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Nisanova A, Yavary A, Deaner J, Ali FS, Gogte P, Kaplan R, Chen KC, Nudleman E, Grewal D, Gupta M, Wolfe J, Klufas M, Yiu G, Soltani I, Emami-Naeini P. Performance of Automated Machine Learning in Predicting Outcomes of Pneumatic Retinopexy. OPHTHALMOLOGY SCIENCE 2024; 4:100470. [PMID: 38827487 PMCID: PMC11141253 DOI: 10.1016/j.xops.2024.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 06/04/2024]
Abstract
Purpose Automated machine learning (AutoML) has emerged as a novel tool for medical professionals lacking coding experience, enabling them to develop predictive models for treatment outcomes. This study evaluated the performance of AutoML tools in developing models predicting the success of pneumatic retinopexy (PR) in treatment of rhegmatogenous retinal detachment (RRD). These models were then compared with custom models created by machine learning (ML) experts. Design Retrospective multicenter study. Participants Five hundred and thirty nine consecutive patients with primary RRD that underwent PR by a vitreoretinal fellow at 6 training hospitals between 2002 and 2022. Methods We used 2 AutoML platforms: MATLAB Classification Learner and Google Cloud AutoML. Additional models were developed by computer scientists. We included patient demographics and baseline characteristics, including lens and macula status, RRD size, number and location of breaks, presence of vitreous hemorrhage and lattice degeneration, and physicians' experience. The dataset was split into a training (n = 483) and test set (n = 56). The training set, with a 2:1 success-to-failure ratio, was used to train the MATLAB models. Because Google Cloud AutoML requires a minimum of 1000 samples, the training set was tripled to create a new set with 1449 datapoints. Additionally, balanced datasets with a 1:1 success-to-failure ratio were created using Python. Main Outcome Measures Single-procedure anatomic success rate, as predicted by the ML models. F2 scores and area under the receiver operating curve (AUROC) were used as primary metrics to compare models. Results The best performing AutoML model (F2 score: 0.85; AUROC: 0.90; MATLAB), showed comparable performance to the custom model (0.92, 0.86) when trained on the balanced datasets. However, training the AutoML model with imbalanced data yielded misleadingly high AUROC (0.81) despite low F2-score (0.2) and sensitivity (0.17). Conclusions We demonstrated the feasibility of using AutoML as an accessible tool for medical professionals to develop models from clinical data. Such models can ultimately aid in the clinical decision-making, contributing to better patient outcomes. However, outcomes can be misleading or unreliable if used naively. Limitations exist, particularly if datasets contain missing variables or are highly imbalanced. Proper model selection and data preprocessing can improve the reliability of AutoML tools. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Arina Nisanova
- School of Medicine, University of California Davis, Davis, California
| | - Arefeh Yavary
- Department of Computer Science, University of California Davis, Davis, California
| | - Jordan Deaner
- Mid Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania
| | | | | | - Richard Kaplan
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | | | - Eric Nudleman
- Shiley Eye Center, University of California San Diego, La Jolla, California
| | | | - Meenakashi Gupta
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Jeremy Wolfe
- Associated Retinal Consultants, Royal Oak, Michigan
| | - Michael Klufas
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Glenn Yiu
- Tschannen Eye Institute, University of California Davis, Sacramento, California
| | - Iman Soltani
- Department of Mechanical and Aerospace Engineering, University of California Davis, Davis, California
| | - Parisa Emami-Naeini
- Tschannen Eye Institute, University of California Davis, Sacramento, California
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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: 0] [Impact Index Per Article: 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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Popovic MM, Muni RH, Kertes PJ, Thiruchelvam D, Chaban YV, Qian J, Hillier R, Redelmeier DA. A Population-Based Analysis of Long-Term Costs and Adverse Events after Pneumatic Retinopexy and Pars Plana Vitrectomy. Ophthalmol Retina 2023; 7:794-803. [PMID: 37286134 DOI: 10.1016/j.oret.2023.05.021] [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: 04/13/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To comprehensively examine the cost effectiveness, reattachment rate, and complications of pneumatic retinopexy (PnR) compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal health care system. DESIGN Population-based, multicenter, consecutive, retrospective longitudinal cohort analysis. SUBJECTS We identified consecutive adults aged ≥ 50 years requiring surgery for primary RRD over a 20-year interval between April 1, 2002, and March 31, 2022. Initial surgery was considered the index date for analyses. INTERVENTION Pneumatic retinopexy was compared with PPV in all analyses. MAIN OUTCOME MEASURES The primary analysis investigated the mean annualized health care costs comparing PnR to PPV over the 2 years after initial surgery. Secondary analyses examined the primary reattachment rate and complications. RESULTS In total, 25 665 eligible patients were identified, with 8794 undergoing PnR and 16 871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8924 and $11 937 after PPV (mean difference, $3013; 95% confidence interval, $2533-$3493; P < 0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (P < 0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections, and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR. CONCLUSIONS Pneumatic retinopexy, when compared with PPV, was associated with lower long-term health care costs. Pneumatic retinopexy appeared to be effective, safe, and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada; ICES, Toronto, Ontario, Canada
| | | | - Jenny Qian
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada
| | - Roxane Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; Translational & Clinical Research Institute, Newcastle University, United Kingdom
| | - Donald A Redelmeier
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Pneumatic Retinopexy Versus Pars Plana Vitrectomy for the Management of Retinal Detachment: A Systematic Review and Meta-Analysis. Ophthalmol Ther 2023; 12:705-719. [PMID: 36717526 PMCID: PMC10011247 DOI: 10.1007/s40123-023-00653-9] [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: 11/23/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair. METHODS We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1. RESULTS PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2.25-5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = - 0.58, 95% CI = - 1.16 to 0.00) and post-op (SMD = - 0.45, 95% CI = - 0.60 to - 0.30) LogMAR, the improvement in visual acuity after surgery was higher in PPV patients (SMD = 0.49, 95% CI = - 0.15 to 1.13). CONCLUSION The success rate of PnR was higher in studies published after 2015 compared to previous studies (82% vs. 59%). Cataract formation and surgery were significantly higher in the PPV arm, while the occurrence of new retinal tears was more frequent in the PnR group. PnR can be used as the primary procedure for RRD repair in selected cases. However, we propose some modifications to the PIVOT criteria, e.g., the exclusion of cases presenting with several risk factors of poor outcomes.
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Muni RH, Lee WW, Bansal A, Ramachandran A, Hillier RJ. A paradigm shift in retinal detachment repair: The concept of integrity. Prog Retin Eye Res 2022; 91:101079. [DOI: 10.1016/j.preteyeres.2022.101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
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Leung EH, Leder HA, Patel S, Reddy R, Boucher N, Sharma C, Blim J, Awh C, Hahn P. Opportunity Cost of Retinal Detachment Surgery vs Office-Based Patient Care. JOURNAL OF VITREORETINAL DISEASES 2022; 6:278-283. [PMID: 37007922 PMCID: PMC9976036 DOI: 10.1177/24741264221098669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work compares physician reimbursements for retinal detachment (RD) surgery with office-based patient care. Methods: A theoretical model was constructed from the physician’s perspective for performing a 90-minute uncomplicated RD surgery with its associated perioperative work in the global period (Current Procedural Terminology code 67108) compared with managing 40 patients per 8-hour clinic day in the equivalent time period. The reimbursement rates were based on the 2019 values set by the US Centers for Medicare and Medicaid Services (CMS). Sensitivity analyses were performed varying the perioperative times, clinical productivity, and postoperative visits. Results: The CMS physician reimbursement rate for 67108 surgery was 17.13 work relative value units (wRVUs); meanwhile, the physician in the reference case could have generated 40.89 wRVUs in the office. CMS reimbursement therefore represented a 58% opportunity cost relative to lost office productivity for the physician. A significant disparity was still present even when modeling 30 patients per day. In sensitivity analyses, clinical productivity exceeded surgical compensation in 99% of modeled scenarios. In threshold analyses, the surgeon in the reference case would have to complete the surgery and all immediate perioperative care within 18 minutes to equal the total CMS valuation. Conclusions: CMS reimbursement for RD surgery resulted in a significant opportunity cost for the physician relative to office-based patient care, which was more pronounced for more efficient clinicians in the office. The sensitivity analyses supported the robustness of the model. Reductions in surgery reimbursements relative to office-based patient care might disincentivize busy clinicians.
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Affiliation(s)
| | | | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rahul Reddy
- Department of Ophthalmology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | | | - Jill Blim
- American Society of Retina Specialists, Chicago, IL, USA
| | - Carl Awh
- Tennessee Retina, Nashville, TN, USA
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Shao I, Dhoot AS, Popovic MM, Oquendo PL, Hamli H, Kertes PJ, Muni RH. Pneumatic retinopexy: a review of an essential technique in vitreoretinal surgical care. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2022.2013817] [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: 10/19/2022]
Affiliation(s)
- Ian Shao
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, 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
| | - Paola L. Oquendo
- Department of Ophthalmology, St. Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Hesham Hamli
- Department of Ophthalmology, St. Michael’s Hospital/Unity Health 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
| | - 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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Huang CY, Mikowski M, Wu L. Pneumatic retinopexy: an update. Graefes Arch Clin Exp Ophthalmol 2021; 260:711-722. [PMID: 34636994 DOI: 10.1007/s00417-021-05448-x] [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: 06/21/2021] [Revised: 08/26/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022] Open
Abstract
Pneumatic retinopexy (PR) is a minimally invasive, non-incisional procedure for repairing uncomplicated rhegmatogenous retinal detachment. It consists of an intravitreal gas injection followed by the maintenance of a postoperative head position and the use of laser or cryopexy to seal the retinal breaks. It was initially indicated for a single or a group of retinal breaks no larger than 1 clock hour involving the superior 8 clock hours in phakic eyes with no proliferative vitreoretinopathy. We aim to perform a narrative review on pneumatic retinopexy since the last major review of 2008, based on a Medline search up to June 20 2021 using multiple search words including pneumatic retinopexy, pneumoretinopexy, retinal detachment, and pars plana vitrectomy. Indications for PR have been expanded and include pseudophakic eyes, eyes with mild PVR, and even breaks in the inferior fundus. Depending on the case selection, PR has a single-operation success rate ranging from 45 to 80%. Despite the lower single operation success rate, the functional outcomes of those eyes repaired successfully by primary PR exceed those of scleral buckling (SB) and pars plana vitrectomy (PPV). Best corrected visual acuity, metamorphopsia scores, mental health scores, and vision-related functioning scores were all better in PR-treated eyes compared to PPV-treated eyes. PR should be strongly considered for eligible patients with a primary uncomplicated rhegmatogenous retinal detachments.
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Affiliation(s)
- Chyong-Yng Huang
- Asociados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes, Paseo Colón, San José, Costa Rica
| | - Mia Mikowski
- Asociados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes, Paseo Colón, San José, Costa Rica
| | - Lihteh Wu
- Asociados de Macula, Vitreo y Retina de Costa Rica, Primer Piso Torre Mercedes, Paseo Colón, San José, Costa Rica. .,Illinois Eye and Ear Infirmary, Department of Ophthalmology, School of Medicine, University of Illinois Chicago, Chicago, IL, USA.
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Yannuzzi NA, Li C, Fujino D, Kelly SP, Lum F, Flynn HW, Parke DW. Clinical Outcomes of Rhegmatogenous Retinal Detachment Treated With Pneumatic Retinopexy. JAMA Ophthalmol 2021; 139:2781202. [PMID: 34137794 PMCID: PMC8374615 DOI: 10.1001/jamaophthalmol.2021.1860] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/02/2021] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Pneumatic retinopexy (PR) is the only clinic-based method of rhegmatogenous retinal detachment (RRD) repair. Registry-acquired clinical practice setting outcomes data with this procedure have not yet been reported. OBJECTIVE To describe the clinical outcomes associated with RRD treated primarily with PR. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, data from patients 19 years and older with noncomplex RRD treated at academic and private ophthalmology practices participating in the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) were analyzed. Data were collected from January 1, 2013, to December 31, 2019, and data were analyzed from January to December 2020. EXPOSURES Data from the IRIS Registry were queried for eyes that underwent PR for noncomplex RRD and had at least 3 months of follow-up. Cases were identified by a combination of diagnosis code for RRD and a Current Procedural Terminology code for PR. MAIN OUTCOMES AND MEASURES The number of eyes that achieved single-operation success (SOS), defined as retinal reattachment without a subsequent retinal detachment surgery or repeated PR. RESULTS Of 9553 included patients, 5827 (61.0%) were male, and the mean (SD) age was 62 (10) years. A total of 9659 eyes were identified. SOS was achieved in 6613 eyes (68.5%). Best-corrected visual acuity significantly differed 9 to 12 months after treatment between the SOS group, with a mean of 0.24 logMAR (95% CI, 0.23-0.25; approximate Snellen equivalent, 20/35), and the single-operation failure group, with a mean of 0.43 logMAR (95% CI, 0.40-0.46; approximate Snellen equivalent, 20/54). Among all patients, the mean time to maximal visual recovery was 268 days (95% CI, 260-276). Endophthalmitis was observed in 3 eyes (0.03%). SOS was associated with female sex (odds ratio, 1.51; 95% CI, 1.38-1.65), while current smoking status was associated single-operation failure (odds ratio, 0.78; 95% CI, 0.68-0.91). CONCLUSIONS AND RELEVANCE In this registry-based study, which encompasses a large number of eyes drawn from multiple, heterogenous electronic health record systems, SOS was achieved in 68.5% of eyes with noncomplex RRD treated by primary PR. It is unknown how these outcomes would have compared with other methods of RRD repair in this cohort.
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Affiliation(s)
- Nicolas A. Yannuzzi
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida
| | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Danielle Fujino
- American Academy of Ophthalmology, San Francisco, California
| | - Scott P. Kelly
- American Academy of Ophthalmology, San Francisco, California
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Harry W. Flynn
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida
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Kertes PJ, Hillier RJ, Muni RH. Letter to the Editor regarding Chronopoulos and colleagues "Pneumatic retinopexy, a critical re-appraisal". Surv Ophthalmol 2021; 66:1073-1075. [PMID: 33872657 DOI: 10.1016/j.survophthal.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Canada; The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Canada; Kensington Vision and Research Centre, University of Toronto, Canada.
| | - Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK; Institute of Translational and Clinical Research, Newcastle University, UK
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Canada; Kensington Vision and Research Centre, University of Toronto, Canada; Keenan Research Centre for Biomedical Science/ Li Ka Shing Knowledge Institute, Toronto, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Canada
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Morescalchi F, Russo A, Gandolfo F, Carnazza M, Bahja H, Costagliola C, Semeraro F. Pneumatic retinopexy preceded by drainage of subretinal fluid for the treatment of severe bullous retinal detachment. Acta Ophthalmol 2021; 99:e109-e116. [PMID: 32573121 DOI: 10.1111/aos.14528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the efficacy and safety outcomes of scleral buckling (SB) and drainage-injection-pneumoretinopexy (DIP), a modified pneumatic retinopexy technique, in which, before gas injection, subretinal fluid is drained with a simultaneous injection of balanced salt solution (BSS) in the vitreous chamber, for the treatment of severe superior bullous rhegmatogenous retinal detachment (SBRD). METHODS This prospective, randomized, comparative study included 58 eyes with severe SBRD that were randomized 1:1 to undergo SB or DIP. The main outcome measures included success rate, visual acuity, mean change in refractive error and surgery duration. RESULTS The primary anatomic success rate was 93% for both procedures. Both groups showed significantly improved visual acuity after surgery. The change in refractive error and surgery duration was significantly higher in the SB group. Drainage-injection-pneumoretinopexy (DIP) appeared to be less traumatic, but with a longer persistence of subretinal fluid in a greater number of patients. CONCLUSION Our findings suggested that both SB and DIP are safe and effective treatments yielding functional and anatomical recovery in patients with severe SBRD. However, the DIP technique may be easier and less costly, with a success rate similar to that of SB.
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Affiliation(s)
- Francesco Morescalchi
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Andrea Russo
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Federico Gandolfo
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Mario Carnazza
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Hassan Bahja
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
| | - Ciro Costagliola
- Eye Clinic Department of Health Sciences University of Molise Campobasso Italy
| | - Francesco Semeraro
- Eye Clinic Department of Neurological and Vision Sciences University of Brescia Brescia Italy
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Pneumatic retinopexy: A critical reappraisal. Surv Ophthalmol 2020; 66:585-593. [PMID: 33359545 DOI: 10.1016/j.survophthal.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022]
Abstract
Pneumatic retinopexy (PR) has been widely advocated for treatment of selected rhegmatogenous retinal detachments: those with small, anterior, superior, retinal breaks and little or no proliferative vitreoretinopathy. It has been suggested that PR is underused and is advantageous because it is an outpatient clinic or office procedure, short in duration, nonincisional, and cost saving - with reduced perioperative morbidity, faster postoperative recovery, better and faster visual recovery, a low rate of complications and a high rate of overall success compared with scleral buckling or pars plana vitrectomy. We reevaluated these advantages to substantiate the effectiveness and efficiency of PR and critically define its role in the treatment of rhegmatogenous retinal detachment. We found that PR has a much higher rate of subsequent reoperation and proliferative vitreoretinopathy than scleral buckling or pars plana vitrectomy for simple, good prognosis rhegmatogenous retinal detachments. PR often involves multiple procedures that largely negates its potential cost savings and subjects the patient to prolonged stress and disability. Scleral buckling rather than PR is ideally suited for simple, good prognosis rhegmatogenous retinal detachments for surgeons who feel comfortable with the technique; alternatively, pars plana vitrectomy is indicated.
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Hillier RJ, Felfeli T, Juncal VR, Muni RH. Re: Elhusseiny et al: Cost Analysis of Pneumatic Retinopexy versus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment (Ophthalmol Retina. 2019;3:956-961). Ophthalmol Retina 2020; 4:e3-e4. [PMID: 32151346 DOI: 10.1016/j.oret.2019.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/08/2019] [Accepted: 12/06/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Roxane J Hillier
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Tina Felfeli
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Canada; Department of Ophthalmology & Vision Sciences, University of Toronto, Canada
| | - Verena R Juncal
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Canada; Department of Ophthalmology & Vision Sciences, University of Toronto, Canada
| | - Rajeev H Muni
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Canada; Department of Ophthalmology & Vision Sciences, University of Toronto, Canada
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Elhusseiny AM, Yannuzzi NA, Smiddy WE. REPLY. Ophthalmol Retina 2020; 4:e4. [PMID: 32151347 DOI: 10.1016/j.oret.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 11/17/2022]
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