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Zajner C, Leung B, Sheidow T, Malvankar-Mehta MS. Quality of Life after Pars Plana Vitrectomy, Scleral Buckle, or Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment: A Meta-Analysis. Curr Eye Res 2024; 49:295-302. [PMID: 37937863 DOI: 10.1080/02713683.2023.2280440] [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: 01/17/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Comparisons of the surgical and anatomic results of rhegmatogenous retinal detachment surgery have been investigated previously. A systematic evaluation of the available evidence comparing quality of life outcomes of either pars plana vitrectomy, scleral buckling, or pneumatic retinopexy has not been evaluated to date. This article analyzes whether pars plana vitrectomy, scleral buckling, or pneumatic retinopexy for the treatment of rhegmatogenous retinal detachment results in differing quality of life outcomes. METHODS In February of 2022, a comprehensive search of MEDLINE, EMBASE, CINHAL, and Cochrane Library was conducted for studies on patients treated surgically for rhegmatogenous retinal detachment and included follow-up measurements of quality of life outcomes. Meta-analysis was completed using STATA v. 14.0. The main outcomes of interest were the mean vision-related quality of life score (VRQOL) and SD of VRQOL of each type of surgical procedure. RESULTS In this systematic review of 13 distinct trials including follow-up of patient quality of life after rhegmatogenous retinal detachment surgery (n = 1063), a better correlation was found between higher quality of life outcomes with scleral buckling than with pars plana vitrectomy (SMD = 0.62, CI: [0.31, 0.93]). There was also no signficant difference in quality of life outcomes between pneumatic retinopexy and pars plana vitrectomy (SMD = 0.08, CI: [-0.07, 0.22]). CONCLUSIONS Scleral buckling results in better quality of life outcomes for patients when compared to pars plana vitrectomy. Pneumatic retinopexy did not show a difference in quality of life outcomes compared to pars plana vitrectomy.
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Affiliation(s)
- Chris Zajner
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Bernice Leung
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Tom Sheidow
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
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Felfeli T, Teja B, Miranda RN, Simbulan F, Sridhar J, Sander B, Naimark DM. Cost-Utility of Rhegmatogenous Retinal Detachment Repair With Pars Plana Vitrectomy, Scleral Buckle, and Pneumatic Retinopexy: A Microsimulation Model. Am J Ophthalmol 2023; 255:141-154. [PMID: 37327958 DOI: 10.1016/j.ajo.2023.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To assess the cost-effectiveness of primary noncomplex rhegmatogenous retinal detachment (RRD) repair, comparing 3 different strategies, pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PnR) from the health care payer perspective over a lifetime. DESIGN Model-based cost-utility analysis. METHODS A simulated cohort of 100,000 adult patients (≥18 years old) requiring primary noncomplex RRD repair in theoretical surgical centers in the United States. Quality-adjusted life years (QALYs), lifetime costs (2022 United States dollars), and the incremental cost-effectiveness ratio (ICER) of the 3 interventions were projected over a lifetime horizon, with a cost-effectiveness threshold of ≤$50,000 per gained QALY. RESULTS Based on inputted parameters, the primary anatomical success was highest for PPV (95.00%) compared to SB (91.76%) and PnR (63.41%). The QALYs associated with PPV, SB, and PnR were (11.87, SD 1.62), (11.84, SD 1.63), and (11.59, SD 1.72), respectively. The incurred lifetime costs of RRD repair and associated postoperative surgeries for PPV, SB, and PnR were $4445.72 (SD 655.75), $4518.04 (662.92), and $3978.45 (728.50), respectively. Parameter-level simulations suggested that PPV was most likely to be the most cost-effective therapy compared to SB and PnR beyond a threshold of $3000/QALY. The incremental cost-effectiveness ratio for PPV compared to PnR was $1693.54. SB was dominant in all scenarios. Threshold analyses indicated that the success rate of PnR would have to be 100% and/or the cost would have to be $2000 or less over lifetime for it to be more cost-effective than PPV. CONCLUSIONS This study found PPV to be the most cost-effective primary procedure for RRD repair at a threshold of $50,000/QALY gained over a lifetime horizon from the health care payer perspective.
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Affiliation(s)
- Tina Felfeli
- From the Department of Ophthalmology and Vision Sciences, University of Toronto (T.F.), Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada.
| | - Bijan Teja
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Anesthesiology and Pain Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto (B.T.), Ontario, Canada
| | - Rafael N Miranda
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., B.S.), Ontario, Canada
| | - Frances Simbulan
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; The Hospital for Sick Children Research Institute, University of Toronto (F.S.), Ontario, Canada
| | - Jayanth Sridhar
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine (J.S.), Florida, USA
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network (T.F., R.N.M., B.S.), Ontario, Canada
| | - David M Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto (T.F., B.T., R.N.M., F.S., J.S., B.S., D.N.), Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre (D.N.), Ontario, Canada
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Scleral Buckling: A Review of Clinical Aspects and Current Concepts. J Clin Med 2022; 11:jcm11020314. [PMID: 35054009 PMCID: PMC8778378 DOI: 10.3390/jcm11020314] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 01/27/2023] Open
Abstract
Scleral buckling represents a valuable treatment option for rhegmatogenous retinal detachment repair. The surgery is based on two main principles: the closure of retinal breaks and the creation of a long-lasting chorioretinal adhesion. Buckles are placed onto the sclera with the purpose of sealing retinal breaks. Cryopexy is usually performed to ensure a long-lasting chorioretinal adhesion. Clinical outcomes of scleral buckling have been shown to be more favorable in phakic eyes with uncomplicated or medium complexity retinal detachment, yielding better anatomical and functional results compared with vitrectomy. Several complications have been described following scleral buckling surgery, some of which are sight-threatening. Expertise in indirect ophthalmoscopy is required to perform this type of surgery. A great experience is necessary to prevent complications and to deal with them. The use of scleral buckling surgery has declined over the years due to increasing interest in vitrectomy. Lack of confidence in indirect ophthalmoscopy and difficulties in teaching this surgery have contributed to limiting its diffusion among young ophthalmologists. The aim of this review is to provide a comprehensive guide on technical and clinical aspects of scleral buckling, focusing also on complications and their management.
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Scleral buckling surgery for stage 4A and 4B retinopathy of prematurity in critically ill neonates. Int Ophthalmol 2021; 42:1093-1100. [PMID: 34724137 DOI: 10.1007/s10792-021-02095-3] [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: 07/12/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the efficacy of scleral buckling in eyes with stage 4A and 4B retinopathy of prematurity (ROP). METHODS Seven eyes of five premature infants underwent scleral buckling for stage 4 ROP in zone II. Five eyes had stage 4A ROP, and two eyes had stage 4B ROP. Six eyes had previous diode laser photocoagulation, and one eye had received an intravitreal ranibizumab injection. Scleral buckling was the procedure of choice due to lack of access to specialized pediatric vitrectomy instrumentation. Average age at surgery was 3.4 months. Postoperative anatomic retinal status, visual acuity outcome and refractive error were assessed. RESULTS The scleral buckle was removed on average 8 months after surgery. Retinal reattachment was achieved in all seven eyes. At final follow-up one eye had macular ectopia and disc dragging, one eye had a macular traction fold and two eyes had optic disc pallor. Average myopic error after buckle removal was -7.5 D. CONCLUSION Scleral buckling can be performed safely and effectively in 4A and 4B stage ROP in critically ill infants, when access to specialized pediatric vitrectomy instrumentation is limited. This surgical technique may provide adequate relief of vitreoretinal traction with improved visual potential.
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Alkabes M, Fogagnolo P, Vezzola D, Muraca A, Savoini A, Wild D, Frerio F, Ranno S, Radice P, De Cillà S. Microscope-assisted episcleral surgery with encircling buckles and chandelier endoillumination for primary rhegmatogenous retinal detachment in phakic and pseudophakic patients: a 12-months comparative study. Ophthalmologica 2021; 244:560-568. [PMID: 34198301 DOI: 10.1159/000517878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Micol Alkabes
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Paolo Fogagnolo
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
| | - Diego Vezzola
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Andrea Muraca
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Alberto Savoini
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Davide Wild
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Filippo Frerio
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Stefano Ranno
- University Eye Clinic, San Giuseppe Hospital, IRCCS MultiMedica, Milano, Italy
| | - Paolo Radice
- Eye Clinic, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Stefano De Cillà
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
- Department of Health Sciences, University East Piedmont A. Avogadro, Novara, Italy
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Factors Affecting the Outcome of Scleral Buckling Surgery for Primary Rhegmatogenous Retinal Detachment. J Ophthalmol 2018; 2018:9016302. [PMID: 30538859 PMCID: PMC6260553 DOI: 10.1155/2018/9016302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Scleral buckle surgery retains a special place in treatment of retinal detachment despite development of new and advanced vitreoretinal surgical techniques. The outcome of any retinal detachment surgery depends on correct selection of patient, type and nature of detachment, and the expertise. This study aims to evaluate various other parameters that determine the outcome of scleral buckle surgery. Method Records of 55 patients with primary rhegmatogenous retinal detachment treated with scleral buckling over a duration of 18 months that had a minimum of 3-month follow-up were retrospectively reviewed. Preoperative and postoperative characteristics were recorded. Parameters that were evaluated to determine the outcome were best-corrected visual acuity (BCVA), anatomical success, and complications. Results A total of 51 eyes of 50 patients that met the inclusion criteria were included. Mean age was 41 ± 19.9 years (range: 9 to 83). Primary anatomical success was achieved in 80.4%. Parameters significantly associated with the anatomical outcome of surgery were status of lens, preoperative visual acuity, and extent of retinal detachment. There was a significant improvement of visual acuity postoperatively. Conclusion Scleral buckle surgery is a highly effective surgery in uncomplicated retinal detachment cases, and single surgery success rates are better in cases with good preoperative visual acuity, partial detachment, and clear crystalline lens.
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Modified Vitrectomy Technique for Phakic Rhegmatogenous Retinal Detachment with Intermediate Break. J Ophthalmol 2018; 2018:6127932. [PMID: 30425854 PMCID: PMC6218725 DOI: 10.1155/2018/6127932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/06/2018] [Accepted: 10/01/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the effects of a modification of the traditional 25-gauge pars plana vitrectomy technique in the treatment of uncomplicated macula-on rhegmatogenous retinal detachment (RRD) with intermediate retinal break(s) and marked vitreous traction in the phakic eye. Methods Prospective, noncomparative, and interventional case series. All consecutive phakic eyes with primary uncomplicated macula-on RRD with intermediate retinal break(s) and marked vitreous traction, with at least 1 year of postoperative follow-up, were enrolled. In all eyes, "localized 25-gauge vitrectomy" under air infusion with localized removal of the vitreous surrounding the retinal break(s), in association with laser photocoagulation and air tamponade, was performed. The primary end point was the rate of primary retinal attachment. Secondary end points were cataract progression and assessed by digital Scheimpflug lens photography (mean change of nuclear density units) and the rate of complications. Results Thirty-two phakic eyes were included in the final analysis. At 12 months, the primary outcome of anatomical success was achieved in 94% of eyes. The mean nuclear density units did not change significantly at any time point during the follow-up. After localized vitrectomy, one eye developed an epiretinal membrane, and one eye developed cystoid macular edema; no other significant complications were reported. Conclusions "Localized vitrectomy" has a high anatomical success rate in phakic eyes with primary uncomplicated macula-on RRD with intermediate retinal break(s) and marked vitreous traction, without causing progression of cataract.
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Air Bubble Technique for Fundus Visualization during Vitrectomy in Aphakia. J Ophthalmol 2017; 2017:4721540. [PMID: 29214075 PMCID: PMC5682074 DOI: 10.1155/2017/4721540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of air bubble technique for vitrectomy in aphakia. Study Design Prospective interventional uncontrolled case series. Methods This study included 53 eyes of 53 patients who are phakic and indicated for phacovitrectomy (7 eyes, group 1), aphakic and indicated for vitrectomy (22 eyes, group 2), or underwent unplanned vitrectomy for immediate management of a phacoemulsification surgery complicated by rupture posterior capsule with dropped nucleus, fragments, or IOL (24 eyes, group 3). Cases with complicated vitreoretinal pathology were not included in this study. All vitrectomy surgeries were conducted by the air bubble technique in the anterior chamber. Main outcomes included anatomical success, visual acuity, and intraoperative and postoperative complications. Results The surgical success was achieved in 50 eyes (94.3%). Conversion to BIOM viewing system was needed in the retinal detachment cases of groups 1 and 2. The mean overall LogMAR visual acuity was significantly improved from 1.29 ± 0.58 preoperatively to 0.56 ± 0.19 at the final visit, 6 months postoperatively (P < 0.001). Conclusion The air bubble technique as visualization method for vitrectomy in aphakia is an effective and cheap technique for immediate management of complications of phacoemulsification surgery. This trial is registered with Pan African Clinical Trial Registry PACTR201709002466296.
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Scleral buckling in phakic uncomplicated primary rhegmatogenous retinal detachment: long-term outcomes. Eur J Ophthalmol 2016; 27:220-225. [PMID: 28106235 PMCID: PMC6379801 DOI: 10.5301/ejo.5000914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/30/2022]
Abstract
Purpose Scleral buckling (SB) is a surgical technique that has been used successfully
to treat retinal detachments for the last 6 decades. The aim of this study
was to report the long-term anatomical and functional outcomes of SB surgery
in phakic patients with uncomplicated primary rhegmatogenous retinal
detachment (PRRD). This article also outlines the benefits of SB compared to
pars plana vitrectomy, such as reducing the risk of developing cataract,
high intraocular pressure, and glaucoma, in addition to reducing surgical
cost. Methods We retrospectively reviewed the clinical notes of 90 phakic eyes with PRRD
treated with SB surgery that had a minimum of 5 years follow-up.
Preoperative and postoperative characteristics were recorded. Main outcome
measures were reattachment rate, best-corrected visual acuity (BCVA)
improvement, and complications. Results A total of 90 eyes (88 patients) with phakic PRRD repaired through SB surgery
were included. Mean age was 49.2 ± 14.6 years (range 20-80). Primary and
final anatomic success was 96.7% and 100%, respectively. Mean preoperative
BCVA was 0.3 ± 0.31 logMAR (6/12) and mean postoperative BCVA 0.1 ± 0.2
logMAR (p<0.001) (6/7.5). There were no cataract or primary open-angle
glaucoma cases after 1 year of follow-up. Mean follow-up was 8.5 ± 2.6 years
(range 5-13). Conclusions We report a high single operation success rate over time in phakic PRRD,
repaired through SB surgery. Functional and anatomical success was
maintained throughout the follow-up without complications. Therefore, the
authors recommend the use of this technique in selected cases in order to
reduce morbidity and the incidence of reoperations.
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Seider MI, Nomides REK, Hahn P, Mruthyunjaya P, Mahmoud TH. Scleral Buckling with Chandelier Illumination. J Ophthalmic Vis Res 2016; 11:304-9. [PMID: 27621789 PMCID: PMC5000534 DOI: 10.4103/2008-322x.188402] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Scleral buckling is a highly successful technique for the repair of rhegmatogenous retinal detachment that requires intra-operative examination of the retina and treatment of retinal breaks via indirect ophthalmoscopy. Data suggest that scleral buckling likely results in improved outcomes for many patients but is declining in popularity, perhaps because of significant advances in vitrectomy instrumentation and visualization systems. Emerging data suggest that chandelier-assisted scleral buckling is safe and has many potential advantages over traditional buckling techniques. By combining traditional scleral buckling with contemporary vitreoretinal visualization techniques, chandelier-assistance may increase the popularity of scleral buckling to treat primary rhegmatogenous retinal detachment for surgeons of the next generation, maintaining buckling as an option for appropriate patients in the future.
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Affiliation(s)
| | | | - Paul Hahn
- Duke University Eye Center, Durham, NC, USA
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Gu R, Zhou M, Jiang C, Yu J, Xu G. Elevated concentration of cytokines in aqueous in post-vitrectomy eyes. Clin Exp Ophthalmol 2015; 44:128-34. [PMID: 26317489 DOI: 10.1111/ceo.12638] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- RuiPing Gu
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye and ENT Hospital, Shanghai Medical College; Fudan University; Shanghai China
| | - Min Zhou
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye and ENT Hospital, Shanghai Medical College; Fudan University; Shanghai China
| | - ChunHui Jiang
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye and ENT Hospital, Shanghai Medical College; Fudan University; Shanghai China
- Department of Ophthalmology; No. 5 People's Hospital of Shanghai; Shanghai China
| | - Jian Yu
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye and ENT Hospital, Shanghai Medical College; Fudan University; Shanghai China
| | - GeZhi Xu
- Department of Ophthalmology and Shanghai Key Laboratory of Visual Impairment and Restoration, Eye and ENT Hospital, Shanghai Medical College; Fudan University; Shanghai China
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Xia F, Jiang YQ. Clinical outcomes of 23-gauge vitrectomy may be better than 20-gauge vitrectomy for retinal detachment repair. Mol Vis 2015; 21:893-900. [PMID: 26392739 PMCID: PMC4556160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/19/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study compared the clinical outcomes between 23-gauge (23-G) vitrectomy and 20-gauge (20-G) vitrectomy for the repair of retinal detachment (RD). METHODS A retrospective comparative analysis of 135 RD patients was conducted between January, 2013 and September, 2014 in the Ophthalmology Department of the Affiliated Hospital of Weifang Medical College. The clinical outcomes of RD patients who underwent 23-G vitrectomy (n = 65) and 20-G vitrectomy (n = 70) were compared. A logistic regression analysis was used for prognostic factors in RD patients. A meta-analysis was performed using the comprehensive Meta-Analysis version 2.0 software. RESULTS Baseline characteristics of RD patients between the 23-G group and the 20-G group were not significantly different (all p>0.05). The postoperative wound closure time was obviously shorter, and postoperative intraocular pressure (IOP; mmHg) and the incidence of macular holes (MH) were evidently lower in the 23-G group than in the 20-G group (all p<0.05). However, no statistical significances in the postoperative retinal reattachment rate or visual acuity improvement in the logarithm of the minimum angle of resolution (logMAR) were detected between the 23-G group and the 20-G group (both p>0.05). The meta-analysis further confirmed a shorter postoperative wound closure time, as well as a lower postoperative IOP and incidence of MH in the 23-G group than in the 20-G group (all p<0.05), while neither the postoperative retinal reattachment rate nor the visual acuity improvement in the logMAR showed statistical significance (all p>0.05). CONCLUSIONS Our retrospective comparative study of RD surgery using 20-G or 23-G techniques revealed a shorter postoperative wound closure time, as well as a lower postoperative IOP and incidence of MH in the 23-G group than in the 20-G group, confirming the superiority of 23-G vitrectomy over 20-G vitrectomy. This study provided a better option of 23-G vitrectomy for clinically managing RD.
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Affiliation(s)
- Fei Xia
- Department of Ophthalmology, the Affiliated Hospital of Weifang Medical University, Weifang, P.R. China
| | - Ya-Qin Jiang
- Department of Ophthalmology, Weifang Eye Hospital, Weifang, P.R. China
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Ma Y, Ying X, Zou H, Xu X, Liu H, Bai L, Xu X, Zhang X. Rhegmatogenous retinal detachment surgery in elderly people over 70 years old: visual acuity, quality of life, and cost-utility values. PLoS One 2014; 9:e110256. [PMID: 25330168 PMCID: PMC4201523 DOI: 10.1371/journal.pone.0110256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/10/2014] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose To evaluate the influence of rhegmatogenous retinal detachment (RRD) surgery on elderly patients in terms of visual acuity, vision-related quality of life and its cost-effectiveness. Methods Elderly patients over 70 years old, who were diagnosed and underwent RRD surgery at Shanghai First People's Hospital, Shanghai Jiao Tong University, China, from January 1, 2009, through January 1, 2013. The participants received scleral buckling surgery and vitreous surgery with or without scleral buckling under retrobulbar anesthesia. We followed the patients for 1 year and collected best-corrected visual acuity (BCVA), vision-related quality of life, and direct medical costs data. Utility values elicited by time-trade-off were analyzed to determine the quality of life. Quality-adjusted life years (QALYs) gained in life expectancy were calculated and discounted at 3% annually. Costs per QALY gained were reported using the bootstrap method. Further analyses were made for two age groups, age 70–79 and age over 80 years. Sensitivity analyses were performed to test stability of the results. Results 98 patients were included in the study. The BCVA significantly improved by 0.53±0.44 (Logarithm of the Minimum Angle of Resolution (logMAR)) at the 1-year postoperative time point (p<0.001). Utility values increased from 0.77 to 0.84 (p<0.001), and an average of 0.4 QALYs were gained in the life expectancy. Costs per QALY gained from the RRD surgery were 33,186 Chinese Yuan (CNY) (5,276 US dollars (USD))/QALY; 24,535 CNY (3,901 USD)/QALY for the age group of 70–79 years and 71,240 CNY (11,326 USD)/QALY for the age group over 80 years. Conclusions RRD surgery improved the visual acuity and quality of life in the elderly patients over 70 years old. According to the World Health Organization’s recommendation, at a threshold of willingness to pay of 115,062 CNY (18,293 USD)/QALY, RRD surgery is cost effective in the elderly patients.
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Affiliation(s)
- Yingyan Ma
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China; Shanghai Eye Disease Prevention & Treatment Center, Shanghai, China
| | - Xiaocheng Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Haiyun Liu
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Bai
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xi Zhang
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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