Outcomes in primary uncomplicated rhegmatogenous retinal detachment repair using pars plana vitrectomy with or without scleral buckle

Accuracy of using the axial length of the fellow eye for IOL calculation in retinal detachment eyes undergoing silicone oil removal

PURPOSE

Evaluate whether the axial length of the fellow eye can be used to calculate the intraocular lens (IOL) in eyes with retinal detachment.

DESIGN

Retrospective, consecutive case series.

METHODS

Our study was conducted at the Goethe University and included patients who underwent silicone oil (SO) removal combined with phacoemulsification and IOL implantation. Preoperative examinations included biometry (IOLMaster 700, Carl Zeiss). We measured axial length (AL) of operated eye (OE) or fellow eye (FE) and compared mean prediction error and mean and median absolute prediction error (MedAE) using four formulas and AL of the OE (Barrett Universal II (BUII)-OE). Additionally, we compared the number of eyes within ±0.50, ±1.00 and ±2.00 dioptre (D) from target refraction.

RESULTS

In total, 77 eyes of 77 patients met our inclusion criteria. MedAE was lowest for the BUII-OE (0.42 D) compared with Kane-FE (1.08 D), BUII-FE (1.02 D) and Radial Basis Function 3.0 (RBF3.0)-FE (1.03 D). This was highly significant (p<0.001). The same accounts for the number of eyes within ±0.50 D of the target refraction with the BUII-OE (44 eyes, 57%) outperforming the RBF3.0-FE (20 eyes, 25.9%), Kane-FE and BUII-FE formula (21 eyes, 27.2%) each.

CONCLUSION

Our results show a statistically and clinically highly relevant reduction of IOL power predictability when using the AL of the FE for IOL calculation. Using the AL of the SO filled eye after initial vitrectomy results in significantly better postoperative refractive results. A two-step procedure using the AL of the OE after reattachment of the retina is highly recommended.

The necessity and role of scleral buckling for rhegmatogenous retinal detachment

PURPOSE OF REVIEW

With a decline in the use of scleral buckling for rhegmatogenous retinal detachment (RRD) repair in recent years, this review seeks to provide a summary of the most recent research findings regarding the role of scleral buckling in the repair of RRD.

RECENT FINDINGS

Many recent studies have compared visual and anatomic outcomes between scleral buckling and pars plana vitrectomy (PPV) for RRD repair. Some suggest superior outcomes with primary scleral buckling, particularly in younger, phakic patients, and in association with other risk factors that we review. Children do best with primary scleral buckling surgery. Functionally, scleral buckling may also result in lower rates of retinal displacement compared to PPV. When PPV is necessary, a supplemental buckle may benefit certain patients, while the advantage remains unclear in other clinical scenarios and necessitates further investigation.

SUMMARY

Scleral buckling is an important technique for the repair of RRD and it is crucial to continue training retina surgeons in this technique to maximize patient outcomes.

REtinal Detachment Outcomes Study (REDOS): study protocol for a factorial, randomized controlled trial

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.

MEDIUM-TERM PERFLUORO-N-OCTANE AS RESCUE POSTOPERATIVE TAMPONADE FOR VERY COMPLEX RETINAL DETACHMENTS: ANATOMICAL AND FUNCTIONAL OUTCOMES

PURPOSE

To report the anatomical and functional outcomes of medium-term perfluoro-n-octane (PFO) tamponade as a rescue procedure in very complex retinal detachments (RDs).

METHODS

We reviewed the case records of 35 consecutive patients who underwent vitrectomy for very complex RDs due to diverse etiologies. The surgical complexity was so graded because of the intraoperative failure to ascertain complete retinal reattachment; perfluoro-n-octane was used as rescue tamponade for 2 to 4 weeks. The second intervention included additional membrane peeling, retinectomy, endophotocoagulation, and gas/silicone oil tamponade. The minimum follow-up was 3 months after the final intervention: the primary outcome was retinal reattachment and the secondary outcome was change in best-corrected visual acuity (BCVA).

RESULTS

The most common presentations were severe trauma with retinal incarceration, preretinal and subretinal hemorrhage, or chronic/recurrent RDs with anterior proliferative vitreoretinopathy. Preoperative BCVA was ≤counting fingers in 31 (88.6%) patients. Complete retinal attachment without any tamponade was achieved in 33 (94.3%) eyes. best-corrected visual acuity improved in 30 (85.7%) eyes: 16 (45.7%) had BCVA ≥20/200 and 21 (60%) regained ambulatory vision (≥5/200). Two eyes developed keratopathy, and four needed antiglaucoma medications.

CONCLUSION

We achieved excellent anatomical outcomes and acceptable functional outcomes in nearly inoperable RDs with few side effects. Medium-term perfluoro-n-octane tamponade can be used as a salvage procedure in very complex RDs where intraoperative reattachment cannot be ensured.

Pre-operative intravitreal bevacizumab for tractional retinal detachment secondary to proliferative diabetic retinopathy: the Alvaro Rodriguez lecture 2023

The treatment of proliferative diabetic retinopathy (PDR) has evolved significantly since the initial use of panretinal photocoagulation as a treatment in the 1950s. Vascular endothelial growth factor inhibitors have provided an effective alternative without the risk of peripheral vision loss. Despite this, the risk of complications requiring surgical intervention in PDR remains high. Intravitreal bevacizumab has shown promise as a preoperative adjuvant to vitrectomy for PDR complications, albeit with a purported risk for tractional retinal detachment (TRD) progression in eyes with significant fibrous proliferation. Here we will discuss anti-VEGF agent use in PDR and its role in surgical intervention for PDR complications including TRD.

Intraocular Lens Calculation Using 8 Formulas in Silicone Oil-Filled Eyes Undergoing Silicone Oil Removal and Phacoemulsification After Retinal Detachment

PURPOSE

To evaluate formulas for intraocular lens (IOL) calculation in silicone oil (SO)-filled eyes.

DESIGN

Retrospective, consecutive case series.

METHODS

We conducted our study at the Department of Ophthalmology, Goethe University, Frankfurt, Germany, and included SO-filled eyes that received SO removal combined with phacoemulsification and IOL implantation. Preoperative assessments included biometry (IOLMaster 700; Carl Zeiss Meditec). To evaluate the measurements, we compared the mean prediction error, and mean and median absolute prediction error of 8 different formulas.

RESULTS

A total of 90 eyes matched our inclusion criteria. The median absolute error was lowest in the Barrett Universal II formula (0.43 diopters [D] ± 0.75) followed by Kane (0.44 D ± 0.75), Hill-radial basis function (0.47 D ± 0.74), Holladay II (0.47 D ± 0.77), Sanders Retzlaff Kraff/theoretical (0.51 D ± 0.74), Holladay I (0.51 D ± 0.76), and Haigis and Hoffer Q (0.52 D ± 0.74 each). Regarding eyes within ±0.5 D Barrett Universal II (57.8%, 52 eyes) performed best, again followed by Kane (56.7%, 51 eyes) and Hill-radial basis function (54.4%, 49 eyes).

CONCLUSION

Using modern formulas for IOL calculation in oil-filled eyes improves predictability but still not as good as in unoperated eyes. This issue is created by the change in refractive index due to the SO fill and therefore a lower precision of axial length measurement and effective lens position prediction.