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Qu S, Zhou Q, Shao YT, Lin MY, Shen JQ, Niu GZ, Han WT, Zhang L, Bi YL. Posterior capsular radial sign: a novel method to confirm anterior vitreous cortex resection in phacovitrectomy. BMC Ophthalmol 2024; 24:231. [PMID: 38822280 PMCID: PMC11143691 DOI: 10.1186/s12886-024-03474-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 05/02/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The main purpose of this paper is to introduce a method that can accurately locate the posterior capsule of the lens to facilitate a relatively complete resection of the anterior vitreous body. METHODS A total of 51 patients in the experimental group and control group were enrolled in this study. Phacoemulsification combined with vitrectomy was performed in all cases. After the cataract procedure was completed in the control group, the surgeon performed a conventional anterior vitrectomy with the operative eye. In the experimental group, anterior vitrectomy was performed according to the threadiness corrugation of the posterior capsule of the lens. During the operation, with the help of triamcinolone, two surgeons confirmed the resection of the anterior vitreous cortex; the best corrected visual acuity and intraocular pressure of all patients were recorded at 1 week, 1 month and 3 months after surgery. RESULTS Fifty patients underwent phacoemulsification combined with vitrectomy, except one patient in the experimental group who was lost to follow-up. After surgery, no significant complications were observed in all patients except two patients in the control group with temporary increases in intraocular pressure. There was no significant difference in preoperative visual acuity between the two groups (t = 0.83, P = 0.25). Both groups had varying degrees of improvement in best corrected visual acuity at 1 week, 1 month and 3 months after surgery. Moreover, there was no significant difference in BCVA between the two groups at the three follow-up time points (t=-1.15, -1.65, -1.09, P = 0.53, 0.21, 0.23). After surgery, no significant complications were observed in all patients except two patients in the control group with temporary increases in intraocular pressure. Incomplete resection of the anterior vitreous cortex was observed in 2 patients in each group, but there was no significant difference (χ2 = 7.81, P > 0.05). CONCLUSION In the process of cataract surgery combined with vitrectomy, thready corrugation appears in the posterior capsule of the lens and is an important sign of its localization. Anterior vitrectomy can be accomplished safely and effectively with the help of thread-like corrugation, and the surgical effect is almost the same as that of traditional surgery. Especially suitable for beginners in vitreous surgery.
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Affiliation(s)
- Shen Qu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Qi Zhou
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Yu-Ting Shao
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Ming-Yue Lin
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Jia-Qi Shen
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Guo-Zhen Niu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Wen-Ting Han
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Li Zhang
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Yan-Long Bi
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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William A, Kuehnel S, Dimopoulos S, Hillenkamp J, Goebel W. The Role of Preoperative Case Selection in the Training of Surgical Repair of Primary Rhegmatogenous Retinal Detachment. Clin Ophthalmol 2023; 17:3113-3122. [PMID: 37881783 PMCID: PMC10593965 DOI: 10.2147/opth.s425646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose To analyse single-operation anatomical success (SOAS) of primary rhegmatogenous retinal detachment (RRD) repair by junior vitreoretinal surgeons guided by preoperative individual case selection by an experienced mentor vitreoretinal surgeon. Methods Retrospective, single institute, observational study, included all patients who underwent standard pars plana vitrectomy (PPV) or combined encircling band (CB) and PPV and gas tamponade in the treatment of RRD from November 2021 to December 2022 were included. Preoperative selection for the surgery decision, whether standard PPV or combined CB & PPV was undertaken through the senior surgeon; according to the location and extensions of the RRD, number of retinal tears (RT) and lens status. We excluded patients with tractional retinal detachment, RD with proliferative vitreoretinopathy stage C, giant tears, trauma, previous scleral buckle, schisis RD and RD requiring silicone oil. The primary outcome measure was to evaluate the single-operation anatomic success (SOAS). Secondary outcome measures evaluated whether there was a statistical significant difference between both procedures. Results Eighty-two eyes were included in the study. Forty-five eyes were selected for combined CB&PPV and 37 eyes for standard PPV. SOAS was achieved in 40 eyes (88.8%) in combined group and 35 eyes (94.5%) in standard PPV group. There was no statistically significant difference in the success rate between both operations, p = 0.65. Conclusion Structured preoperative selection of standardized surgical techniques according to the degree of complexity of RD together with close supervision enables junior vitreoretinal surgeons in training to achieve re-attachment rates of more than 80% with both types of surgeries.
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Affiliation(s)
- Antony William
- Department of Ophthalmology, University Eye Hospital Würzburg, Würzburg, Germany
| | - Sophia Kuehnel
- Department of Ophthalmology, University Eye Hospital Würzburg, Würzburg, Germany
| | - Spyridon Dimopoulos
- Department of Ophthalmology, University Eye Hospital Tübingen, Tübingen, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University Eye Hospital Würzburg, Würzburg, Germany
| | - Winfried Goebel
- Department of Ophthalmology, University Eye Hospital Würzburg, Würzburg, Germany
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Wu PY, Fung AT, Dave VP, Iu LPL, Sjahreza E, Chaikitmongkol V, Sivagurunathan PD, Ahn J, Misra DK, Wong CW, Chou HD. COVID-19 reduced scleral buckling training in fellows and shifted young ophthalmologists' preference toward vitrectomy: An Asia-Pacific survey. Clin Exp Ophthalmol 2023; 51:585-597. [PMID: 37170410 DOI: 10.1111/ceo.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 04/22/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND To assess rhegmatogenous retinal detachment (RRD) surgery trends and training among young ophthalmologists (YOs, vitreoretinal fellows or attendings/consultants with ≤10 years of independent practice) and the impact of the COVID-19 pandemic. METHODS An anonymous online survey was completed by 117 YOs in the Asia-Pacific regarding their RRD surgery experiences in 2021-2022. RESULTS To achieve a 90% probability of surgical competency, 91 vitrectomy and 34 scleral buckling (SB) completions during fellowship were needed. In total, 49 (41.9%) YOs had fellowship affected by COVID-19. In the COVID versus pre-COVID era, however, the volume of SB completions per fellowship year decreased significantly (median [IQR] 3.3 [1.5, 9] vs. 13 [6.5, 23]; p < 0.001) and was lower than the required volume to achieve competency. YOs were less confident in conducting SB versus vitrectomy (3.5 ± 1.1 vs. 4.2 ± 0.8, p < 0.001), and they reported a decrease in the proportion of SB (-3.1%, p = 0.047) and an increase in the proportion of vitrectomy (+4.8%, p < 0.001) after the pandemic outbreak. Apart from RRD clinical characteristics, surgical confidence is among the main factors that affect surgical method decisions. During the pandemic, more YOs may have avoided SB due to the need for general anaesthesia, leading to longer surgical time and risk of viral transmission during intubation/extubation. CONCLUSIONS SB surgical exposure is suboptimal in most fellowship programs in the 11 Asia-Pacific countries/regions we surveyed and further declined during the COVID-19 pandemic. YOs are less confident in performing SB, leading to a trend toward primary vitrectomy since the COVID-19 outbreak.
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Affiliation(s)
- Po-Yi Wu
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Adrian T Fung
- Westmead and Central (Save Sight Institute) Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Vivek P Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Lawrence P L Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | | | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Premala D Sivagurunathan
- Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Malaysian Ministry of Health, Kota Bharu, Kelantan, Malaysia
| | - Jeeyun Ahn
- Department of Ophthalmology, Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- College of Medicine, Seoul National University, Seoul, Korea
| | - Diva K Misra
- Vitreo-Retina Services, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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The Learning Curve of Surgery of Diabetic Tractional Retinal Detachment-A Retrospective, Comparative Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010073. [PMID: 36676697 PMCID: PMC9860931 DOI: 10.3390/medicina59010073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
Background and Objectives: There are few data in the literature concerning the learning curve of tractional retinal detachment (TRD) surgery. We have analyzed the experience gained by a vitreoretinal surgeon over 10 years. Materials and Methods: A retrospective, comparative study of 34 TRD cases operated using 20G instruments between 2008 and 2011 (group A) and 94 cases operated using 23G instruments between 2015 and 2019 (group B). The preoperative characteristics, the type of endotamponade, and the anatomical and functional success were reviewed. Results: The group A patients had a significantly higher rate of concomitant vitreous hemorrhage (VH) at presentation (64.7% vs. 37.2%) and of non-macular retinal detachments (52.9% vs. 39.3%). The rate of silicone oil endotamponade was high in both groups (76.4% vs. 68.1%), but in group B 25.5% were left without a tamponade (vs. none in group A). A postoperative anatomical success was obtained in 76.5% of eyes in group A and 84.04% of eyes in group B (where it was improved to 89.3% by reinterventions). The presenting visual acuity (VA) was very low in both groups (0.01 and 0.05, respectively). The proportion of eyes with improved or stabilized VA was 85.3% in group A and 79.8% in group B (statistically non-significant difference). Conclusions: The anatomical success rate improves quite slowly with increasing surgeon experience and can be further improved by reinterventions. Visual improvement does not match the rate of anatomical improvement. With increasing experience and self-confidence, the surgeon will approach more difficult cases, a fact that may slow down the increase in surgical success rates.
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Effect of surgeon-related factors on outcome of retinal detachment surgery: analyses of data in Japan-retinal detachment registry. Sci Rep 2022; 12:4213. [PMID: 35273253 PMCID: PMC8913601 DOI: 10.1038/s41598-022-07838-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/22/2022] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to investigate the effects of surgeon-related factors on the surgical outcome of pars plana vitrectomy (PPV) and scleral buckling (SB) surgery on eyes with a rhegmatogenous retinal detachment (RRD). This was a nationwide, multicenter, observational study of the data in the Japan-RD Registry. Registered cases that had undergone surgery for a RRD by 128 accredited surgeons in 26 institutions were studied. The surgeon-related factors that significantly affected surgical success and visual outcomes of simple RRD treated by PPV or SB at 6 months postoperatively were analyzed and compared. Among 3446 registered cases, 2533 cases met the inclusion criteria with 1896 in the PPV group and 637 cases in the SB group. The median total number of lifetime cases was 150 and the rate of surgeries/year was 22. Multivariate regression analyses showed that the number and rate of surgeries/year were not significantly associated with the surgical outcome in the PPV group. However, surgeons with a higher average annual number of surgeries had significantly better surgical outcomes in the SB group (P = 0.038). Analyses of a nationwide registry showed that SB but not PPV surgeries require sufficient experience and case numbers to acquire and maintain skills to treat RRDs successfully.
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Moussa G, Kalogeropoulos D, Wai Ch'ng S, Lett KS, Mitra A, Tyagi AK, Sharma A, Andreatta W. The effect of supervision and out-of-hours surgery on the outcomes of primary macula-on retinal detachments operated by vitreoretinal fellows: A review of 435 surgeries. Ophthalmologica 2021; 245:239-248. [PMID: 34818241 DOI: 10.1159/000517879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- George Moussa
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom,
| | - Dimitrios Kalogeropoulos
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Soon Wai Ch'ng
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Kim Son Lett
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Arijit Mitra
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Ajai K Tyagi
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Ash Sharma
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Walter Andreatta
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
- Kantonsspital Winterthur, Winterthur, Switzerland
- University of Zurich, Zurich, Switzerland
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7
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Radeck V, Helbig H, Barth T, Gamulescu MA, Maerker D, Prahs P. The learning curve of retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 2021; 259:2167-2173. [PMID: 33544177 PMCID: PMC8352825 DOI: 10.1007/s00417-021-05096-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the learning curve of vitreoretinal (VR) surgeons beginning training in retinal detachment (RD) surgery. Methods The files of all consecutive patients undergoing VR surgery for uncomplicated RD between Jan 2005 und Mar 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment within 3 months after surgery. Results Ten surgeons started their VR career during this period. Together, these 10 surgeons performed 3786 RD operations (mean 379; median 251; range 71–1053). Primary success rate after one operation was 90% (3420 of 3786). When starting to operate retinal detachments, VR surgeons had a primary success rate of about 80%. Redetachment rates steadily decreased and stabilized at just under 10% after about 200 operations. Beginners needed more than twice the time for the procedure compared to experienced surgeons. The individual learning curves varied widely. In our series, female surgeons seem to have a faster learning curve. Conclusion RD surgery performed by VR surgeons in training had acceptable results. With increasing experience, success rates continuously improve reaching stable levels after approximately 200 operations. The training of VR surgeons requires considerable resources.
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Affiliation(s)
- Viola Radeck
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - Horst Helbig
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany.
| | - Teresa Barth
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - Maria-Andreea Gamulescu
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - David Maerker
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - Philipp Prahs
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
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Zaletel Benda P, Vratanar B, Petrovski G, Gavrić AU, Matović K, Gornik A, Vergot K, Lumi A, Lumi X. Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment. J Clin Med 2020; 9:jcm9103251. [PMID: 33053642 PMCID: PMC7601405 DOI: 10.3390/jcm9103251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022] Open
Abstract
Pars plana vitrectomy (PPV) is a surgical approach mainly chosen for complex rhegmatogenous retinal detachment (RRD) repair with highly variable functional results. The aim of this analysis was to evaluate the impact of preoperative factors and postoperative optical coherence tomography (OCT) macular findings on the functional outcome of patients undergoing primary PPV for RRD. A retrospective analysis was performed on 88 eyes of 88 patients with complex RRD managed by PPV. A swept source OCT was used to obtain images at the postoperative visit at least 6 months after PPV. Hierarchical linear regression model was used to evaluate the influence of preoperative factors related to patient, ocular clinical and postoperative OCT macular findings on functional outcomes of PPV for RRD. Duration of symptoms (p = 0.031) and discontinuity of the ellipsoid zone (EZ) on OCT (p = 0.024) showed statistically significant negative correlation, while preoperative best-corrected visual acuity (BCVA; p < 0.001) showed statistically significant positive correlation to postoperative BCVA. Preoperative BCVA and duration of symptoms can be used as prognostic factors for visual outcome in patients undergoing PPV for RRD. Discontinuity of the EZ was the only postoperative OCT variable related to worse postoperative visual outcome.
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Affiliation(s)
- Polona Zaletel Benda
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Bor Vratanar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia;
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway;
| | - Ana Uršula Gavrić
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Katja Matović
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Ana Gornik
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Katarina Vergot
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Anila Lumi
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
| | - Xhevat Lumi
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia; (P.Z.B.); (A.U.G.); (K.M.); (A.G.); (K.V.); (A.L.)
- Correspondence: ; Tel.: +38-615-221-900
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9
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Abraham JR, Srivastava SK, K Le T, Sharma S, Rachitskaya A, Reese JL, Ehlers JP. Intraoperative OCT-Assisted Retinal Detachment Repair in the DISCOVER Study: Impact and Outcomes. Ophthalmol Retina 2019; 4:378-383. [PMID: 31948909 DOI: 10.1016/j.oret.2019.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/04/2019] [Accepted: 11/04/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study is to evaluate intraoperative OCT (iOCT) utility and outcomes during retinal detachment (RD) repair. DESIGN The Determination of Feasibility of Intraoperative Spectral-Domain Microscope Combined/Integrated OCT Visualization during En Face Retinal and Ophthalmic Surgery (DISCOVER) intraoperative OCT study is a prospective Institutional Review Board-approved study. PARTICIPANTS Participants in the DISCOVER study undergoing surgical repair for RD. METHODS This was a post hoc analysis of eyes in the DISCOVER study undergoing surgical repair for RDs. Inclusion criteria included iOCT after perfluorocarbon liquid placement and at least 6 months follow-up. Exclusion criteria included severe retinal pathology unrelated to RD. Surgeons completed standardized questionnaires after each case evaluating the iOCT instrument's utility. Functional and surgical outcome data were collected at the latest available time point between 6 and 12 months. Outcomes were evaluated in 2 groups: uncomplicated primary and complex cases. MAIN OUTCOME MEASURES Intraoperative OCT utility, single-surgery success, and visual acuity outcomes. RESULTS A total of 103 eyes were included in this study: 51 uncomplicated primary and 52 complex cases. Intraoperative OCT provided valuable information in 36% of cases. In 12% of cases, iOCT data directly altered surgical decision making. There was a significantly higher rate of valuable iOCT feedback in complex cases compared with primary cases (50% vs. 22%, P < 0.01). Among primary cases, 48 (94%) had successful single surgery repair with a mean postoperative visual acuity of 20/47 compared with the complex group's 75% single surgery success (n=39) and mean postoperative visual acuity of 20/92. CONCLUSIONS This study affirms the potential impact of iOCT in assisting select cases of RD repair, particularly with complex pathology. The single surgery success rate was good with more than 80% of cases successfully repaired with 1 surgery.
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Affiliation(s)
- Joseph R Abraham
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thuy K Le
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sumit Sharma
- Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Jamie L Reese
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
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10
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Park SH, Yang SC, Lee JJ, Kwon H, Park SW, Lee JE. Fortified Barrier Laser On The Vitreous Base In Vitrectomy For Rhegmatogenous Retinal Detachment. Clin Ophthalmol 2019; 13:2127-2133. [PMID: 31802842 PMCID: PMC6827521 DOI: 10.2147/opth.s223415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the efficacy of fortified barrier laser (FBL) on the vitreous base in vitrectomy for rhegmatogenous retinal detachment (RRD). Patients and methods This was a retrospective study of patients who underwent vitrectomy for RRD without proliferative vitreoretinopathy. Barrier laser was applied as 3-4 rows surrounding the break at the end of fluid-air exchange. For the FBL, 3-4 rows of laser burn were additionally made about 0.5 clock-hour long adjacent to the break along the posterior border of the vitreous base. The primary outcome was single surgery success rate (SSSR) between two groups: FBL and conventional barrier laser (CBL) groups. Results Overall, 118 eyes were included; 50 eyes in the FBL group and 68 eyes in the CBL group. SSSR was 100% (50/50) in the FBL group and 91.2% (62/68) in the CBL group with a significant difference (p=0.038). Four eyes of the recurrent cases in the CBL group were related to reopening of the break. All eyes achieved reattachment, and no differences were found in postoperative visual acuity at 6 months. Conclusion FBL on the vitreous base was efficacious in improving the anatomical success rate of vitrectomy.
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Affiliation(s)
- Sun Ho Park
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sang Cheol Yang
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jae Jung Lee
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hanjo Kwon
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sung Who Park
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology, School of Medicine, Pusan National University, Yangsan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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11
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Shields RA, Ludwig CA, Powers MA, Tijerina JD, Schachar IH, Moshfeghi DM. Surgical timing and presence of a vitreoretinal fellow on postoperative adverse events following pars plana vitrectomy. Eur J Ophthalmol 2018; 30:81-87. [PMID: 30426767 DOI: 10.1177/1120672118811980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To evaluate the adverse event rate following pars plana vitrectomy as a function of surgical start time and the presence of a vitreoretinal fellow. METHODS Single-institution retrospective cohort study of patients undergoing pars plana vitrectomy from 1 January 2016 to 31 December 2016 at Stanford University School of Medicine (Palo Alto, CA, USA). Records were reviewed for surgical start time, the presence of vitreoretinal fellow, and postoperative adverse events defined as any finding deviating from the expected postoperative course requiring observation or intervention. RESULTS A total of 310 pars plana vitrectomies were performed. There was no statistical difference in the rate of any adverse event when comparing cases starting after 16:01 (9/13, 69.2%) and after 12:01 (42/99, 42.4%) to a morning start time (69/198, 34.9%, adjusted p = 0.083). There was a statistically significant increase in the risk of postoperative vitreous hemorrhage with afternoon and evening cases as compared to morning cases (adjusted p = 0.021). In addition, there was no difference in any adverse event with a fellow present (93/244, 38.1%) compared to without (27/66, 40.9%, adjusted p = 0.163). There was a higher risk of postoperative hypotony when a fellow was involved (6.6% vs 0%, p = 0.028), though this difference disappeared after adjusting for confounders (adjusted p = 0.252). There was no difference in the length of surgery with and without a fellow (49 vs 54 min, respectively; p = 0.990). DISCUSSION Afternoon start time and the presence of a fellow were not independent risk factors for postoperative adverse events.
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Affiliation(s)
- Ryan A Shields
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cassie A Ludwig
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Matthew A Powers
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jonathan D Tijerina
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ira H Schachar
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Darius M Moshfeghi
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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ROYAL COLLEGE OF OPHTHALMOLOGISTS' NATIONAL DATABASE STUDY OF VITREORETINAL SURGERY: Report 7, Intersurgeon Variations in Primary Rhegmatogenous Retinal Detachment Failure. Retina 2018; 38:334-342. [PMID: 28221255 DOI: 10.1097/iae.0000000000001538] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND/PURPOSE To audit variations in primary rhegmatogenous retinal detachment (RD) anatomical failure rates between surgeons, grades of surgeons, and techniques of RD surgery. METHODS Clinical data of a total of 5,857 eyes undergoing primary RD surgery, from 2000 to 2013 were retrospectively extracted from 15 centers using the same commercially available electronic medical record system, from three vitreoretinal units using an in-house electronic medical record, and from the British and Eire Association of Vitreoretinal Surgeons online registry. RESULTS The 5,857 primary RD operations were performed by 117 surgeons: 3,349 (57.2%) by consultants, 520 (8.9%) by independent nonconsultants, and 1,988 (33.9%) by trainees. Surgery comprised pars plana vitrectomy for 4,666 (79.7%) operations, scleral buckle for 815 (13.9%), and pars plana vitrectomy + scleral buckle for 376 (6.4%). The RD reoperation rate at 6 months after primary surgery was 13.9% (725/5,202) and did not differ significantly between consultants and trainees (P = 0.382). For surgeons contributing ≥50 cases, the mean (range) reoperation rates were 13.1% (6.7%-26.8%), 15.1% (11.3%-18.2%), and 15.3% (9.4%-22.1%) for consultants, independent nonconsultants, and trainee surgeons, respectively. The scleral buckle failure rate was not significantly different from pars plana vitrectomy (P = 0.095). Data were not adjusted for case-mix complexity. CONCLUSION The grades of surgeons and the technique of surgery were not associated with a significant difference in primary unadjusted RD failure rates.
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Gizicki R, Chow D, Mak MY, Wong DT, Muni RH, Altomare F, Berger AR, Giavedoni L. Differences in Surgical Performance of Internal Limiting Membrane Peeling for Macular Hole Repair Between Supervised Vitreoretinal Fellows and Vitreoretinal Faculty at a Single Institution. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2474126417721402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To investigate the differences in surgical maneuvers between vitreoretinal fellows and experienced vitreoretinal surgeons (attendings) when performing internal limiting membrane (ILM) peel during macular hole (MH) surgery and repair. Methods: Prospective case series. Macular hole surgeries performed by fellows and attendings at St Michael’s Hospital (Toronto, Canada) were recorded during a 12-month period. Evaluation of recordings was masked. Total peel time (TPL) in seconds, total movement attempts initiating and extending ILM flaps, intrasurgical complications, and surgical efficiency (ratio of approaches leading to case progression to total approaches) were quantified. Results: A total of 145 surgeries were evaluated; 44 met inclusion and exclusion criteria. Of the 44 cases, 25 were performed by fellows and 19 by attendings. Mean TPL was shorter for attendings (336 vs 506 seconds, P = .0032). Attendings had a lower average total movement attempts (32.2 vs 43.2, P = .045) and average flap initiation attempts (16.1 vs 23.3, P = .042). Surgical efficiency was better for attendings (45% vs 37% of approaches led to case progression, P = .038). There was no significant difference between groups in total flap extension attempts or intrasurgical complications. Conclusions: Compared to fellows, attendings peel ILM in MH surgery faster, more efficiently with a lower number of flap initiation attempts and total movements.
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Affiliation(s)
- Robert Gizicki
- St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David Chow
- St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Retina Institute, Toronto, Ontario, Canada
| | - Michael Y.K. Mak
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David T. Wong
- St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev H. Muni
- St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Filiberto Altomare
- St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alan R. Berger
- St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Retina Institute, Toronto, Ontario, Canada
| | - Louis Giavedoni
- St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto Retina Institute, Toronto, Ontario, Canada
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Chaturvedi V, Basham RP, Rezaei KA. Scleral depressed vitreous shaving, 360 laser, and perfluoropropane (C3 F8) for retinal detachment. Indian J Ophthalmol 2016; 62:804-8. [PMID: 25116775 PMCID: PMC4152652 DOI: 10.4103/0301-4738.138621] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To review the characteristics and outcomes of patients who underwent pars plana vitrectomy (PPV) with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 gas for rhegmatogenous retinal detachment (RRD). Materials and Methods: A retrospective review of a consecutive series of patients who underwent primary repair of RRD by PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% perfluoropropane (C3F8) was conducted. Patients with less than 3 months follow-up, previous retinal surgery, and higher than grade B proliferative vitreoretinopathy were excluded. Results: Ninety-one eyes were included in the study. The mean age was 60.1 years. The mean follow-up was 13.7 months. The macula was detached in 63% (58/91) of the eyes. The reattachment rate after one surgical procedure was 95% (86/91) while overall reattachment rate was 100%. There was no statistically significant difference between reattachment rates of superior, nasal/temporal, or inferior RRDs. The mean final best corrected visual acuity (BCVA) was 20/40. Of all the patients, 66% of patients with macula-off RRDs had a final BCVA of 20/40 or better. Conclusions: PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 leads to successful anatomical reattachment with visual improvement in patients with primary RRD.
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Affiliation(s)
| | | | - Kourous A Rezaei
- Department of Ophthalmology, Rush University Medical Center, Chicago; Illinois Retina Associates, Harvey, Illinois, USA
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15
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Keller J, Haynes RJ, Sparrow JM. Sequential Hypothesis Testing to Characterise the Learning Curve and Monitor Surgical Performance in Retinal Detachment Surgery. Ophthalmologica 2016; 235:157-62. [PMID: 26863026 DOI: 10.1159/000443749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/30/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterise the learning curve of primary retinal detachment (RD) repair for trainee surgeons and monitor the outcomes of surgery for established surgeons. PROCEDURES Primary RD operations were analysed sequentially using the cumulative sum (CUSUM) and the sequential probability ratio test (SPRT). RESULTS 359 analysed cases of primary RD were audited with a recurrent RD (ReRD) rate of 14.7%. The individual rate of ReRD ranged from 9.4 to 17.4% (p = 0.74). SPRT and CUSUM analyses showed that ReRD occurred at random when operated by senior surgeons but a learning curve was discernible for junior surgeons. There was a trend for a higher proportion of ReRD caused by untreated breaks in cases operated by junior surgeons (p = 0.75). CONCLUSION SPRT and CUSUM are useful methods to monitor surgical outcomes and should be included in audits of sequential operations such as RD. Trainee surgeons experience a quantifiable learning curve.
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Abou Shousha M. Assessment of chandelier-assisted scleral buckling surgery. JOURNAL OF THE EGYPTIAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.4103/2090-0686.174684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Walter P. Retinal detachment surgery: the dilemma between personal experience and clinical trials. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Comparison between subjective and objective internal limiting membrane peeling area during epiretinal membrane surgery. Retina 2014; 34:1335-40. [PMID: 24384614 DOI: 10.1097/iae.0000000000000066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the reliability of surgeons in estimating internal limiting membrane peeling area during epiretinal membrane surgery and to evaluate their ability to remove a predetermined internal limiting membrane surface. METHODS One senior surgeon and two junior surgeons were asked to reach a target internal limiting membrane peeling surface (ILMPS) with an eccentricity of 1 optic disk diameter (centered on the fovea) in patients undergoing epiretinal membrane surgery. The ILMPS was measured on video recordings during epiretinal membrane surgery with no dye and then after brilliant blue G staining. RESULTS Thirty patients were included. Median (interquartile range) ILMPS was 9.3 mm(2) (5.7-16.3 mm(2)) and 7.4 mm(2) (3.7-16.4 mm) before and after brilliant blue G, respectively (P = 0.17). The ILMPS was significantly larger in eyes operated by the senior surgeon than in those operated by the junior surgeons (P = 0.01). The senior surgeon reached the target ILMPS more often than the junior surgeons: 87% versus 47%, respectively (P = 0.02). CONCLUSION Subjective estimation of the ILMPS with no dye was fair, but this area was larger for the surgeon with greater surgical expertise.
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19
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Nagpal M, Bhardwaj S, Mehrotra N. Scleral Buckling for Rhegmatogenous Retinal Detachment Using Vitrectomy-Based Visualization Systems and Chandelier Illumination. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2013; 2:165-8. [PMID: 26108108 DOI: 10.1097/apo.0b013e3182929b75] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to evaluate an alternative approach to scleral buckling surgery using vitrectomy-based chandelier visualization systems instead of the indirect ophthalmoscope. DESIGN This was a prospective case series. METHODS Ten eyes underwent scleral buckling under microscope using contact wide-angle lens with 25-gauge chandelier illumination and were followed up for 6 months. RESULTS An encirclage was done in 8 eyes, and segmental buckle used in 2 eyes. Excellent intraoperative visualization was achieved, and all routine buckling steps were easily replicated with this approach. CONCLUSIONS Using contact wide-angle lens along with chandelier illumination under microscope allows good visualization for scleral buckling procedure. This approach may allow excellent visibility with zooming capabilities for each step of the procedure as well as allows transmission to a monitor in the theater for teaching purposes apart from allowing better ergonomics for the surgeon.
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Affiliation(s)
- Manish Nagpal
- From the Retina Foundation, Ahmedabad, Gujarat, India
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20
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Ehrlich R, Niederer RL, Ahmad N, Polkinghorne P. Timing of acute macula-on rhegmatogenous retinal detachment repair. Retina 2013; 33:105-10. [PMID: 22990323 DOI: 10.1097/iae.0b013e318263ceca] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine if same-day or next available surgery changed the outcome of patients presenting with acute macula-on rhegmatogenous retinal detachments. METHODS A retrospective review of patients presenting with acute macula-on rhegmatogenous retinal detachments treated with small-gauge vitrectomy was performed. Data collection included subjects' demographics, duration of symptoms, location and extent of the retinal detachment, and timing of surgery. The primary outcome was anatomical and functional success rate for patients having same-day surgery compared with those for whom surgery was delayed. RESULTS One hundred and fourteen patients were included in this study. Sixty-two patients operated on day of presentation, 46 patients operated the day after presentation, and in 6 patients, surgery was delayed from 2 to 5 days. Time to surgery in hours ranged between 1 and 120 hours (mean 14.5 ± 15.05 hours). Retinal reattachment was achieved in 95.6% of patients, with 80% requiring only one procedure. Mean initial visual acuity was logarithm of the minimum angle of resolution 0.42 (SD 0.6), and mean final visual acuity was logarithm of the minimum angle of resolution 0.39 (SD 0.67) (P = 0.53). Time to surgery was not found to effect final anatomical outcome (P = 0.56). No statistically significant association was observed between change in visual acuity and time to surgery (P = 0.99). CONCLUSION Modest delay in timing of surgery for macula-on rhegmatogenous retinal detachment did not adversely impact on patients' outcome.
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Affiliation(s)
- Rita Ehrlich
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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21
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Pastor JC, Fernández I, Coco RM, Sanabria MR, Rodríguez de la Rúa E, Piñon RM, Martinez V, Sala-Puigdollers A, Gallardo JM, Velilla S. Variations in Functional and Anatomical Outcomes and in Proliferative Vitreoretinopathy Rate along a Prospective Collaborative Study on Primary Rhegmatogenous Retinal Detachments: The Retina 1 Project-Report 4. ISRN OPHTHALMOLOGY 2012; 2012:206385. [PMID: 24527230 PMCID: PMC3912585 DOI: 10.5402/2012/206385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 09/26/2012] [Indexed: 11/24/2022]
Abstract
Purpose. To analyse variations in the anatomical and functional outcomes and in proliferative vitreoretinopathy (PVR) rate of a prospective multicentric study that was primarily designed for identification of clinical risk factors for PVR. Methods. 1,046 retinal detachment (RD) cases were analysed. Cases were divided into two series based upon variation in PVR rate determined by logistic regression analysis. Series 1 (S1) included RD treated during 2004-2005 (n = 481) and Series 2 (S2) during 2006–2008 (n = 565). Pre-, intra-, and postoperative characteristics were recorded. Results. There were few differences in the preoperative characteristics. S2 had more vitrectomies and scleral bands and fewer explants and associated cataract extractions than S1. Anatomic reattachment improved from 87.9% to 92.9% in S1 and S2, respectively, (P = 0.006). Visual acuity at 3 months ≥20/40 increased from 36.5% of S1 to 44.2% in S2 (P = 0.049). PVR rate diminished from 14.1% in S1 to 8.1% in S2 (P = 0.002). Centres with higher rates of PVR in S1 showed the greatest reductions in S2. Conclusion. An improvement in anatomical and functional outcome and PVR rate occurred in participating centres cannot be attributed to the learning curve of surgeons. We speculated that it could be an effect of their participation in the study.
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Affiliation(s)
- J Carlos Pastor
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain ; Ciber BBN, 50018 Zaragoza, Spain
| | - Itziar Fernández
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Ciber BBN, 50018 Zaragoza, Spain
| | - Rosa M Coco
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain
| | - María R Sanabria
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Department of Ophthalmology, Complejo Asistencial de Palencia (CAPA), 34005 Palencia, Spain
| | - Enrique Rodríguez de la Rúa
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Department of Ophthalmology, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - Rosa M Piñon
- Department of Ophthalmology, Hospital General Universitario de Burgos, 09005 Burgos, Spain
| | - Vicente Martinez
- Department of Ophthalmology, Hospital Vall d'Hebrón, 08035 Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, 47011 Valladolid, Spain ; Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain
| | - José M Gallardo
- Department of Ophthalmology, Hospital Reina Sofia, 14004 Córdoba, Spain
| | - Sara Velilla
- Department of Ophthalmology, Hospital San Millán, 26006 Logroño, Spain
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Shah NV, Houston SK, Murray TG, Markoe AM. Evaluation of the surgical learning curve for I-125 episcleral plaque placement for the treatment of posterior uveal melanoma: a two decade review. Clin Ophthalmol 2012; 6:447-52. [PMID: 22536035 PMCID: PMC3334212 DOI: 10.2147/opth.s30307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the surgical learning curve in episceral plaque brachytherapy placement in the management of posterior uveal melanoma. Methods A retrospective chart review of two cohorts of 250 consecutive patients undergoing plaque placement for posterior uveal melanoma from 2002 to 2004 and from 2008 to 2009 was conducted. The plaque–tumor apposition rates verified by intraoperative echography were evaluated and correlated with surgical volume over a 19-year period. Results In an initial study of 29 consecutive patients undergoing plaque placement from January 1992 to January 1995, a suboptimal plaque placement rate of 21% (n = 29) was identified. This percentage declined to 12% (n = 100) from January 2002 to January 2004, and further declined to 4% (n = 150) from June 2008 to August 2009. The tumor–plaque apposition rates for these three groups were 79% (1992–1995), 88% (2002–2004), and 96% (2008–2009). An estimated surgical volume of 1275 cases was performed to achieve a >90% precision rate for first application of primary plaque centration. Conclusion There are challenges to mastering the precise placement of radioactive plaques for posterior uveal melanoma. We have demonstrated a significant learning curve for plaque placement techniques, and have emphasized the importance of intraoperative ultrasound in the verification of plaque placement, thus allowing for intraoperative repositioning.
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Affiliation(s)
- Nisha V Shah
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Intraoperative conversion rate to a large, limbal opening in minimally invasive strabismus surgery (MISS). Graefes Arch Clin Exp Ophthalmol 2011; 249:1553-7. [PMID: 21607635 DOI: 10.1007/s00417-011-1707-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/19/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND To evaluate which factors predispose to an intraoperative conversion to the usual limbal approach in minimally invasive strabismus surgery (MISS). METHODS This study included 451 consecutive patients operated on by one surgeon at Kantonsspital St Gallen, Switzerland, with minimally invasive rectus muscle surgery between February 2003 and December 2007. We evaluated the intraoperative conversion rate to the usual limbal approach over time, and performed a retrospective determination of date of surgery, age of patient, motility of the eye, primary or revision surgery, and the type and dose of surgery in 982 consecutive rectus muscle procedures. RESULTS In 3.6% (35/982) of MISS procedures, an intraoperative conversion to a large, limbal approach was necessary. The overall conversion rate decreased over time, from 8.4% in 2003 to 0.4% in 2007. The multivariate regression analysis showed a significant negative influence between the date of surgery and the conversion rate (p < 0.005). Muscle resections were associated with a higher conversion rate (p < 0.001). The other evaluated factors had no significant influence on an intraoperative enlargement of the conjunctival opening. CONCLUSIONS This study confirms the reliability of the new MISS technique, and shows a low conversion rate to the usual limbal approach. The conversion rate decreased over time with increasing surgical experience. Muscle resections were associated with a higher conversion rate, while the age of the patient, the motility of the eye, revision surgery and the dose of surgery had no significant influence on an intraoperative conversion.
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Ehrlich R, Ahmad N, Welch S, Hadden P, Polkinghorne P. Vitreoretinal fellow surgical outcome of small gauge pars plana vitrectomy for acute rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2011; 249:1147-52. [PMID: 21390512 DOI: 10.1007/s00417-011-1638-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 02/07/2011] [Accepted: 02/11/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Our purpose was to determine the anatomical outcome following small gauge vitrectomy for acute rhegmatogenous retinal detachment (RRD) operated by vitreoretinal fellows. METHODS We undertook a retrospective review of adult patients presenting with an acute RRD treated with small gauge vitrectomy where the operating surgeon was either a vitreoretinal fellow or consultant surgeon. The patient's demographics were recorded as well as relevant clinical findings. The end point was determined to be the anatomical outcome and number of surgeries. RESULTS Two hundred and twelve eyes were included in this study. The age range was 21-90 years, with approximately one third of the patients being female. The macula was attached in 53% at presentation, and 65% of the eyes were phakic. Primary re-attachment with a single operation was achieved in 75% of cases, and final re-attachment rate was 92%. Mean presenting visual acuity was LogMAR 1.07 (SD 1.09) and final visual acuity was LogMAR 0.63 (SD 0.85). We found no association between final anatomical success and experience of the surgeon (p = 0.6). CONCLUSION We found that acute RRD treated by vitreoretinal fellows using small gauge vitrectomy did not place the patient at any discernable disadvantage.
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Affiliation(s)
- Rita Ehrlich
- Department of Ophthalmology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand.
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