings’ table

We will investigate potential explanations of clinical or statistical heterogeneity by comparing outcomes within subgroups to compare the relative effect of PPV combined with scleral buckle and PPV alone by the type of tamponade used in surgery (silicon oil or gas), participant age, retinal tear etiology, duration of symptoms, grades or quadrants of retinal tear extension (90° to 180° or one or two quadrants, 180° to 270° or two or three quadrants, and 270° to 360° or three or four quadrants), lens status (phakic, pseudophakic or aphakic) and presence of proliferative vitreoretinopathy (grade C) according to the Retinal Society classification (Machemer 1991), whenever sufficient data are reported.

We will produce a ’Summary of findings’ table for the following outcomes: primary surgical success, mean change in BCVA from baseline measured in logMAR units, proportion of study eyes that required a second surgery for retinal reattachment, adverse events, and economic outcomes. We will use the GRADE approach to assess the quality of the evidence (Guyatt 2011). Given the certainty, we will consider limitations in any included studies, the consistency of the effect, imprecision of results, indirectness of results and publication bias.

Sensitivity analysis

ACKNOWLEDGEMENTS

We will examine the impact of excluding trials with high risk of bias in all the following domains incomplete data, unpublished data and industry funding to assess the robustness of estimates with respect to these factors.

We thank Lori Rosman, Information Specialist for Cochrane Eyes and Vision (CEV), who created and will execute the electronic search strategies. We thank the CEV US Satellite for their comments on the protocol.

REFERENCES

Additional references Adelman 2013 Adelman RA, Parnes AJ, Sipperley JO, Ducournau D. Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2. Ophthalmology 2013;120(9): 1809–13. Al-Khairi 2008 Al-Khairi AM, Al-Kahtani E, Kangave D, Abu El-Asrar AM. Prognostic factors associated with outcomes after giant retinal tear management using perfluorocarbon liquids. European Journal of Ophthalmology 2008;18(2):270–7. Ambresin 2003 Ambresin A, Wolfensberger TJ, Bovey EH. Management of giant retinal tears with vitrectomy, internal tamponade, and peripheral 360 degrees retinal photocoagulation. Retina 2003;23(5):622–8. Ang 2010 Ang GS, Townend J, Lois N. Epidemiology of giant retinal tears in the United Kingdom: the British Giant Retinal Tear Epidemiology Eye Study (BGEES). Investigative Ophthalmology and Visual Science 2010;51(9):4781–7. Ang 2012 Ang GS, Townend J, Lois N. Interventions for prevention of giant retinal tear in the fellow eye. Cochrane Database of Systematic Reviews 2012, Issue 2. [DOI: 10.1002/ 14651858.CD006909.pub3]

Aylward 1993 Aylward GW, Cooling RJ, Leaver PK. Trauma-induced retinal detachment associated with giant retinal tears. Retina 1993;13(2):136–41. Cahill 1998 Cahill MT, Barry PJ, Kenna PF. Giant retinal tear in Usher syndrome type II: coincidence or association?. Retina 1998; 18(2):177–8. Chang 1989 Chang S, Lincoff H, Zimmerman NJ, Fuchs W. Giant retinal tears. Surgical techniques and results using perfluorocarbon liquids. Archives of Ophthalmology 1989; 107(5):761–6. Chou 2007 Chou SC, Yang CH, Lee CH, Yang CM, Ho TC, Huang JS, et al. Characteristics of primary rhegmatogenous retinal detachment in Taiwan. Eye 2007;21(8):1056–61. Cooling 1980 Cooling RJ, Rice NS, Mcleod D. Retinal detachment in congenital glaucoma. British Journal of Ophthalmology 1980;64(6):417–21. Deeks 2011 Deeks JJ, Higgins JP, Altman DG. Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org. Donoso 2003 Donoso LA, Edwards AO, Frost AT, Ritter R 3rd, Ahmad N, Vrabec T, et al. Clinical variability of Stickler syndrome:

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role of exon 2 of the collagen COL2A1 gene. Survey of Ophthalmology 2003;48(2):191–203. Dotrelova 1997 Dotrelova D, Karel I, Clupkova E. Retinal detachment in Marfan’s syndrome. Characteristics and surgical results. Retina 1997;17(5):390–6. Dowler 1995 Dowler JG, Lyons CJ, Cooling RJ. Retinal detachment and giant retinal tears in aniridia. Eye 1995;9(Pt 3):268–70. Duquesne 1996 Duquesne N, Bonnet M, Adeleine P. Preoperative vitreous hemorrhage associated with rhegmatogenous retinal detachment: a risk factor for postoperative proliferative vitreoretinopathy?. Graefe’s Archive for Clinical and Experimental Ophthalmology 1996;234(11):677–82. Freeman 1978 Freeman HM. Fellow eyes of giant retinal breaks. Transactions of the American Ophthalmological Society 1978; 76:343–82. Freeman 1981 Freeman HM, Castillejos ME. Current management of giant retinal breaks: results with vitrectomy and total air fluid exchange in 95 cases. Transactions of the American Ophthalmological Society 1981;79:89–102. Ghosh 2004 Ghosh YK, Banerjee S, Savant V, Kotamarthi V, Benson MT, Scott RA, et al. Surgical treatment and outcome of patients with giant retinal tears. Eye 2004;18(10):996–1000. Girard 1994 Girard P, Mimoun G, Karpouzas I, Montefiore G. Clinical risk factors for proliferative vitreoretinopathy after retinal detachment surgery. Retina 1994;14(5):417–24. Glanville 2006 Glanville JM, Lefebvre C, Miles JN, Camosso-Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association 2006; Vol. 94, issue 2:130–6. Glasspool 1973 Glasspool MG, Kanski JJ. Prophylaxis in giant tears. Transactions of the Ophthalmological Societies of the United Kingdom 1973;93:363–71. Goezinne 2008 Goezinne F, La Heij EC, Berendschot TT, Gast ST, Liem AT, Lundqvist IL, et al. Low redetachment rate due to encircling scleral buckle in giant retinal tears treated with vitrectomy and silicone oil. Retina 2008;28(3):485–92.

editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org. Hoffman 1986 Hoffman ME, Sorr EM. Management of giant retinal tears without scleral buckling. Retina 1986;6(4):197–204. Holland 1977 Holland PM, Smith TR. Broad scleral buckle in the management of retinal detachments with giant tears. American Journal of Ophthalmology 1977;83(4):518–25. Hovland 1968 Hovland KR, Schepens CL, Freeman HM. Developmental giant retinal tears associated with lens coloboma. Archives of Ophthalmology 1968;80(3):325–31. Kanski 1975 Kanski JJ. Giant retinal tears. American Journal of Ophthalmology 1975;79(5):846–52. Kertes 1997 Kertes PJ, Wafapoor H, Peyman GA, Calixto N Jr, Thompson H. The management of giant retinal tears using perfluoroperhydrophenanthrene. A multicenter case series. Vitreon Collaborative Study Group. Ophthalmology 1997; 104(7):1159–65. Kon 1999 Kon CH, Occleston NL, Aylward GW, Khaw PT. Expression of vitreous cytokines in proliferative vitreoretinopathy: a prospective study. Investigative Ophthalmology and Visual Science 1999;40(3):705–12. Kreiger 1992 Kreiger AE, Lewis H. Management of giant retinal tears without scleral buckling. Use of radical dissection of the vitreous base and perfluoro-octane and intraocular tamponade. Ophthalmology 1992;99(4):491–7. Leaver 1981 Leaver PK, Lean JS. Management of giant retinal tears using vitrectomy and silicone oil/fluid exchange. A preliminary report. Transactions of the Ophthalmological Societies of the United Kingdom 1981;101(1):189–91. Leaver 1984 Leaver PK, Cooling RJ, Feretis EB, Lean JS, McLeod D. Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: results at six months. British Journal of Ophthalmology 1984;68(6):432–8. Lee 2009 Lee SY, Ong SG, Wong DW, Ang CL. Giant retinal tear management: an Asian experience. Eye 2009;23(3):601–5.

Guyatt 2011 Guyatt GH, Oxman AD, Schünemann HJ, Tugewell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. Journal of Clinical Epidemiology 2011;64(4):380–2.

Machemer 1972 Machemer R, Parel JM, Norton EW. Vitrectomy: a pars plana approach. Technical improvements and further results. Transactions - American Academy of Ophthalmology and Otolaryngology 1972;76:462–6.

Higgins 2011 Higgins JP, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S,

Machemer 1991 Machemer R, Aaberg TM, Freeman HM, Irvine AR, Lean JS, Michels RM. An updated classification of retinal

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

7

detachment with proliferative vitreoretinopathy. American Journal of Ophthalmology 1991;112(2):159–65. Malbran 1990 Malbran E, Dodds RA, Hulsbus R, Charles DE, Buonsanti JL, Adrogue E. Retinal break type and proliferative vitreoretinopathy in nontraumatic retinal detachment. Graefe’s Archive for Clinical and Experimental Ophthalmology 1990;228(5):423–5. Mathis 1992 Mathis A, Pagot V, Gazagne C, Malecaze F. Giant Retinal tears: surgical techniques and results using perfluorodecalin and silicone oil tamponade. Retina 1992;12(3):S7–10. May 1992 May DR. Buckle-less repair of giant retinal tears. Ophthalmology 1992;99(8):1181–2. Miller 1986 Miller B, Miller H, Patterson R, Ryan SJ. Retinal wound healing. Cellular activity at the vitreoretinal interface. Archives of Ophthalmology 1986;104(2):281–5. Mitry 2011 Mitry D, Singh J, Yorston D, Siddiqui MA, Wright A, Fleck BW, et al. The predisposing pathology and clinical characteristics in the Scottish retinal detachment study. Ophthalmology 2011;118(7):1429–34. Navarro 2005 Navarro R, Gris O, Broc L, Corcostegui B. Bilateral giant retinal tear following posterior chamber phakic intraocular lens implantation. Journal of Refractive Surgery 2005;21(3): 298–300. Norton 1969 Norton EW, Aaberg T, Fung W, Curtin VT. Giant retinal tears. I. Clinical management with intravitreal air. American Journal of Ophthalmology 1969;68(6):1011–21. Ozdamar 1998 Ozdamar A, Aras C, Sener B, Oncel M, Karacorlu M. Bilateral retinal detachment associated with giant retinal tear after laser-assisted in situ keratomileusis. Retina 1998; 18(2):176–7. Pal 2005 Pal N, Sharma YR, Azad R, Chandra P. Isolated bilateral microspherophakia with giant retinal tear and rhegmatogenous retinal detachment. Journal of Pediatric Ophthalmology and Strabismus 2005;42(4):238–40. Review Manager 5 2014 [Computer program] Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014. Rofail 2005 Rofail M, Lee LR. Perfluoro-n-octane as a postoperative vitreoretinal tamponade in the management of giant retinal tears. Retina 2005;25(7):897–901.

Ryan 1985 Ryan SJ. The pathophysiology of proliferative vitreoretinopathy in its management. American Journal of Ophthalmology 1985;100(1):188–93. Schepens 1962 Schepens CL, Dobble JG, McMeel JW. Retinal detachments with giant breaks: preliminary report. Transactions American Academy of Ophthalmology and Otolaryngology 1962;66:471–9. Schepens 1967 Schepens CL, Freeman HM. Current management of giant retinal breaks. Transactions - American Academy of Ophthalmology and Otolaryngology 1967;71(3):474–87. Schipper 2000 Schipper I, Senn P. Giant retinal tears after photorefractive keratectomy. Retina 2000; Vol. 20, issue 2:225–6. Scott 1975 Scott JD. Giant tear of the retina. Transactions of the Ophthalmological Societies of the United Kingdom 1975;95 (1):142–4. Scott 1976 Scott JD. Equatorial giant tears affected by massive vitreous retraction. Transactions of the Ophthalmological Societies of the United Kingdom 1976;96(2):309–12. Scott 2002 Scott IU, Murray TG, Flynn HW Jr, Feuer WJ, Schiffman JC. Outcomes and complications associated with giant retinal tear management using perfluoro-n-octane. Ophthalmology 2002;109(10):1828–33. Shinoda 2008 Shinoda H, Nakajima T, Shinoda K, Suzuki K, Ishida S, Inoue M. Jamming of 25-gauge instruments in the cannula during vitrectomy for vitreous haemorrhage. Acta Ophthalmologica 2008;86(2):160–4. Sirimaharaj 2005 Sirimaharaj M, Balachandran C, Chan WC, Hunyor AP, Chang AA, Gregory-Roberts J, et al. Vitrectomy with short term postoperative tamponade using perfluorocarbon liquid for giant retinal tears. British Journal of Ophthalmology 2005;89(9):1176–9. Stickler 2001 Stickler GB, Hughes W, Houchin P. Clinical features of hereditary progressive arthro-ophthalmopathy (Stickler syndrome): a survey. Genetics in Medicine 2001;3(3):192–6. Tseng 2004 Tseng W, Cortez RT, Ramirez G, Stinnett S, Jaffe GJ. Prevalence and risk factors for proliferative vitreoretinopathy in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery. American Journal of Ophthalmology 2004;137(6):1105–15. Vidaurri-Leal 1984 Vidaurri-Leal J, de Bustros S, Michels RG. Surgical treatment of giant retinal tears with inverted posterior

Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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retinal flaps. American Journal of Ophthalmology 1984;98 (4):463–6.

Green WR editor(s). Retina-Vitreous-Macula. Philadelphia: WB Saunders, 1999:1248–71.

Vilaplana 1999 Vilaplana D, Guinot A, Escoto R. Giant retinal tears after photorefractive keratectomy. Retina 1999;19(4):342–3.

Williams 2006 Williams GA, Aaberg TA Jr. Techniques of scleral buckling. In: Ryan SJ, Wilkinson CP editor(s). Retina. 4th Edition. Vol. 3, Philadelphia: Elsevier Mosby, 2006.

Weichel 2006 Weichel ED, Martidis A, Fineman MS, McNamara JA, Park CH, Vander JF, et al. Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for primary repair of pseudophakic retinal detachment. Ophthalmology 2006;113(11):2033–40. Weller 1990 Weller M, Wiedemann P, Heimann K. Proliferative vitreoretinopathy - is it anything more than wound healing at the wrong place?. International Ophthalmology 1990;14 (2):105–17. Wiedemann 1988 Wiedemann P, Weller M. The pathophysiology of proliferative vitreoretinopathy. Acta Ophthalmologica. Supplement 1988;189:3–15. Wilkinson 1999 Wilkinson CP. Scleral buckling techniques: a simplified approach. In: Guyer DR, Yannuzi LA, Chang S, Shields JA,

Wolfensberger 2003 Wolfensberger TJ, Aylward GW, Leaver PK. Prophylactic 360 degrees cryotherapy in fellow eyes of patients with spontaneous giant retinal tears. Ophthalmology 2003;110 (6):1175–7. Yeung 2008 Yeung L, Yang KJ, Chen TL, Wang NK, Chen YP, Ku WC, et al. Association between severity of vitreous haemorrhage and visual outcome in primary rhegmatogenous retinal detachment. Acta Ophthalmologica 2008;86(2):165–9. Yorston 2002 Yorston DB, Wood ML, Gilbert C. Retinal detachment in East Africa. Ophthalmology 2002;109(12):2279–83. Yoshino 1989 Yoshino Y, Ideta H, Nagasaki H, Uemura A. Comparative study of clinical factors predisposing patients to proliferative vitreoretinopathy. Retina 1989;9(2):97–100. ∗ Indicates the major publication for the study

APPENDICES

Appendix 1. CENTRAL search strategy #1 MeSH descriptor: [Retinal Detachment] explode all trees #2 MeSH descriptor: [Retinal Perforations] explode all trees #3 MeSH descriptor: [Vitreous Detachment] explode all trees #4 MeSH descriptor: [Vitreoretinopathy, Proliferative] explode all trees #5 vitreoretinopath* #6 retin* near/3 break* #7 retin* near/3 tear* #8 retin* near/3 detach* #9 retin* near/3 perforat* #10 {or #1-#9} #11 MeSH descriptor: [Vitrectomy] explode all trees #12 MeSH descriptor: [Vitreoretinal Surgery] explode all trees #13 vitrec* #14 PPV* #15 vitre* surg* #16 {or #11-#15} #17 #10 and #16

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Appendix 2. MEDLINE Ovid search strategy 1. Randomized Controlled Trial.pt. 2. Controlled Clinical Trial.pt. 3. (randomized or randomised).ab,ti. 4. placebo.ab,ti. 5. drug therapy.fs. 6. randomly.ab,ti. 7. trial.ab,ti. 8. groups.ab,ti. 9. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 10. exp animals/ not humans.sh. 11. 9 not 10 12. exp Retinal Detachment/ 13. exp Retinal Perforations/ 14. exp Vitreous Detachment/ 15. exp Vitreoretinopathy, Proliferative/ 16. vitreoretinopath*.tw. 17. (retin* adj3 break*).tw. 18. (retin* adj3 tear*).tw. 19. (retin* adj3 detach*).tw. 20. (retin* adj3 perforat*).tw. 21. or/12-20 22. exp Vitrectomy/ 23. vitrect*.tw. 24. exp Vitreoretinal Surgery/ 25. exp Vitreous Body/su [Surgery] 26. limit 25 to yr=“1966 - 1983” 27. PPV*.tw. 28. vitre* surg*.tw. 29. or/22-24,26-28 30. 21 and 29 31. 11 and 30 The search filter for trials at the beginning of the MEDLINE strategy is from the published paper by Glanville 2006.

Appendix 3. Embase.com search strategy #1 ’randomized controlled trial’/exp #2 ’randomization’/exp #3 ’double blind procedure’/exp #4 ’single blind procedure’/exp #5 random*:ab,ti #6 #1 OR #2 OR #3 OR #4 OR #5 #7 ’animal’/exp OR ’animal experiment’/exp #8 ’human’/exp #9 #7 AND #8 #10 #7 NOT #9 #11 #6 NOT #10 #12 ’clinical trial’/exp #13 (clin* NEAR/3 trial*):ab,ti #14 ((singl* OR doubl* OR trebl* OR tripl*) NEAR/3 (blind* OR mask*)):ab,ti #15 ’placebo’/exp #16 placebo*:ab,ti Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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#17 random*:ab,ti #18 ’experimental design’/exp #19 ’crossover procedure’/exp #20 ’control group’/exp #21 ’latin square design’/exp #22 #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 #23 #22 NOT #10 #24 #23 NOT #11 #25 ’comparative study’/exp #26 ’evaluation’/exp #27 ’prospective study’/exp #28 control*:ab,ti OR prospectiv*:ab,ti OR volunteer*:ab,ti #29 #25 OR #26 OR #27 OR #28 #30 #29 NOT #10 #31 #30 NOT (#11 OR #23) #32 #11 OR #24 OR #31 #33 ’retina tear’/exp #34 ’retina detachment’/exp #35 ’vitreous body detachment’/exp #36 (retin* NEXT/3 break*):ab,ti #37 (retin* NEXT/3 tear*):ab,ti #38 (retin* NEXT/3 detach*):ab,ti #39 (retin* NEXT/3 perforat*):ab,ti #40 ’vitreoretinopathy’/exp #41 vitreoretinopath*:ab,ti #42 #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 #43 ’vitreoretinal surgery’/exp #44 vitrec*:ab,ti #45 ppv*:ab,ti #46 vitre*:ab,ti AND surg*:ab,ti #47 #43 OR #44 OR #45 OR #46 #48 #42 AND #47 #49 #32 AND #48

Appendix 4. LILACS search strategy (MH:C11.768.648$ OR MH:C11.768.740$ OR “vitreous detachment” OR MH:C11.980$ OR (retin$ AND break$) OR (retin$ AND tear$) OR (retin$ AND detach$) OR (retin$ AND perforat$) OR MH:C11.768.890$ OR MH:C11.975$ OR vitreoretinopathy$) AND (vitrec$ OR MH:E04.540.960$ OR PPV$ OR (vitre$ AND surg$) OR MH:E04.540.980$)

Appendix 5. PubMed search strategy 1. ((randomized controlled trial[pt]) OR (controlled clinical trial[pt]) OR (randomised[tiab] OR randomized[tiab]) OR (placebo[tiab]) OR (drug therapy[sh]) OR (randomly[tiab]) OR (trial[tiab]) OR (groups[tiab])) NOT (animals[mh] NOT humans[mh]) 2. (retina*[tw] AND (break*[tw] OR tear*[tw] OR detach*[tw] OR perforat*[tw])) NOT Medline[sb] 3. vitreoretinopath*[tw] NOT Medline[sb] 4. #2 OR #3 5. (vitrec*[tw] OR PPV*[tw] OR Pars Plana[tw]) NOT Medline[sb] 6. (vitre*[tw] AND surg*[tw]) NOT Medline[sb] 7. #5 OR #6 8. #1 AND #4 AND #7 Pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy for giant retinal tear (Protocol) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Appendix 6. ClinicalTrials.gov search strategy (retina OR retinal OR “vitreous detachment” OR vitreoretinopathy) AND (vitrectomy OR PPV OR “vitreous surgery” OR “vitreoretinal surgery”)

Appendix 7. WHO ICTRP search strategy (retina AND vitrectomy OR retinal AND vitrectomy OR “vitreous detachment” AND vitrectomy OR vitreoretinopathy AND vitrectomy OR retina AND “vitreous surgery” OR retinal AND “vitreous surgery” OR “vitreous detachment” AND “vitreous surgery” OR vitreoretinopathy AND “vitreous surgery” OR retina AND “vitreoretinal surgery” OR retinal AND “vitreoretinal surgery” OR “vitreous detachment” AND “vitreoretinal surgery” OR vitreoretinopathy AND “vitreoretinal surgery”)

CONTRIBUTIONS OF AUTHORS MG, MF and DZ developed the protocol. JLR, LN, RC and FG critically reviewed the clinical sections. AJ and RC critically reviewed the statistical sections.

DECLARATIONS OF INTEREST MG: no conflict of interest or financial interest. JLR: no conflict of interest or financial interest. DZ: no conflict of interest or financial interest. MF: no conflict of interest or financial interest. AJ: no conflict of interest or financial interest. LN: no conflict of interest or financial interest. RC: no conflict of interest or financial interest. FG: no conflict of interest or financial interest.

SOURCES OF SUPPORT

Internal sources • No sources of support supplied

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External sources • Methodological support provided by the Cochrane Eyes and Vision US Project, supported by grant 1 U01 EY020522, National Eye Institute, National Institutes of Health, USA. • National Institute for Health Research (NIHR), UK. • Richard Wormald, Co-ordinating Editor for Cochrane Eyes and Vision (CEV) acknowledges financial support for his CEV research sessions from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology. • This protocol was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the CEV UK editorial base. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

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