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Schutz JS. Re: Shor et al.: Pneumatic retinopexy for rhegmatogenous retinal detachment in elderly patients (Ophthalmol Retina. 2023;7:959-964). Ophthalmol Retina 2024; 8:e13. [PMID: 38441509 DOI: 10.1016/j.oret.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/22/2023] [Accepted: 01/05/2024] [Indexed: 04/07/2024]
Affiliation(s)
- James S Schutz
- Department of Ophthalmology, Cumberland Foreside, Maine.
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2
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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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3
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Li H, Cao J, You K, Zhang Y, Ye J. Artificial intelligence-assisted management of retinal detachment from ultra-widefield fundus images based on weakly-supervised approach. Front Med (Lausanne) 2024; 11:1326004. [PMID: 38379556 PMCID: PMC10876892 DOI: 10.3389/fmed.2024.1326004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
Background Retinal detachment (RD) is a common sight-threatening condition in the emergency department. Early postural intervention based on detachment regions can improve visual prognosis. Methods We developed a weakly supervised model with 24,208 ultra-widefield fundus images to localize and coarsely outline the anatomical RD regions. The customized preoperative postural guidance was generated for patients accordingly. The localization performance was then compared with the baseline model and an ophthalmologist according to the reference standard established by the retina experts. Results In the 48-partition lesion detection, our proposed model reached an 86.42% (95% confidence interval (CI): 85.81-87.01%) precision and an 83.27% (95%CI: 82.62-83.90%) recall with an average precision (PA) of 0.9132. In contrast, the baseline model achieved a 92.67% (95%CI: 92.11-93.19%) precision and limited recall of 68.07% (95%CI: 67.25-68.88%). Our holistic lesion localization performance was comparable to the ophthalmologist's 89.16% (95%CI: 88.75-89.55%) precision and 83.38% (95%CI: 82.91-83.84%) recall. As to the performance of four-zone anatomical localization, compared with the ground truth, the un-weighted Cohen's κ coefficients were 0.710(95%CI: 0.659-0.761) and 0.753(95%CI: 0.702-0.804) for the weakly-supervised model and the general ophthalmologist, respectively. Conclusion The proposed weakly-supervised deep learning model showed outstanding performance comparable to that of the general ophthalmologist in localizing and outlining the RD regions. Hopefully, it would greatly facilitate managing RD patients, especially for medical referral and patient education.
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Affiliation(s)
- Huimin Li
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jing Cao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kun You
- Zhejiang Feitu Medical Imaging Co., Ltd, Hangzhou, Zhejiang, China
| | - Yuehua Zhang
- Zhejiang Feitu Medical Imaging Co., Ltd, Hangzhou, Zhejiang, China
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Peiretti E, Caporossi T, Tatti F, Scampoli A, Mangoni L, Carlà MM, Siotto Pintor E, Carta V, Iovino C, Rizzo S. Two-port dry vitrectomy for rhegmatogenous retinal detachment: a pilot study. Eye (Lond) 2023; 37:3801-3806. [PMID: 37301938 PMCID: PMC10698169 DOI: 10.1038/s41433-023-02617-6] [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: 01/18/2023] [Revised: 05/13/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of a new surgical technique for the management of primary rhegmatogenous retinal detachment (RRD), consisting of localized PPV near the retinal break(s), without infusion line, associated with a drainage of subretinal fluid and cryoretinopexy. METHODS Multicentric prospective study conducted at the University Hospital of Cagliari and IRCCS Fondazione Policlinico Universitario A. Gemelli, Roma. Twenty eyes affected by RRD with the causative retinal break(s) in the superior meridians were enrolled between February 2022 and June 2022. Patients with cataract ≥3, aphakia, significant posterior capsule opacification, giant retinal tears, retinal dialysis, history of trauma and PVR ≥C2 were excluded. All eyes underwent a two-port 25-gauge PPV with localized removal of the vitreous surrounding retinal break(s), followed by 20% SF6 injection and cryopexy. The surgical time was recorded for each procedure. Best-corrected visual acuity (BCVA) was measured at baseline and postoperative 6 months. RESULTS Primary anatomic success at 6 months was achieved by 85% of patients. No complications occurred, except for three (15%) retinal re-detachments. The average surgical time was 8.61 ± 2.16 min. Overall, the difference between pre- and last postoperative mean BCVA was statistically significant (p = 0.02). CONCLUSIONS Two-port dry PPV demonstrated safety and efficacy for the treatment of RRD, reaching an 85% of anatomical success rate. Although further studies are necessary to confirm the efficacy and long-term benefit of this treatment, we believe that this surgical technique could be considered a valid and safe alternative for the management of primary RRD.
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Affiliation(s)
- Enrico Peiretti
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Tomaso Caporossi
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Filippo Tatti
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Alessandra Scampoli
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Lorenzo Mangoni
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Matteo Mario Carlà
- Catholic University Sacro Cuore, Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Valentina Carta
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Claudio Iovino
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Eye Clinic, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stanislao Rizzo
- Catholic University Sacro Cuore, Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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5
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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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Caporossi T, Scampoli A, Tatti F, Mangoni L, Carlà MM, Pintor ES, Frongia F, Iovino C, Bernardinelli P, Peiretti E. Two-Port “Dry Vitrectomy” as a New Surgical Technique for Rhegmatogenous Retinal Detachment: Focus on Macula-on Results. Diagnostics (Basel) 2023; 13:diagnostics13071301. [PMID: 37046519 PMCID: PMC10093090 DOI: 10.3390/diagnostics13071301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
We evaluated a new surgical technique for treating primary rhegmatogenous retinal detachment (RRD), consisting of localized vitrectomy near the retinal break associated with drainage of subretinal fluid without infusion. Twelve eyes of twelve patients with primary RRDs with macula-on superior, temporal, and/or nasal quadrants’ RRD with retinal breaks between 8 and 4 o’clock, pseudophakic or phakic eyes, were enrolled. All eyes underwent a two-port 25-gauge vitrectomy with localized removal of the vitreous surrounding the retinal break(s), followed by a 20% SF6 injection and cryopexy. The difference between pre-operative (T0) and post-operative mean BCVA at 6 months follow-up (T6) was not statistically significant (0.16 logMAR vs. 0.21 logMAR; p = 0.055). Primary anatomic success at 6 months was achieved by 86% of patients. No other complications, except for two retinal re-detachments linked to an incorrect head position of the patients, were recorded. Although further studies are necessary to evaluate the treatment’s efficacy, we believe our technique could be considered a valid alternative for managing primary RRD.
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Affiliation(s)
- Tomaso Caporossi
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy
- Department of Neuroscience, Sensory Organs and Chest, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Alessandra Scampoli
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy
- Department of Neuroscience, Sensory Organs and Chest, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Filippo Tatti
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Lorenzo Mangoni
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Matteo Mario Carlà
- Department of Neuroscience, Sensory Organs and Chest, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Emanuele Siotto Pintor
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Francesca Frongia
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Claudio Iovino
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Eye Clinic, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Patrizio Bernardinelli
- Department of Neuroscience, Sensory Organs and Chest, Catholic University of the Sacred Heart, 00168 Rome, Italy
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Peiretti
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Zheng C, Wen D, Xu K, Zhang X, Ren X, Li X. Advances in biomaterials as a retinal patch for the repair of rhegmatogenous retinal detachment. Front Bioeng Biotechnol 2022; 10:997243. [DOI: 10.3389/fbioe.2022.997243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Rhegmatogenous retinal detachment (RRD) is the most common retinological emergency that can cause blindness without surgical treatment. RRD occurs when liquefied vitreous accumulates between the neurosensory retina and the retinal pigment epithelium via retinal breaks, which are caused by the separation of the vitreous from the retina with aging. Currently, the main treatment option is pars plana vitrectomy, which involves surgical removal of the vitreous and laser photocoagulation around retinal breaks to generate firm chorioretinal adhesion, as well as subsequent filling of the vitreous cavity with long-lasting substitutes (expansile gas or silocone oil) to prevent the connection between the subretinal space and the vitreous cavity via the breaks before the chorioretinal adhesion firm enough. However, the postoperative face-down position and the not very satisfactory first retinal reattachment rate place a heavy burden on patients. With the development of technology and materials engineering, researchers have developed biomaterials that can be used as a retinal patch to seal retinal breaks and prevent the connection of subretinal space and vitreous cavity via breaks, thus replacing the long-lasting vitreous substitutes and eliminating the postoperative face-down position. Preclinical studies have demonstrated that biomaterial sealants have enough biocompatibility and efficacy in the in vitro and in vivo experiments. Some sealants have been used in clinical trials on a small scale, and the results indicate promising application prospects of the biomaterial sealants as retinal patches in the repair of RRD. Herein, we review the recent advances in biomaterials as retinal patches for the repair of RRD, focusing on the biomaterial categories, methods, and procedures for sealing retinal breaks, as well as their biocompatibility and efficacy, current limitations, and development perspectives.
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Ngo NT, Martin A. Pneumatic Retinopexy: Confronting Ocular Disease With Visual Art. Cureus 2022; 14:e29649. [PMID: 36320951 PMCID: PMC9612899 DOI: 10.7759/cureus.29649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
As part of a series of autobiographical case reports about physicians reporting on their own medical afflictions, a psychiatrist copes with a retinal detachment through an artistic collaboration with a medical student. The air bubble injected into the patient's eye shapeshifts during the six weeks of recovery and becomes the basis for a collaborative artistic project. The series of jointly created images becomes a source of comfort and solace for the patient and of developmental growth for the medical student becoming a physician.
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Affiliation(s)
- Nealie T Ngo
- Child Psychiatry, University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, USA
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Hsiao CH, Chen HJ, Hsia WP, Chang CJ. Surgical outcomes and prognostic factors in traumatic retinal detachment following closed-globe injuries. Int Ophthalmol 2022; 42:1849-1860. [PMID: 34994873 DOI: 10.1007/s10792-021-02182-5] [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: 07/30/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the anatomical and functional results of retinal detachment (RD) surgery following closed-globe injuries (CGI). METHODS Patients treated with vitreoretinal surgeries due to RD following CGI from 2014 to 2020 were retrospectively reviewed. Data included demographics, mechanism of injury, preoperative evaluation, and surgical intervention. Outcome measurements included anatomic success, best corrected visual acuity (BCVA), and possible prognostic factors. RESULTS A total of 67 eyes from 64 patients (49 males; mean age 52.84 years) were included. The most common causes of the CGI were work-related injury (22.4%) and traffic accidents (23.9%). The primary and final anatomic success rates were 80.6% (54/67) and 89.6% (60/67), respectively. In the multivariable analysis of the logistic regression models, the poor prognostic factor was proliferative vitreoretinopathy (PVR) (P = 0.009) for primary anatomic success. The median preoperative and final BCVA were logMAR 0.7 (IQR, 0.3-1.6) and logMAR 0.5 (IQR, 0.1-1.1), respectively (P = 0.077). Poorly presenting BCVA (counting fingers or worse) and giant tear were associated with poor visual outcomes. CONCLUSION Work-related injuries and traffic accidents are the prevalent causes of RD following CGI. The anatomic outcomes were favorable, but visual outcomes varied. Poor prognostic factors included PVR and poorly presenting BCVA, highlighting the importance of a careful initial evaluation.
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Affiliation(s)
- Chung-Hao Hsiao
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hung-Ju Chen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei Ping Hsia
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Jen Chang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan. .,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan.
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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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11
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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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Abstract
Retinal detachments are a potentially sight-threatening ophthalmic emergency that may result in significant, irreversible vision loss. The risk of developing retinal detachment increases with advancing age, myopia and trauma. Pre-existing retinal degenerations can precipitate a pre-detachment symptomatic period of photopsia or floaters, allowing clinicians to intervene early and prevent detachments. Novel imaging techniques, such as spectral-domain optical coherence tomography, and well-established topographic modalities, such as B scan, can help to elucidate the type of detachment and any underlying causes, and help with surgical management. The overarching goal of treatment is to identify and seal all retinal holes, relieve vitreoretinal traction and prevent further recurrence. Prompt prophylactic retinopexy of retinal holes and tears is crucial in preventing retinal detachment, the main treatments of which are pars plana vitrectomy, tamponading agents and silicone scleral buckle.
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Affiliation(s)
- Ahmed Ibrar
- Ophthalmology Department, Great Western Hospital, Swindon, UK
| | - Maghsoudlou Panayiotis
- Ophthalmology Department, Great Western Hospital, Swindon, UK.,Department of Stem Cells and Regenerative Medicine, University College London, London, UK
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