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Lin JB, Narayanan R, Philippakis E, Yonekawa Y, Apte RS. Retinal detachment. Nat Rev Dis Primers 2024; 10:18. [PMID: 38485969 DOI: 10.1038/s41572-024-00501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Abstract
Retinal detachment (RD) occurs when the neurosensory retina, the neurovascular tissue responsible for phototransduction, is separated from the underlying retinal pigment epithelium (RPE). Given the importance of the RPE for optimal retinal function, RD invariably leads to decreased vision. There are three main types of RD: rhegmatogenous, tractional and exudative (also termed serous) RD. In rhegmatogenous RD, one or more retinal breaks enable vitreous fluid to enter the subretinal space and separate the neurosensory retina from the RPE. In tractional RD, preretinal, intraretinal or subretinal membranes contract and exert tangential forces and elevate the retina from the underlying RPE. Finally, in exudative RD, an underlying inflammatory condition, vascular abnormality or the presence of a tumour causes exudative fluid to accumulate in the subretinal space, exceeding the osmotic pump function of the RPE. The surgical management of RD usually involves pars plana vitrectomy, scleral buckling or pneumatic retinopexy. The approach taken often depends on patient characteristics as well as on practitioner experience and clinical judgement. Advances in surgical technology and continued innovation have improved outcomes for many patients. However, even if retinal re-attachment is achieved, some patients still experience decreased vision or other visual symptoms, such as metamorphopsia, that diminish their quality of life. Continued research in the areas of neuroprotection and retinal biology as well as continued surgical innovation are necessary to enhance therapeutic options and outcomes for these patients.
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Affiliation(s)
- Jonathan B Lin
- Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Raja Narayanan
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Elise Philippakis
- Université de Paris, Ophthalmology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rajendra S Apte
- John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
- Department of Developmental, Regenerative, and Stem Cell Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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Huang YT, Yang CH, Chen SJ, Cheng CK, Ho TC, Wu TT, Sheu SJ, Hsieh YT, Chang CJ, Wu JS, Liu L, Chen SN. Guidelines and treatment patterns for primary rhegmatogenous retinal detachments: Expert consensus and survey in Taiwan Retina Society. J Chin Med Assoc 2024; 87:25-32. [PMID: 37815297 DOI: 10.1097/jcma.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Rhegmatogenous retinal detachment (RRD) is a significant cause of vision loss and requires appropriate surgical intervention. There are several approaches available, including observation, laser demarcation, pneumatic retinopexy, scleral buckling, and pars plana vitrectomy, which are chosen based on patient condition, surgeon experience, and national health insurance policies. Despite the various options, there is still no consensus on the optimal intervention. To address this, the Taiwan Retina Society assembled an expert committee with 11 experienced retina specialists to review the current evidence and develop a guideline with seven recommendations for managing RRD patients. Additionally, a survey was conducted with six questions to assess treatment patterns in Taiwan, which included input from the expert committee and an open poll at the 2023 Congress of the Taiwan Retina Society. This report provides a comprehensive summary of the current knowledge and expert consensus on the treatment of RRD, discussing the characteristics of current approaches and providing an overview of current treatment patterns in Taiwan. These findings aim to provide ophthalmologists with the best possible treatment for RRD.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, Eye center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Jen Chang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Jian-Sheng Wu
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - San-Ni Chen
- Department of Ophthalmology, Eye center, China Medical University Hospital, Taichung, Taiwan, ROC
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Hébert M, Bourgault S, Caissie M, Tourville É, Dirani A. REtinal Detachment Outcomes Study (REDOS): study protocol for a factorial, randomized controlled trial. Trials 2023; 24:820. [PMID: 38124155 PMCID: PMC10734075 DOI: 10.1186/s13063-023-07815-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Few large randomized controlled trials provide strong evidence to guide surgical repair of primary rhegmatogenous retinal detachment (RRD) repair. The purpose of this factorial, single-blind, randomized controlled trial is to analyze and compare the surgical outcomes, functional visual outcomes, complications, and quality of life associated with RRD repair using (A) pars plana vitrectomy only (PPV) or PPV with scleral buckle (PPV-SB) and (B) sulfur hexafluoride gas (SF6) or perfluoropropane gas (C3F8) tamponade. METHODS Eligible patients with moderately complex RRD will be randomized 1:1 to PPV or PPV-SB and 1:1 to SF6 or C3F8 gas tamponade. Approximately 560 patients will be recruited to be able to detect a difference of around 10% in SSAS rate between the groups. Patients will be followed using multimodal imaging and quality of life questionnaires after the surgical repair until 1 year postoperative. The primary outcome will be a single-surgery anatomic success (SSAS), defined as the absence of reoperation for recurrent RRD in the operating room. Secondary outcomes will be pinhole visual acuity (PHVA) at 8-10 weeks and 6 months, final best-corrected visual acuity (BCVA), final retina status (i.e., attached or detached), time to onset of RRD recurrence, severity and number of complications, and questionnaire results. DISCUSSION This will be the first 2 × 2 factorial RCT examining repair techniques in primary RRD. It will also be the first RCT to compare gas tamponade between the two most common agents. Notably, it will be adequately powered to detect a clinically significant effect size. The use of multimodal imaging will also be a novel aspect of this study, allowing us to compare head-to-head the impact of adding an SB to the retina's recovery after RRD repair and of differing gas tamponades. Until now, the treatment of RRD has been largely guided by pragmatic retrospective cohort studies. There is a lack of strong evidence guiding therapeutic decisions and this trial will address (1) whether supplemental SB is justified and (2) whether longer duration gas tamponade with C3F8 is necessary. TRIAL REGISTRATION ClinicalTrials.gov NCT05863312. Registered on 18 May 2023.
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Affiliation(s)
- Mélanie Hébert
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Serge Bourgault
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Mathieu Caissie
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Éric Tourville
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada
| | - Ali Dirani
- Department of Ophthalmology, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, 1050 Ch Ste-Foy Street, Québec, QC, G1S 4L8, Canada.
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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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Perez EA, Scott NL, Russell JF. Improved Visual Outcomes after Severe Open-Globe Injuries Associated with Perioperative Vitreoretinal Evaluation. Ophthalmol Retina 2023; 7:771-778. [PMID: 37148970 DOI: 10.1016/j.oret.2023.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To investigate the impact of perioperative evaluation by a vitreoretinal surgeon on outcomes after severe open-globe injury (OGI). DESIGN Retrospective, comparative study. SUBJECTS Open-globe injury cohorts from 2 academic United States ophthalmology departments with disparate OGI management protocols and vitreoretinal referral patterns. METHODS Patients with severe OGI (presenting visual acuity [VA] of counting fingers or worse) from the University of Iowa Hospitals and Clinics (UIHC) were compared with patients with severe OGI from the Bascom Palmer Eye Institute (BPEI). At UIHC, almost all cases of OGI were repaired by anterior segment surgeons, with postoperative vitreoretinal referral at the surgeon's discretion. In contrast, at BPEI, all OGIs were both repaired and managed postoperatively by a vitreoretinal surgeon. MAIN OUTCOME MEASURES Rate of vitreoretinal surgeon evaluation, rate of pars plana vitrectomy (PPV) (either primary or secondary), and VA at the last follow-up. RESULTS Overall, 74 subjects from UIHC and 72 subjects from BPEI met the inclusion criteria. There were no differences in preoperative VA or rates of vitreoretinal pathology. The rate of vitreoretinal surgeon evaluation was 100% at BPEI and 65% at UIHC (P < 0.001), and the rate of PPV was 71% at BPEI and 40% at UIHC (P < 0.001). Median VA at the last follow-up in the BPEI cohort was 1.35 logarithm of the minimum angle of resolution (logMAR) (interquartile range [IQR], 0.53-2.30, corresponding to a Snellen VA of ∼ 20/500) compared with a median VA of 2.70 logMAR (IQR, 0.93-2.92, corresponding to a Snellen VA of light perception) in the UIHC cohort (P = 0.031). Overall, 68% of patients in the BPEI cohort had an improvement in VA from presentation to last follow-up versus 43% in the UIHC cohort (P = 0.004). CONCLUSIONS Automatic perioperative evaluation by a vitreoretinal surgeon was associated with a higher rate of PPV and improved visual outcomes. Prompt evaluation by a vitreoretinal surgeon, either preoperatively or in the early postoperative period, should be considered, when logistically feasible, in severe OGIs because PPV is frequently indicated and may result in significant visual improvement. 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)
- Eli A Perez
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Nathan L Scott
- Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Jonathan F Russell
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
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Heydinger S, Ufret-Vincenty R, Robertson ZM, He YG, Wang AL. Comparison of Surgical Outcomes for Uncomplicated Primary Retinal Detachment Repair. Clin Ophthalmol 2023; 17:907-915. [PMID: 36960322 PMCID: PMC10029931 DOI: 10.2147/opth.s405913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose To compare the outcomes of primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV), scleral buckling (SB), or combined scleral buckling with vitrectomy (SB/PPV). Patients and Methods Single-institution, retrospective, observational study of 179 patients with primary RRD managed at a large academic hospital system. We excluded patients with less than 6 months of follow-up, previous vitrectomy or buckle, giant retinal tears, aphakia, recurrent forms of RRD, or extensive proliferative vitreoretinopathy (Grade C or worse) documented on exam or requiring membrane peel. Outcome measures included primary anatomical success at 6 months, functional success defined as BCVA ≥ 20/200, and best corrected visual acuity (BCVA) using logMAR scoring. Subgroup analysis was performed in the following patient groups: phakic, pseudophakic, inferior detachments, and prior pneumatic retinopexy. Results Primary anatomical success was achieved in 145 of 179 eyes (81.0%), with SB/PPV showing a significantly greater success rate (p = 0.046) when compared to SB and PPV. Functional success was achieved in 137 of the 145 anatomically successful eyes (94.5%), with values ranging between 92% and 97% amongst the interventions (p = 0.552). No difference was found in final BCVA (p = 0.367). Patients with inferior detachment had an odds ratio of 2.15 for primary anatomic failure. Prior pneumatic retinopexy did not significantly affect any of the primary outcomes. Conclusion SB/PPV yielded a significantly better primary anatomical success rate when compared to SB and PPV. Functional success and final BCVA was similar amongst the interventions. Inferior detachments were associated with worse primary anatomic outcomes. Prior pneumatic retinopexy did not significantly affect surgical outcomes.
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Affiliation(s)
- Stanton Heydinger
- University of Texas Southwestern Medical School, University of Texas Southwestern, Dallas, TX, USA
- Correspondence: Stanton Heydinger, Department of Ophthalmology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, USA, Tel +1 816-500-9088, Email
| | - Rafael Ufret-Vincenty
- Department of Ophthalmology, University of Texas Southwestern, Dallas, TX, USA
- Department of Ophthalmology, Parkland Hospital, Dallas, TX, USA
| | - Zachary M Robertson
- Department of Ophthalmology, University of Texas Southwestern, Dallas, TX, USA
- Department of Ophthalmology, Parkland Hospital, Dallas, TX, USA
| | - Yu-Guang He
- Department of Ophthalmology, University of Texas Southwestern, Dallas, TX, USA
- Department of Ophthalmology, Parkland Hospital, Dallas, TX, USA
| | - Angeline L Wang
- Department of Ophthalmology, University of Texas Southwestern, Dallas, TX, USA
- Department of Ophthalmology, Parkland Hospital, Dallas, TX, USA
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Eshtiaghi A, Dhoot AS, Mihalache A, Popovic MM, Nichani PAH, Sayal AP, Yu HJ, Wykoff CC, Kertes PJ, Muni RH. Pars Plana Vitrectomy with and without Supplemental Scleral Buckle for the Repair of Rhegmatogenous Retinal Detachment: A Meta-analysis. Ophthalmol Retina 2022; 6:871-885. [PMID: 35227949 DOI: 10.1016/j.oret.2022.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/06/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
TOPIC It is unclear whether there are differences in safety and efficacy between pars plana vitrectomy (PPV) alone and PPV with a supplemental scleral buckle (SB; PPV-SB) for the treatment of rhegmatogenous retinal detachment. CLINICAL RELEVANCE This meta-analysis aimed to compare the safety and efficacy of these surgical procedures. METHODS In this meta-analysis, Ovid MEDLINE, Embase, and Cochrane Library were systematically searched (January 2000-June 2021). The primary outcome was the final best corrected visual acuity (BCVA), whereas the secondary outcomes were reattachment rates and complications. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized controlled trials (RCTs) and the risk of bias in nonrandomized studies of interventions tool for nonrandomized studies. RESULTS This study included 15 661 eyes from 38 studies (32 observational studies and 6 RCTs). The median follow-up duration was 6 months. The final BCVA was similar between PPV and PPV-SB (weighted mean difference [WMD], -0.03 logarithm of the minimum angle of resolution [-0.14 to 0.07]; P = 0.55). There was a significant difference in the single-operation success rate (SOSR) (88.2% versus 86.3%; relative risk [RR], 0.97 [0.95-1.00]; P = 0.03), favoring PPV-SB; however, there was no significant difference in the final reattachment rate (RR, 1.00 [0.99-1.01]; P = 0.56). Pars plana vitrectomy required a significantly higher number of operations to achieve final anatomical reattachment (WMD, 0.13 [0.02-0.24]; P = 0.02). In terms of complications, PPV was significantly less likely to be associated with macular edema (RR, 0.47 [0.25-0.88]; P = 0.02) and epiretinal membrane formation (RR, 0.70 [0.52-0.94]; P = 0.02), but these differences were no longer significant in studies published after 2010 or in RCTs. Significant proliferative vitreoretinopathy, lens status, and macular attachment status did not mediate differences in these effects. CONCLUSIONS There were no significant differences in the final visual acuity outcomes between PPV and PPV-SB. Pars plana vitrectomy with supplemental SB was associated with a greater SOSR than standalone PPV, although the magnitude of the effect was small, with a high number needed to treat. The final reattachment rate was similar. In recent studies and in RCTs, the risk of complications was similar between the procedures.
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Affiliation(s)
- Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Prem A H Nichani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hannah J Yu
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Charles C Wykoff
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.
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Outcomes in primary uncomplicated rhegmatogenous retinal detachment repair using pars plana vitrectomy with or without scleral buckle. Retina 2022; 42:1161-1169. [PMID: 35174803 DOI: 10.1097/iae.0000000000003425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare outcomes following primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB). METHODS This is a retrospective cohort study with propensity score analysis in a single tertiary care center between 2014 and 2018 comparing patients with primary uncomplicated RRD repaired using PPV only or PPV-SB (full cohort: n=1516, propensity-matched cohort: n=908). The primary outcome was single surgery anatomic success (SSAS), while secondary outcomes were 3-month and final pinhole visual acuity (PHVA) in logarithm of the minimum angle of resolution (logMAR) and final retina status. RESULTS In the full cohort, SSAS was achieved in 745 (91%) of PPV patients vs. 623 (89%) of PPV-SB patients (p=0.13). This was 390 (92%) vs. 314 (88%) in phakic patients (p=0.06) compared to 353 (91%) vs. 301 (90%) in pseudophakic patients (p=0.79), respectively. After matching, SSAS was achieved in 424 (93%) of PPV patients vs. 412 (91%) of PPV-SB patients (p=0.14). Median PHVA after PPV was better at 3 months (PPV: 20/40 vs. PPV-SB: 20/50; both cohorts: p<0.001) and final follow-up (PPV: 20/29 vs. PPV-SB: 20/38; full cohort: p<0.001 and PPV: 20/29 vs. PPV-SB: 20/36; matched cohort: p<0.001). CONCLUSION Addition of SB does not significantly change the rate of SSAS compared to PPV only in primary uncomplicated RRD. It is also associated with worse PHVA at follow-up.
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Rosenberg DM, Ghayur HS, Deonarain DM, Sarohia GS, Phillips MR, Garg S, Bakri SJ, Wykoff CC, Chaudhary V. Supplemental Scleral Buckle for the Management of Rhegmatogenous Retinal Detachment by Pars Plana Vitrectomy: A Meta-Analysis of Randomized Controlled Trials. Ophthalmologica 2021; 245:101-110. [PMID: 34731858 DOI: 10.1159/000520220] [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: 06/24/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The present review aimed to synthesize evidence from randomized controlled trials (RCTs) that compared outcomes of pars plana vitrectomy (PPV) with and without a supplementary scleral buckle (SB) for management of rhegmatogenous retinal detachment (RRD). METHODS The authors searched MEDLINE, Embase, and CENTRAL to identify RCTs in English that compared PPV with and without supplemental SB. Risk of bias was assessed according to the Cochrane Risk of Bias 2 tool. We present risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) estimated using random-effects meta-analyses. RESULTS We identified 6 RCTs involving 705 eyes. Primary reattachment (6 studies, 345 eyes PPV, 324 eyes PPV + SB; RR 0.99, 95% CI 0.93-1.06, I2 = 0%, p = 0.78) and final anatomic success rates (4 studies, 272 eyes PPV, 267 eyes PPV + SB; RR 1.00, 95% CI 0.98-1.02, I2 = 0%, p = 0.89) were similar between the 2 groups. Postoperative visual acuity improvement (5 studies, 244 eyes PPV, 222 eyes PPV + SB; MD 6.09 letters, 95% CI -0.47-12.64, I2 = 69%, p = 0.07) and frequency of adverse events (6 studies, 1,294 observations PPV, 1,221 observations PPV + SB; RR 0.76, 95% CI 0.57-1.01, I2 = 25%, p = 0.06) likewise did not differ significantly between the treatment groups. CONCLUSION Low-certainty evidence from RCTs did not demonstrate a benefit in placement of a supplemental SB during vitrectomy for management of RRD in the current analysis. Additional high-quality trials are needed to provide more precise estimates of the effect.
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Affiliation(s)
- Daniel M Rosenberg
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Huphy S Ghayur
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Deven M Deonarain
- St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, Ontario, Canada
| | - Gurkaran S Sarohia
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta, Canada,
| | - Mark R Phillips
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sunir Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Varun Chaudhary
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, Ontario, Canada.,Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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10
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Arjmand P, Felfeli T, Mandelcorn ED. Combined Pars Plana Vitrectomy and Segmental Scleral Buckle for Rhegmatogenous Retinal Detachment with Inferior Retinal Breaks. Clin Ophthalmol 2021; 15:3515-3519. [PMID: 34434043 PMCID: PMC8380623 DOI: 10.2147/opth.s321371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe a variation of the traditional segmental scleral buckle (SB) without an encircling band combined with 23-gauge pars plana vitrectomy (PPV) for the management of rhegmatogenous retinal detachment (RRD) with inferior retinal breaks. Patients and Methods This is a single-center, retrospective, consecutive review of all RRDs with inferior retinal breaks that were treated with PPV and segmental SB without an encircling band between May 2019 and February 2020. Results A total of 12 eyes of 12 patients were included in the study. All patients had at least 1 inferior retinal break and more than 2 clock hours of retinal detachment. Eight eyes had RRD with macular involvement at presentation. Seven eyes had a persistent RRD following previous pneumatic retinopexy (C3F8). All eyes were treated by PPV combined with a segmental #510 sponge without an encircling band. Surgery anatomical success was 100%. Mean logMAR visual acuity was 1 (SD 0.6; 20/160) and 0.5 (SD 0.4; 20/60) at 3 months and last follow-ups, respectively. No scleral buckle-related complications were noted over the 4.1 (SD 0.8) month follow-up period. Conclusion The combined segmental buckling technique is a safe and effective adjunct to PPV in treatment of inferior RRD.
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Affiliation(s)
- Parnian Arjmand
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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11
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Xu D, Belin PJ, Staropoli PC, Yannuzzi NA, Vangipuram G, Chiang A, Shah GK, Townsend JH, Ryan EH, Klufas MA. Clinical Outcomes in Sequential, Bilateral Rhegmatogenous Retinal Detachment: A Multicenter, Paired-Eye Analysis. Ophthalmol Retina 2021; 5:797-804. [PMID: 33197679 DOI: 10.1016/j.oret.2020.11.002] [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: 07/04/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To assess the clinical outcomes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD) by using a paired-eye comparison. DESIGN Multicenter, retrospective cohort study. PARTICIPANTS Patients with sequential, bilateral RRD treated with pars plana vitrectomy (PPV), scleral buckle (SB), or PPV plus SB over an 11-year period (October 2008-April 2019) from 4 vitreoretinal practices were included. METHODS Data were collected on patient demographics, anatomic characteristics of the RRD, surgical procedures, and best-corrected visual acuity (VA). These variables, along with single-operation anatomic success (SOAS) and type and number of surgical procedures, were assessed with a paired-eye comparison. MAIN OUTCOME MEASURES Single-operation anatomic success between the initial-eye and subsequent-eye RRD. RESULTS Five hundred four eyes of 252 patients were included. The mean interval between RRD in either eye was 13.6 ± 13.4 months. Single-operation anatomic success in the initial eye was 82.5% with a mean of 1.2 surgeries (range, 1-4 surgeries). Single-operation anatomic success in the subsequent eye was 83.7% (P = 0.80) with a mean of 1.2 surgeries (range, 1-4 surgeries; P = 0.68). Visual acuity was better in the subsequent eye at presentation (mean, 20/62 vs. 20/149; P < 0.001) and postoperative month 6 (mean, 20/41 vs. 20/49; P = 0.03), but final VA was similar (20/36 vs. 20/37; P = 0.68). Macular detachment was less prevalent (34.1% vs. 56.0%; P < 0.001) with fewer quadrants detached (mean, 1.9 quadrants vs. 2.0 quadrants; P = 0.010) in the subsequent eye. Mean duration of symptoms was shorter in the subsequent eye (mean, 5.9 days vs. 7.5 days; P = 0.008). In patients who underwent a different surgical technique in each eye, PPV plus SB yielded a higher SOAS of 89.7% compared with 69.0% for PPV alone in 116 eyes (P = 0.010). CONCLUSIONS In this study of sequential, bilateral RRD, the SOAS was similar for each eye. The second eye was more likely to be treated earlier and to have less macular involvement, but the final VA outcomes were similar. Pars plana vitrectomy plus SB yielded a significantly higher SOAS than PPV or SB alone.
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Affiliation(s)
- David Xu
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
| | | | - Patrick C Staropoli
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | - Nicolas A Yannuzzi
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Allen Chiang
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | | | - Justin H Townsend
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Michael A Klufas
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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12
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Popovic MM, Muni RH, Nichani P, Kertes PJ. Pars plana vitrectomy, scleral buckle, and pneumatic retinopexy for the management of rhegmatogenous retinal detachment: a meta-analysis. Surv Ophthalmol 2021; 67:184-196. [PMID: 34043984 DOI: 10.1016/j.survophthal.2021.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
We reviewed the literature on the efficacy and safety of pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PR) for the management of rhegmatogenous retinal detachments (RRDs). A systematic search was performed on three databases from inception to September 2020. Randomized controlled trials (RCTs) comparing RRD management options were included. Meta-analysis was performed using a random effects model. Eighteen RCTs and 2,751 eyes were included. For PPV versus SB, early postoperative corrected distance visual acuity (CDVA) favored SB (weighted mean <1 month postoperatively: ~counting fingers for PPV versus ~20/260 for SB, P = 0.02), but differences were nonsignificant at other time points. There was no difference for primary reattachment (P = 0.08). PPV had a lower incidence of choroidal detachment (P = 0.004), hypotony (P = 0.01), and strabismus/diplopia (P = 0.04) but a higher incidence of iatrogenic breaks (P = 0.003) and cataract development/progression (P = 0.05) relative to SB. Combination management was nonsignificantly different relative to PPV alone for CDVA, complications and reattachment rate. In closing, PPV is associated with a slower visual recovery, but similar final visual acuity and primary reattachment rate relative to SB. Combination procedures did not improve primary reattachment rates or vision relative to standalone PPV. Heterogeneity was seen across the included trials, and further randomized trials are needed to reduce the uncertainty of these estimates.
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Affiliation(s)
- Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Prem Nichani
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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13
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Echegaray JJ, Vanner EA, Zhang L, Fortun JA, Albini TA, Berrocal AM, Smiddy WE, Flynn HW, Sridhar J, Gregori NZ, Townsend JH, Davis JL, Haddock LJ. Outcomes of Pars Plana Vitrectomy Alone versus Combined Scleral Buckling plus Pars Plana Vitrectomy for Primary Retinal Detachment. Ophthalmol Retina 2021; 5:169-175. [PMID: 32980532 DOI: 10.1016/j.oret.2020.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/29/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE We compared the outcomes of primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) alone versus combined scleral buckling plus PPV (SB+PPV). DESIGN Retrospective, observational study. PARTICIPANTS Patients with primary RRD who underwent PPV or SB+PPV from June 1, 2014, through December 31, 2017. METHODS We performed a single-institution, retrospective, observational study of 488 consecutive patients with primary RRD repaired via PPV alone or SB+PPV and gas tamponade. We excluded patients younger than 18 years and those with advanced proliferative vitreoretinopathy, giant retinal tear, trauma, or secondary forms of RRD. We performed logistic regression and Cox proportional hazard regression analyses to identify potential risk factors associated with a retinal redetachment. MAIN OUTCOME MEASURES Single-operation anatomic success (SOAS), defined as adequate retinal reattachment achieved with only 1 procedure. RESULTS The mean follow-up interval was 14.3 months. Single-operation anatomic success and final anatomic success were achieved in 425 eyes (87.1%) and 487 eyes (99.8%), respectively. Single-operation anatomic success was achieved in 90 of 111 eyes (81.1%) with PPV alone compared with 345 of 374 eyes (92.2%) with SB+PPV (P = 0.0010). Scleral buckling plus PPV showed greater SOAS than PPV alone in phakic eyes (P < 0.0001), but not in eyes with a posterior chamber intraocular lens (PCIOL). Retinal redetachments occurred on average at 1.5 and 9 months after the initial surgery. Significant best-corrected visual acuity improvement was associated with SOAS (P < 0.0001). CONCLUSIONS Scleral buckling plus PPV resulted in greater SOAS outcomes than PPV alone for primary RRD repair. Phakic eyes achieved greater surgical success with SB+PPV, whereas eyes with a PCIOL achieved similar results with both methods. Most retinal redetachments occurred within the initial postoperative 3-month period. Single-operation anatomic success was associated with statistically significant visual improvement.
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Affiliation(s)
- Jose J Echegaray
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Elizabeth A Vanner
- Department of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida
| | - Lily Zhang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jorge A Fortun
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ninel Z Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Luis J Haddock
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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14
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Rao P, Kaiser R, Lum F, Atchison E, Parke DW, Williams GA. Reoperation Rates of Patients Undergoing Primary Noncomplex Retinal Detachment Surgery in a Cohort of the IRIS Registry. Am J Ophthalmol 2021; 222:69-75. [PMID: 32898502 DOI: 10.1016/j.ajo.2020.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To present the reoperation rates of patients who underwent a primary noncomplex RD repair in a cohort of the American Academy of Ophthalmology IRIS Registry. DESIGN Retrospective, nonrandomized comparative clinical study. METHODS This was a retrospective, nonrandomized cohort study of patients who underwent a primary noncomplex RD repair with either a scleral buckle (SB) or vitrectomy with or without scleral buckle (PPV±SB) between 2013 and 2016. The primary outcome was the odds of reoperation within 12 months. RESULTS Of 24,068 patients, 2,937 patients (12.2%) underwent an SB and 21,131 patients (87.8%) a PPV ± SB. The overall reoperation rate was 12.2% for SB and 11.6% for PPV ± SB. After multivariate adjustment for age and initial RD diagnosis, the PPV ± SB group exhibited a lower odds of reoperation within 12 months compared with SB only (OR 0.84, 95% CI 0.75-0.96, P = .007). However, there was an age interaction. Patients ≤50 years old with PPV ± SB exhibited a higher odds of reoperation (OR 1.46, 95% CI 1.14-1.88, P = .003) compared to SB only. Patients >50 years with PPV ± SB had a lower odds of reoperation (OR 0.73, 95% CI 0.63-0.84, P < .0001). CONCLUSION The odds of reoperation of PPV ± SB compared with SB only varies depending on the patient's age. Further subset analyses are required to determine if there are clinically relevant differences with respect to RD configuration or other RD repair types (PPV only vs PPV with SB).
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Affiliation(s)
- Prethy Rao
- Emory Eye Center, Atlanta, Georgia, USA.
| | | | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California, USA
| | | | - David W Parke
- American Academy of Ophthalmology, San Francisco, California, USA
| | - George A Williams
- American Academy of Ophthalmology, San Francisco, California, USA; Associated Retinal Consultants, Royal Oak, Michigan, USA
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15
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Management of uncomplicated primary retinal rhegmatogenous detachment. Int Ophthalmol 2021; 41:1709-1716. [PMID: 33511514 DOI: 10.1007/s10792-021-01729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to compare the vitreoretinal surgery outcomes in patients with uncomplicated rhegmatogenous retinal detachment (RRD). DESIGN This was a retrospective, nonrandomized consecutive case series study. PARTICIPANTS Six hundred and eighty-three eyes with primary uncomplicated RRD between 2013 and 2017 were included in this study. METHOD Patients were treated by one of the following methods: pars plana vitrectomy (PPV), scleral buckling (SB), and combined PPV with SB (PPV + SB). The success rate was divided into an anatomical and functional one, the anatomical success rate was retinal reattachment, and the functional success rate was defined as a statistically significant improvement in BCVA patients within a 6-month follow-up period. RESULTS This study involved 683 eyes; of these, 79 eyes underwent PPV, combined PPV/SB was performed on 180 eyes, and 424 eyes underwent SB. The anatomical success rates were 83.5% for PPV and 80% for combined SB/PPV. The anatomical success rate for the SB group was 75.5%. There were no significant differences between these groups in terms of anatomical success rates (0.191) or functional success rates (p = 0.534). There was no significant difference between the PPV alone and PPV + SB in terms of the likelihood of anatomic success (p-value: 0.503) or functional success (p-value: 0.839). Preoperative worse BCVA and presence of PVR were associated with poor prognosis (p-value: 0.024, 0.013, respectively). CONCLUSION In the setting of appropriate instruments for microincision pars plana deep vitrectomy, it seems the surgical outcomes of scleral buckling and PPV are not different in patients with primary uncomplicated RRD. The supplementary band has not additional benefits in patients who underwent PPV with this type of RRD.
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16
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Sanhueza A, González R. Pars plana vitrectomy plus scleral buckle versus pars plana vitrec-tomy in pseudophakic retinal detachment. Medwave 2020; 20:e7965. [PMID: 32759890 DOI: 10.5867/medwave.2020.06.7964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Cataract surgery increases the risk for rhegmatogenous retinal detachment. Pars plana vitrectomy and scleral buckling are two surgical procedures used for its repair. The combination of both techniques had been proposed for rhegmatogenous retinal detachment in patients with previous cataract surgery (pseudophakic or aphakic), but its effectiveness remains unclear. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified four systematic reviews with eight studies overall, one of them was a randomized trial. With this data, we conclud-ed that pars plana vitrectomy plus scleral buckle may make little or no difference in primary or final retinal reattachment rate nor in final visual acuity, but the certainty of the evidence is low. In terms of surgery complications, we are uncertain if vitrecto-my plus scleral buckle increases the risk of proliferative vitreoretinopathy or reduces the risk of glaucoma because the certainty of the evidence is very low.
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Affiliation(s)
- Ana Sanhueza
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Raúl González
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Oftalmología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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IMPACT OF INNER LIMITING MEMBRANE PEELING ON VISUAL RECOVERY AFTER VITRECTOMY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT INVOLVING THE FOVEA. Retina 2020; 39:853-859. [PMID: 29394235 DOI: 10.1097/iae.0000000000002046] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the impact of inner limiting membrane peeling during vitrectomy for macula-involving retinal detachment on best-corrected visual acuity (VA). METHODS Retrospective analysis of 89 eyes with primary macula-involving retinal detachment, which was undergoing vitrectomy, endolaser, retinotomy, endodrainage, and SF6 tamponade. Membrane-blue-assisted membrane peeling had been performed in 61 of the eyes (Group 1) but not in the other 28 (Group 2), which served as controls. RESULTS Age, lens status, and incidence of proliferative vitreoretinopathy 26.2% versus 39.3%; P = 0.23 in the 2 groups were comparable. The preoperative visual acuity (Early Treatment Diabetic Retinopathy Study letters) was 25.7 ± 27.9 in Group 1 and 28.8 ± 29.9 in Group 2 (P = 0.47). After surgery, these rose from 62.3 ± 30.5 (Group 1) and 34.2 ± 35.8 (Group 2) after 1 week (P = 0.090), through 83.1 ± 8.0 and 57.2 ± 32.4 at 1 month (P = 0.0005), to 92.1 ± 4.5 and 74.4 ± 23.1 Early Treatment Diabetic Retinopathy Study letters after 6 months (P = 0.0005). More than 6-month incidences of proliferative vitreoretinopathy (13.1% vs. 28.6%; P = 0.13) were similar, whereas the redetachment rate (9.8% vs. 32.1%; P = 0.014), the incidence of secondary epiretinal membranes (1.6% vs. 35.7%; P = 0.0005), and the revitrectomy rate were lower in group 1 (9.8% vs. 53.6%; P = 0.0005). CONCLUSION Inner limiting membrane peeling during vitrectomy for macula-involving retinal detachment may substantially contribute to the visual recovery, reducing the incidence of secondary epiretinal membrane formation.
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18
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Yannuzzi NA, Brown K, Callaway NF, Patel NA, Albini TA, Berrocal AM, Davis JL, Gregori NN, Fortun J, Haddock LJ, Lee WH, Schwartz SG, Sridhar J, Smiddy WE, Flynn HW, Townsend J. The Influence of Surgical Timing on Clinical Outcomes in Primary Extramacular Retinal Detachment in a Tertiary Referral Center. JOURNAL OF VITREORETINAL DISEASES 2020; 4:91-95. [PMID: 37008372 PMCID: PMC9976257 DOI: 10.1177/2474126419893816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE This article reports the influence of timing on the clinical outcomes in primary extramacular rhegmatogenous retinal detachment (RRD) at a tertiary referral center. METHODS A retrospective case series was conducted of all patients presenting between January 1, 2014 and December 31, 2016, with primary extramacular RRD. Retinal detachments with grade C proliferative vitreoretinopathy, combined tractional and RRD, eyes with inflammatory disease, and prior retinal surgery were excluded. The main outcome measures were single-operation anatomic success (SOAS), final anatomic success, and best-corrected visual acuity (BCVA). RESULTS There were 202 eyes of 198 patients with an average of 22 months' follow-up (range, 6-47 months). Eyes were operated on an average of 1.1 days after initial presentation. At last clinical examination, SOAS had been achieved in 174 (86%) eyes, final anatomic success in 200 (99%) eyes, and average postoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 0.18 (Snellen equivalent, 20/30; SD, 0.36). In those treated the day of presentation, average postoperative logMAR BCVA was 0.18 (Snellen, 20/31) in comparison to 0.18 (Snellen, 20/30) in those treated the day after presentation and 0.14 (Snellen, 20/28) in those treated after 2 days or more (P = .92). CONCLUSIONS Regarding timing of surgery, SOAS and BCVA outcomes in primary extramacular RRDs were favorable with an urgent and semiurgent approach to repair. There was no difference in visual and anatomic outcomes between patients who were operated on the day of presentation and those treated a short time later when clinical decisions were made by the treating surgeon on a case-by-case basis.
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Affiliation(s)
- Nicolas A. Yannuzzi
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Karen Brown
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Natalia F. Callaway
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Nimesh A. Patel
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Thomas A. Albini
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Audina M. Berrocal
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Janet L. Davis
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Ninel N. Gregori
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Jorge Fortun
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Luis J. Haddock
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Wen-Hsiang Lee
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Stephen G. Schwartz
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - William E. Smiddy
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Harry W. Flynn
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Justin Townsend
- Department of Ophthalmology, Miller School of Medicine, Bascom
Palmer Eye Institute, University of Miami, Miami, FL, USA
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SUPPLEMENTAL SCLERAL BUCKLE IN THE ERA OF SMALL INCISION VITRECTOMY AND WIDE-ANGLE VIEWING SYSTEMS. Retina 2019; 40:1894-1899. [DOI: 10.1097/iae.0000000000002706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Abstract
PURPOSE To describe the complication of subretinal gas after pars plana vitrectomy for rhegmatogenous retinal detachment, as well as its management. METHODS The presence of subretinal gas was noted on postoperative Day 1 after pars plana vitrectomy for a chronic rhegmatogenous retinal detachment. Resolution of subretinal gas was facilitated by an infusion line and external sclerotomy to expand the vitreous cavity. Residual subretinal gas was removed through a posterior retinotomy after fluid-air exchange. RESULTS This technique resulted in the successful evacuation of subretinal gas, allowing for chorioretinal adhesion and reattachment of the retina. CONCLUSION Subretinal gas can rarely occur after pars plana vitrectomy for rhegmatogenous retinal detachment. This complication can be successfully managed by way of external drainage, followed by evacuation of residual gas through fluid-air exchange and posterior retinotomy.
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21
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EFFECTS OF INTERNAL LIMITING MEMBRANE PEELING COMBINED WITH REMOVAL OF IDIOPATHIC EPIRETINAL MEMBRANE: A Systematic Review of Literature and Meta-Analysis. Retina 2018; 37:1813-1819. [PMID: 28207608 DOI: 10.1097/iae.0000000000001537] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the effects on postoperative prognosis of internal limiting membrane (ILM) peeling in conjunction with removal of idiopathic epiretinal membranes (ERMs). METHODS MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were systematically searched for studies that compared ILM peeling with no ILM peeling in surgery to remove idiopathic ERM. Outcome measures were best-corrected visual acuity, central macular thickness, and ERM recurrence. Studies that compared ILM peeling with no ILM peeling for the treatment of idiopathic ERM were selected. RESULTS Sixteen studies that included 1,286 eyes were selected. All the included studies were retrospective or prospective comparative studies; no randomized controlled study was identified. Baseline preoperative best-corrected visual acuity and central macular thickness were equal between ILM peeling and no ILM peeling groups. Postoperatively, there was no statistically significant difference in best-corrected visual acuity (mean difference 0.01 logarithm of the minimum angle of resolution [equivalent to 0.5 Early Treatment Diabetic Retinopathy Study letter]; 95% CI -0.05 to 0.07 [-3.5 to 2.5 Early Treatment Diabetic Retinopathy Study letters]; P = 0.83) or central macular thickness (mean difference 13.13 μm; 95% CI -10.66 to 36.93; P = 0.28). However, the recurrence rate of ERM was significantly lower with ILM peeling than with no ILM peeling (odds ratio 0.25; 95% CI 0.12-0.49; P < 0.0001). CONCLUSION Currently available evidence in the literature indicates that additional ILM peeling in vitrectomy for idiopathic ERM could result in a significantly lower ERM recurrence rate, but it does not significantly influence postoperative best-corrected visual acuity and central macular thickness.
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Wong D, Chan YK, Bek T, Wilson I, Stefánsson E. Intraocular currents, Bernoulli's principle and non-drainage scleral buckling for rhegmatogenous retinal detachment. Eye (Lond) 2018; 32:213-221. [PMID: 29350687 DOI: 10.1038/eye.2017.312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 11/09/2022] Open
Abstract
For many years, it is not fully understood how non-drainage scleral buckling surgery brings about spontaneous reattachment of the detached retina when retinal breaks remain open at the end of surgery. Various explanations have been put forward, but none more interesting than the effect of fluid currents associated with eye movements. One such explanation involved the physics of the Bernoulli's principle. Daniel Bernoulli was an eighteenth century Swiss mathematician and he described an equation based on the conservation of energy. The sum of pressure energy, potential energy and kinetic energy remains constant. Bernoulli's equation usually applies to closed system such as the flow of fluid through pipes. When fluid flows through a constriction, the speed of fluid increases, the kinetic energy increases. If there was no change in elevation (potential energy), then the increase in kinetic energy must be accompanied by a decrease in pressure energy. In ophthalmic surgery, the Bernoulli's effect is the basis for venturi pumps that drive vitrectomy and phacoemulsification machines. This essay expounds on how Bernoulli's effect might be relevant to scleral buckling for retinal detachment repair. In the era when vitrectomy is increasing the primary surgical operation for retinal detachment, the pervasive advice is to emphasise the importance of patient adopting head posture and remaining still postoperatively. The exception is non-drainage scleral buckling surgery. Early postoperative mobilisation may be vital to achieve reattachment.
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Affiliation(s)
- D Wong
- Royal Liverpool University Hospital, Liverpool, UK
| | - Y K Chan
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong SAR, China
| | - T Bek
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - I Wilson
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - E Stefánsson
- Landspitali University hospital, University of Iceland, Reykjavík, Iceland
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Haugstad M, Moosmayer S, Bragadόttir R. Primary rhegmatogenous retinal detachment - surgical methods and anatomical outcome. Acta Ophthalmol 2017; 95:247-251. [PMID: 27860442 DOI: 10.1111/aos.13295] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/16/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the study was to evaluate the anatomical success of surgical management of primary rhegmatogenous retinal detachment (RRD) and to compare the anatomical outcomes from different surgical techniques. METHODS During 2012, 517 consecutive eyes (514 patients) were operated by 11 surgeons at the Department of Ophthalmology, Oslo University Hospital. Patient records were retrospectively analysed with no exclusions. Main outcome measures were primary and final anatomical success. Primary anatomical success was defined as retinal reattachment 6 months after primary surgery with reoperations excluded. Final anatomical success was defined as retinal reattachment 6 months after primary surgery with reoperations included. RESULTS Incidence of RRD was 18.6 eyes per 100 000 person-years. The macula was detached in 50.5% of the eyes at baseline. Of 517 operated eyes, 317 (61.3%) underwent pars plana vitrectomy (PPV), 23 (4.5%) pars plana vitrectomy together with a scleral buckle (PPV-SB), 175 (33.9%) scleral buckle (SB) surgery and two (0.4%) pneumatic retinopexy (PR). Primary anatomical success was 89.0% in the PPV group, 87.0% in the PPV-SB group and 85.7% in the SB group. Final anatomical success was 98.1% in the PPV group, 100% in the PPV-SB group and 99.4% in the SB group. Factors which were correlated to the redetachment were detachment of more than 6 clock hours (p = 0.003) and visual acuity (VA) on Snellen chart <0.5 (p = 0.02) at baseline. CONCLUSION This study showed no significant differences in the surgical success rates in the treatment of RRD between pars plana vitrectomy, scleral buckle or the combined procedure of vitrectomy and buckle. Factors which were found to be correlated to the redetachment of the retina were large detachment and low VA.
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Affiliation(s)
- Marta Haugstad
- Department of Ophthalmology; Oslo University Hospital; Oslo Norway
| | - Stefan Moosmayer
- Department of Orthopedic Surgery; Martina Hansens Hospital; Sandvika Norway
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Lindsell LB, Sisk RA, Miller DM, Foster RE, Petersen MR, Riemann CD, Hutchins RK. Comparison of outcomes: scleral buckling and pars plana vitrectomy versus vitrectomy alone for primary repair of rhegmatogenous retinal detachment. Clin Ophthalmol 2016; 11:47-54. [PMID: 28053500 PMCID: PMC5189967 DOI: 10.2147/opth.s112190] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the combination of scleral buckling (SB) and pars plana vitrectomy (PPV) versus PPV alone in the primary repair of rhegmatogenous retinal detachments (RRDs). Methods The current study was a retrospective, comparative, interventional, consecutive case series of 179 eyes of 174 patients who underwent primary RRD repair by five surgeons between January 1, 2008 and December 31, 2010, utilizing SB with PPV or PPV. Univariate and multivariate analyses were used to compare the efficacy of the two surgical strategies and assess for risk factors of proliferative vitreoretinopathy (PVR). Results Single surgery anatomic success (SSAS) was similar (P=0.76) between the PPV group (112 of 132 eyes, 85%) and SB with PPV group (39 of 47 eyes, 83%). Final anatomic success was 100% in each group. There was no difference in rates of PVR formation (PPV 16% vs SB with PPV 19%, P=0.70). Final logarithm of the minimum angle of resolution acuity was 0.33 (20/43) in the PPV group and 0.37 (20/47) in the SB with PPV group (P=0.62). Postoperative anterior chamber fibrin was highly correlated with PVR formation (PVR 13% vs no PVR 0.7%, P=0.003; odds ratio =68.37, P=0.007). Separate analysis of medium- to high-complexity cases showed similar SSAS (PPV 86% vs SB with PPV 83%, P=0.45). Conclusion SB with PPV versus PPV alone were similarly efficacious for repair of primary RRDs of varying complexity. SSAS rates, PVR incidence, and final visual acuities were not significantly different.
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Affiliation(s)
- Luke B Lindsell
- Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Robert A Sisk
- Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Daniel M Miller
- Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Robert E Foster
- Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Michael R Petersen
- Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Christopher D Riemann
- Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Robert K Hutchins
- Cincinnati Eye Institute, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
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