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Hébert M, Bourgault S, Caissie M, Tourville É, Dirani A. REtinal Detachment Outcomes Study (REDOS): study protocol for a factorial, randomized controlled trial. Trials 2023; 24:820. [PMID: 38124155 PMCID: PMC10734075 DOI: 10.1186/s13063-023-07815-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Few large randomized controlled trials provide strong evidence to guide surgical repair of primary rhegmatogenous retinal detachment (RRD) repair. The purpose of this factorial, single-blind, randomized controlled trial is to analyze and compare the surgical outcomes, functional visual outcomes, complications, and quality of life associated with RRD repair using (A) pars plana vitrectomy only (PPV) or PPV with scleral buckle (PPV-SB) and (B) sulfur hexafluoride gas (SF6) or perfluoropropane gas (C3F8) tamponade. METHODS Eligible patients with moderately complex RRD will be randomized 1:1 to PPV or PPV-SB and 1:1 to SF6 or C3F8 gas tamponade. Approximately 560 patients will be recruited to be able to detect a difference of around 10% in SSAS rate between the groups. Patients will be followed using multimodal imaging and quality of life questionnaires after the surgical repair until 1 year postoperative. The primary outcome will be a single-surgery anatomic success (SSAS), defined as the absence of reoperation for recurrent RRD in the operating room. Secondary outcomes will be pinhole visual acuity (PHVA) at 8-10 weeks and 6 months, final best-corrected visual acuity (BCVA), final retina status (i.e., attached or detached), time to onset of RRD recurrence, severity and number of complications, and questionnaire results. DISCUSSION This will be the first 2 × 2 factorial RCT examining repair techniques in primary RRD. It will also be the first RCT to compare gas tamponade between the two most common agents. Notably, it will be adequately powered to detect a clinically significant effect size. The use of multimodal imaging will also be a novel aspect of this study, allowing us to compare head-to-head the impact of adding an SB to the retina's recovery after RRD repair and of differing gas tamponades. Until now, the treatment of RRD has been largely guided by pragmatic retrospective cohort studies. There is a lack of strong evidence guiding therapeutic decisions and this trial will address (1) whether supplemental SB is justified and (2) whether longer duration gas tamponade with C3F8 is necessary. TRIAL REGISTRATION ClinicalTrials.gov NCT05863312. Registered on 18 May 2023.
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Affiliation(s)
- Mélanie Hébert
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Serge Bourgault
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Mathieu Caissie
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Éric Tourville
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Ali Dirani
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada.
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Muni RH, Minaker SA, Mason RH, Popovic MM, Kertes PJ, Hillier RJ. Novel classification system for management of rhegmatogenous retinal detachment with minimally invasive detachment surgery: a network meta-analysis of randomized trials focused on patient-centred outcomes. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:97-112. [PMID: 34798054 DOI: 10.1016/j.jcjo.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 07/25/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe a novel classification system for primary rhegmatogenous retinal detachment (RRD) based on level 1 evidence assessing the functional outcomes of repair techniques with the goal of using a minimally invasive detachment surgery. METHODS A systematic review and network meta-analysis of randomized, controlled trials comparing pneumatic retinopexy (PnR), scleral buckle (SB), or pars plana vitrectomy (PPV) for RRD was conducted. Primary outcomes were best-corrected visual acuity (BCVA), metamorphopsia, and operative complications. A meta-analysis was performed with a random effects maximum likelihood model, with outcomes of standardized mean difference (SMD) or risk ratio (RR) and 95% confidence interval. Inclusion and exclusion criteria were assessed to inform a classification system. RESULTS Fourteen trials were included. RRDs were classified from categories 1-3 based on configuration (simple to complex). There was no significant difference in final BCVA between PnR and PPV (categories 1 and 2; SMD = -0.10, 95% CI -0.24 to 0.04), nor was a final BVCA difference found between SB and PPV (SMD = 0.01, 95% CI -0.05 to 0.08), combined SB + PPV and PPV (SMD = 0.02, 95% CI -0.08 to 0.12), or combined SB + PPV and SB (SMD = 0.01, 95% CI -0.11 to 0.12). SB had an elevated risk of choroidal detachment (RR = 5.17, 95% CI 1.68-15.97), hypotony (RR = 12.26, 95% CI 1.63-92.04), and strabismus or diplopia (RR = 5.86, 95% CI 1.04-32.91) compared with PPV but a lower risk of iatrogenic breaks (RR = 0.08, 95% CI 0.02-0.43). Vertical metamorphopsia scores were superior for PnR over PPV at 12 months (Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial, p = 0.026). CONCLUSION This novel classification system may be useful for future trials assessing morphologic categories of RRD in a systematic manner. Minimally invasive detachment surgery may allow for trials to focus on maximizing functional outcomes while minimizing morbidity.
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Affiliation(s)
- Rajeev H Muni
- Department of Ophthalmology, Unity Health Toronto, St. Michael's Hospital, Toronto, ON; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON.
| | - Samuel A Minaker
- Department of Ophthalmology, Unity Health Toronto, St. Michael's Hospital, Toronto, ON; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Ryan H Mason
- Department of Ophthalmology, Unity Health Toronto, St. Michael's Hospital, Toronto, ON; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Marko M Popovic
- Department of Ophthalmology, Unity Health Toronto, St. Michael's Hospital, Toronto, ON; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Eshtiaghi A, Dhoot AS, Mihalache A, Popovic MM, Nichani PAH, Sayal AP, Yu HJ, Wykoff CC, Kertes PJ, Muni RH. Pars Plana Vitrectomy with and without Supplemental Scleral Buckle for the Repair of Rhegmatogenous Retinal Detachment: A Meta-analysis. Ophthalmol Retina 2022; 6:871-885. [PMID: 35227949 DOI: 10.1016/j.oret.2022.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/06/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
TOPIC It is unclear whether there are differences in safety and efficacy between pars plana vitrectomy (PPV) alone and PPV with a supplemental scleral buckle (SB; PPV-SB) for the treatment of rhegmatogenous retinal detachment. CLINICAL RELEVANCE This meta-analysis aimed to compare the safety and efficacy of these surgical procedures. METHODS In this meta-analysis, Ovid MEDLINE, Embase, and Cochrane Library were systematically searched (January 2000-June 2021). The primary outcome was the final best corrected visual acuity (BCVA), whereas the secondary outcomes were reattachment rates and complications. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized controlled trials (RCTs) and the risk of bias in nonrandomized studies of interventions tool for nonrandomized studies. RESULTS This study included 15 661 eyes from 38 studies (32 observational studies and 6 RCTs). The median follow-up duration was 6 months. The final BCVA was similar between PPV and PPV-SB (weighted mean difference [WMD], -0.03 logarithm of the minimum angle of resolution [-0.14 to 0.07]; P = 0.55). There was a significant difference in the single-operation success rate (SOSR) (88.2% versus 86.3%; relative risk [RR], 0.97 [0.95-1.00]; P = 0.03), favoring PPV-SB; however, there was no significant difference in the final reattachment rate (RR, 1.00 [0.99-1.01]; P = 0.56). Pars plana vitrectomy required a significantly higher number of operations to achieve final anatomical reattachment (WMD, 0.13 [0.02-0.24]; P = 0.02). In terms of complications, PPV was significantly less likely to be associated with macular edema (RR, 0.47 [0.25-0.88]; P = 0.02) and epiretinal membrane formation (RR, 0.70 [0.52-0.94]; P = 0.02), but these differences were no longer significant in studies published after 2010 or in RCTs. Significant proliferative vitreoretinopathy, lens status, and macular attachment status did not mediate differences in these effects. CONCLUSIONS There were no significant differences in the final visual acuity outcomes between PPV and PPV-SB. Pars plana vitrectomy with supplemental SB was associated with a greater SOSR than standalone PPV, although the magnitude of the effect was small, with a high number needed to treat. The final reattachment rate was similar. In recent studies and in RCTs, the risk of complications was similar between the procedures.
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Affiliation(s)
- Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Prem A H Nichani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hannah J Yu
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Charles C Wykoff
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.
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Outcomes in primary uncomplicated rhegmatogenous retinal detachment repair using pars plana vitrectomy with or without scleral buckle. Retina 2022; 42:1161-1169. [PMID: 35174803 DOI: 10.1097/iae.0000000000003425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare outcomes following primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB). METHODS This is a retrospective cohort study with propensity score analysis in a single tertiary care center between 2014 and 2018 comparing patients with primary uncomplicated RRD repaired using PPV only or PPV-SB (full cohort: n=1516, propensity-matched cohort: n=908). The primary outcome was single surgery anatomic success (SSAS), while secondary outcomes were 3-month and final pinhole visual acuity (PHVA) in logarithm of the minimum angle of resolution (logMAR) and final retina status. RESULTS In the full cohort, SSAS was achieved in 745 (91%) of PPV patients vs. 623 (89%) of PPV-SB patients (p=0.13). This was 390 (92%) vs. 314 (88%) in phakic patients (p=0.06) compared to 353 (91%) vs. 301 (90%) in pseudophakic patients (p=0.79), respectively. After matching, SSAS was achieved in 424 (93%) of PPV patients vs. 412 (91%) of PPV-SB patients (p=0.14). Median PHVA after PPV was better at 3 months (PPV: 20/40 vs. PPV-SB: 20/50; both cohorts: p<0.001) and final follow-up (PPV: 20/29 vs. PPV-SB: 20/38; full cohort: p<0.001 and PPV: 20/29 vs. PPV-SB: 20/36; matched cohort: p<0.001). CONCLUSION Addition of SB does not significantly change the rate of SSAS compared to PPV only in primary uncomplicated RRD. It is also associated with worse PHVA at follow-up.
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Dhoot AS, Popovic MM, Nichani PAH, Eshtiaghi A, Mihalache A, Sayal AP, Yu H, Wykoff CC, Kertes PJ, Muni RH. Pars Plana Vitrectomy versus Scleral Buckle: A Comprehensive Meta-Analysis of 15,947 Eyes. Surv Ophthalmol 2021; 67:932-949. [PMID: 34896191 DOI: 10.1016/j.survophthal.2021.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
Pars plana vitrectomy (PPV) and scleral buckling (SB) are two of the most common surgical treatments for rhegmatogenous retinal detachment (RRD). This meta-analysis compares the efficacy and safety of PPV and SB for RRD. A systematic literature review was performed using Ovid MEDLINE, EMBASE and Cochrane CENTRAL from 2000 to June 2021. Comparative studies, randomized controlled trials and observational studies investigating PPV and SB for RRD repair were included. The primary endpoint was final best- corrected visual acuity (BCVA). Secondary endpoints were reattachment rates, total operation time, and incidence of adverse events. Subgroup analyses including phakic status, presence of PVR-C or greater at baseline, and macular attachment status were conducted. Across 41 studies (8 RCTs, 33 observational studies), 5,401 SB and 10,546 PPV eyes were included. SB achieved a statistically significant, but likely not clinically significant, better final BCVA than PPV (0.38 ± 0.53 vs. 0.33 ± 0.53 logMAR (20/48 vs. 20/43 Snellen); weighted mean difference [WMD]: 0.07; 95% confidence interval: [0.02-0.11]; P=0.005). SB had a better final BCVA compared to PPV in observational studies (P=0.007) but not in RCTs (P=0.21). SB had a lower incidence of post-operative cataract formation (P<0.00001) and iatrogenic breaks (P<0.00001), but a higher incidence of choroidal hemorrhage (P=0.007), choroidal detachment (P=0.004), and residual subretinal fluid (RSRF) (P<0.00001). Primary (86.5% vs. 84.8%; P=0.13) and final (96.7% vs. 97.7%; P=0.12) reattachment rates were similar between PPV and SB. PPV had a significantly higher primary reattachment rate in RCTs (P=0.02) but not in observational studies (P=0.30). SB was associated with a better final BCVA than PPV; however, this result was primarily driven by observational studies and phakic patients who developed cataracts. Primary and final reattachment rates were similar between the comparators. SB was associated with a significantly lower incidence of iatrogenic breaks and cataracts, while PPV was associated with a reduced risk of choroidal detachment, subretinal hemorrhage, and RSRF.
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Affiliation(s)
- Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Prem A H Nichani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Yu
- Retina Consultants of Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States of America
| | - Charles C Wykoff
- Retina Consultants of Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States of America
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.
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Xu ZY, Azuara-Blanco A, Kadonosono K, Murray T, Natarajan S, Sii S, Smiddy W, Steel DH, Wolfensberger TJ, Lois N. Reporting of Complications in Retinal Detachment Surgical Trials: A Systematic Review Using the CONSORT Extension for Harms. JAMA Ophthalmol 2021; 139:2781201. [PMID: 34137800 DOI: 10.1001/jamaophthalmol.2021.1836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Knowledge on the frequency and severity of complications in surgical trials for rhegmatogenous retinal detachment (RRD) is essential to determine whether surgical procedures are developed and compared adequately, taking into account not only efficacy but also harms. OBJECTIVE To review standards of reporting of complications in recent randomized clinical trials of RRD surgery. EVIDENCE REVIEW This systematic review included randomized clinical trials on RRD surgery published between January 2008 and January 2021 in Embase, MEDLINE, and Web of Science Core Collection databases. Titles, abstracts, and full-text articles retrieved were reviewed for eligibility by 2 independent authors. Eligible studies were evaluated against checklist items from the Consolidated Standards of Reporting Trials Extension for Harms criteria by 2 independent authors, and discrepancies were resolved by discussion with a third author. FINDINGS Fifty studies were included. The median number of checklist items fulfilled was 8 (range, 0-15), of a possible total of 18. Frequently reported items were discussions balanced with regard to efficacy and adverse events (42 studies [84%]) and inclusions of harm-associated timing of data collection (41 studies [82%]). The least frequently reported items were distinctions between expected and unexpected adverse events (1 study [2%]) and mentions of the use of a validated instrument to report adverse event severity (4 studies [8%]). Frequency of complications was commonly reported (29 studies [58%]) in contrast with complication severity (10 studies [20%]). CONCLUSIONS AND RELEVANCE This review suggests that severity of complications of RRD surgery has been infrequently quantified and reported in randomized clinical trials and potentially represents an important area of improvement in future RRD surgical trials.
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Affiliation(s)
- Zheng Yang Xu
- Centre for Public Health, Queen's University, Belfast, United Kingdom
| | | | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Japan
| | | | | | - Samantha Sii
- Department of Ophthalmology, Lincoln County Hospital, United Kingdom
| | | | - David H Steel
- Sunderland Eye Infirmary, University of Newcastle Upon Tyne, United Kingdom
- Institute of Genetic Medicine, University of Newcastle Upon Tyne, United Kingdom
| | | | - Noemi Lois
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University, Belfast, United Kingdom
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Popovic MM, Muni RH, Nichani P, Kertes PJ. Pars plana vitrectomy, scleral buckle, and pneumatic retinopexy for the management of rhegmatogenous retinal detachment: a meta-analysis. Surv Ophthalmol 2021; 67:184-196. [PMID: 34043984 DOI: 10.1016/j.survophthal.2021.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
We reviewed the literature on the efficacy and safety of pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PR) for the management of rhegmatogenous retinal detachments (RRDs). A systematic search was performed on three databases from inception to September 2020. Randomized controlled trials (RCTs) comparing RRD management options were included. Meta-analysis was performed using a random effects model. Eighteen RCTs and 2,751 eyes were included. For PPV versus SB, early postoperative corrected distance visual acuity (CDVA) favored SB (weighted mean <1 month postoperatively: ~counting fingers for PPV versus ~20/260 for SB, P = 0.02), but differences were nonsignificant at other time points. There was no difference for primary reattachment (P = 0.08). PPV had a lower incidence of choroidal detachment (P = 0.004), hypotony (P = 0.01), and strabismus/diplopia (P = 0.04) but a higher incidence of iatrogenic breaks (P = 0.003) and cataract development/progression (P = 0.05) relative to SB. Combination management was nonsignificantly different relative to PPV alone for CDVA, complications and reattachment rate. In closing, PPV is associated with a slower visual recovery, but similar final visual acuity and primary reattachment rate relative to SB. Combination procedures did not improve primary reattachment rates or vision relative to standalone PPV. Heterogeneity was seen across the included trials, and further randomized trials are needed to reduce the uncertainty of these estimates.
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Affiliation(s)
- Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Prem Nichani
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Rao P, Kaiser R, Lum F, Atchison E, Parke DW, Williams GA. Reoperation Rates of Patients Undergoing Primary Noncomplex Retinal Detachment Surgery in a Cohort of the IRIS Registry. Am J Ophthalmol 2021; 222:69-75. [PMID: 32898502 DOI: 10.1016/j.ajo.2020.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To present the reoperation rates of patients who underwent a primary noncomplex RD repair in a cohort of the American Academy of Ophthalmology IRIS Registry. DESIGN Retrospective, nonrandomized comparative clinical study. METHODS This was a retrospective, nonrandomized cohort study of patients who underwent a primary noncomplex RD repair with either a scleral buckle (SB) or vitrectomy with or without scleral buckle (PPV±SB) between 2013 and 2016. The primary outcome was the odds of reoperation within 12 months. RESULTS Of 24,068 patients, 2,937 patients (12.2%) underwent an SB and 21,131 patients (87.8%) a PPV ± SB. The overall reoperation rate was 12.2% for SB and 11.6% for PPV ± SB. After multivariate adjustment for age and initial RD diagnosis, the PPV ± SB group exhibited a lower odds of reoperation within 12 months compared with SB only (OR 0.84, 95% CI 0.75-0.96, P = .007). However, there was an age interaction. Patients ≤50 years old with PPV ± SB exhibited a higher odds of reoperation (OR 1.46, 95% CI 1.14-1.88, P = .003) compared to SB only. Patients >50 years with PPV ± SB had a lower odds of reoperation (OR 0.73, 95% CI 0.63-0.84, P < .0001). CONCLUSION The odds of reoperation of PPV ± SB compared with SB only varies depending on the patient's age. Further subset analyses are required to determine if there are clinically relevant differences with respect to RD configuration or other RD repair types (PPV only vs PPV with SB).
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Affiliation(s)
- Prethy Rao
- Emory Eye Center, Atlanta, Georgia, USA.
| | | | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California, USA
| | | | - David W Parke
- American Academy of Ophthalmology, San Francisco, California, USA
| | - George A Williams
- American Academy of Ophthalmology, San Francisco, California, USA; Associated Retinal Consultants, Royal Oak, Michigan, USA
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Management of uncomplicated primary retinal rhegmatogenous detachment. Int Ophthalmol 2021; 41:1709-1716. [PMID: 33511514 DOI: 10.1007/s10792-021-01729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to compare the vitreoretinal surgery outcomes in patients with uncomplicated rhegmatogenous retinal detachment (RRD). DESIGN This was a retrospective, nonrandomized consecutive case series study. PARTICIPANTS Six hundred and eighty-three eyes with primary uncomplicated RRD between 2013 and 2017 were included in this study. METHOD Patients were treated by one of the following methods: pars plana vitrectomy (PPV), scleral buckling (SB), and combined PPV with SB (PPV + SB). The success rate was divided into an anatomical and functional one, the anatomical success rate was retinal reattachment, and the functional success rate was defined as a statistically significant improvement in BCVA patients within a 6-month follow-up period. RESULTS This study involved 683 eyes; of these, 79 eyes underwent PPV, combined PPV/SB was performed on 180 eyes, and 424 eyes underwent SB. The anatomical success rates were 83.5% for PPV and 80% for combined SB/PPV. The anatomical success rate for the SB group was 75.5%. There were no significant differences between these groups in terms of anatomical success rates (0.191) or functional success rates (p = 0.534). There was no significant difference between the PPV alone and PPV + SB in terms of the likelihood of anatomic success (p-value: 0.503) or functional success (p-value: 0.839). Preoperative worse BCVA and presence of PVR were associated with poor prognosis (p-value: 0.024, 0.013, respectively). CONCLUSION In the setting of appropriate instruments for microincision pars plana deep vitrectomy, it seems the surgical outcomes of scleral buckling and PPV are not different in patients with primary uncomplicated RRD. The supplementary band has not additional benefits in patients who underwent PPV with this type of RRD.
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Han SU, Choi HJ, Song JH. Surgical Results of Scleral Buckling without Subretinal Fluid Drainage in Patients with Primary Rhegmatogenous Retinal Detachment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.11.1302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Nossair AA, Ewais WA, Eissa SA. Chandelier-assisted scleral buckling using wide angle viewing contact lens for pseudophakic retinal detachment repair. Int J Ophthalmol 2019; 12:627-633. [PMID: 31024818 DOI: 10.18240/ijo.2019.04.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 11/07/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate a modified technique for scleral buckling (SB) in pseudophakic retinal detachment (RD). METHODS A retrospective non-comparative study included 21 consecutive eyes with uncomplicated pseudophakic RD that was repaired by chandelier assisted SB using wide angle viewing (WAV) contact lens. Segmental tire alone was used in 5 eyes (23.81%), and combined with encircling band in 7 eyes (33.33%). Radial sponge alone was used in 3 eyes (14.29%) and combined with encircling band in 6 eyes (28.57%). RESULTS Primary success rate was (90.48%). External drainage of subretinal fluid was performed in 8 eyes (38.1%). Intraoperative complications included vitreous prolapse at chandelier sclerotomy site in 4 eyes (19.05%) and localized subretinal hemorrhage at drainage site in one eye (4.76%). No case of intraocular lens (IOL) displacement, retinal incarceration or iatrogenic retinal tear was detected. Postoperative complications included choroidal detachment in one eye (4.76%), elevated intraocular pressure in 2 eyes (9.52%), epiretinal membrane formation in one eye (4.76%) and proliferative vitreoretinopathy in 3 eyes (14.29%). Mean postoperative corrected distance visual acuity was 0.7±0.3 logMAR units. CONCLUSION Chandelier-assisted SB using WAV contact lens is a reliable technique for repairing selected cases of simple pseudophakic RD.
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Affiliation(s)
- Ashraf Ahmed Nossair
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt.,Dar El Oyoun Hospital, Dokki, Giza 1261, Egypt
| | - Wael Ahmed Ewais
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt.,Dar El Oyoun Hospital, Dokki, Giza 1261, Egypt
| | - Sherif Ahmed Eissa
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
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Bhardwaj G, Walker RJE, Ezra E, Mirza Z, Muqit MMK. A 21-Year Study of Vitreoretinal Surgery for Aphakic Retinal Detachment: Long-Term Surgical Outcomes and Complications. Ophthalmol Retina 2019; 3:784-790. [PMID: 31104986 DOI: 10.1016/j.oret.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/13/2019] [Accepted: 04/01/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the characteristics and outcomes of primary retinal detachment (RD) surgery in aphakic patients. DESIGN Retrospective case series. PARTICIPANTS Sixty eyes with primary aphakic RD (ARD) in 51 patients. METHODS A consecutive series of patients who underwent vitreoretinal surgery for primary rhegmatogenous ARD was analyzed retrospectively between 1997 and 2018 at Moorfields Eye Hospital. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), surgical outcomes, and complications. RESULTS Mean BCVA improved from 1.31 to 1.08 logarithm of the minimum angle of resolution (logMAR; P = 0.081) over a mean follow-up period of 8.2 years. Macula-off retinal detachments showed significantly improved BCVA from 1.72 to 1.1 logMAR (P = 0.007). Mean age was 38.8 years, and the most common cause of aphakia was congenital cataract surgery (55%). The macula was attached in 45% eyes, and grade C proliferative vitreoretinopathy (PVR) was present in 12%. Operations performed were vitrectomy (88%), combined vitrectomy and scleral buckle (8%), and encirclement (3%). The final anatomic success rate was 88%, and PVR was a significant predictor of redetachment (P = 0.03; odds ratio, 20.7; 95% confidence interval, 2.8-152.2). Raised intraocular pressure was the most common postoperative complication at 30%, with a rate of de novo postoperative glaucoma of 6.7% at final follow-up. CONCLUSIONS We report high rates of primary and overall anatomic success for surgery in ARD surgery. Grade C PVR was a positive predictor for surgical failure. Final visual outcomes were limited by ocular comorbidity, and we report significant improved visual outcomes for macula-off ARD.
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Affiliation(s)
- Gaurav Bhardwaj
- Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Robbie J E Walker
- Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Eric Ezra
- Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Zahir Mirza
- Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Mahiul M K Muqit
- Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom.
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Cacioppo V, Govetto A, Radice P, Virgili G, Scialdone A. Premacular membrane formation after scleral buckling for primary rhegmatogenous retinal detachment: prospective study and pathophysiological insights. Br J Ophthalmol 2018; 103:481-487. [DOI: 10.1136/bjophthalmol-2017-311787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/24/2018] [Accepted: 05/22/2018] [Indexed: 11/03/2022]
Abstract
PurposeTo investigate the incidence, clinical features and risk factors of premacular membrane (PMM) formation after primary rhegmatogenous retinal detachment (RRD) repair with scleral buckling (SB) alone.MethodsThis institutional, prospective and consecutive case series included phakic eyes with RRD, treated with SB alone within 7 days from the occurrence of symptoms, with a follow-up of 6 months. Spectral-domain optical coherence tomography images were reviewed. The association of PMM development and morphology with preoperative and intraoperative RRD features was analysed.ResultsNinety-two patients with a mean age of 56±13 years completed the 6 months follow-up period. Postoperatively, eyes with any PMM stage were 30 out of 92 (32.6%) at 1 month and 47 out of 92 (51,1%) at both 3 months and 6 months. Over the follow-up period, 17 out of 47 PMMs (36.2%) progressed to later stages. Progression of PMMs to later stages were observed only in RRDs involving the macular region (17 out of 35 eyes, 48.5%), while none of the PMMs in macula-sparing detachments progressed to later stages (p=0.020). The risk factors significantly associated with postoperative new onset of PMM were preoperative RRDs involving the macular region (p=0.001), cryopexy time (p=0.045), presence of horseshoe tears (p=0.003), worse preoperative visual acuity (p=0.004) and subretinal fluid drainage (p=0.047).ConclusionThe incidence of postoperative PMM formation after RRD repair with SB alone was high. In retinal detachments involving the macular region PMM were more severe, tending to anatomical progression and functional deterioration. Activation of foveal Müller cell in detachments involving the macula may be a key factor in PMM progression.
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Paulus YM, Leung LS, Pilyugina S, Blumenkranz MS. Comparison of Pneumatic Retinopexy and Scleral Buckle for Primary Rhegmatogenous Retinal Detachment Repair. Ophthalmic Surg Lasers Imaging Retina 2017; 48:887-893. [PMID: 29121357 DOI: 10.3928/23258160-20171030-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare pneumatic retinopexy (PR) and scleral buckle for the repair of primary rhegmatogenous retinal detachment. PATIENTS AND METHODS Retrospective analysis of 90 patients undergoing surgery for primary rhegmatogenous retinal detachment, with 46 patients undergoing PR compared with 44 patients undergoing scleral buckle procedure (SBP). RESULTS Both groups had similar baseline characteristics. Single surgery reattachment rate was 95.5% with SBP and 67% with PR (P = .00057). Final reattachment rate was 100% with SBP and 97.8% with PR. A final visual acuity (VA) of 20/40 or better occurred in 89% of patients with SBP and 72% of patients with PR (P = .04). PR and SBP had a similar mean VA if the primary procedures were successful, whereas those patients with unsuccessful PR had lower mean final acuities. CONCLUSIONS This study demonstrates that SBP has a significantly higher rate of single surgery reattachment than PR, along with improved final VA. Initial success of PR may be an important predictor of final visual outcome. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:887-893.].
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