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Alberti M, Ilsby C, Christensen UC, Kiilgaard JF, la Cour M. Preoperative Positioning and Progression of Fovea-on Retinal Detachments. Ophthalmol Retina 2024; 8:137-147. [PMID: 37659721 DOI: 10.1016/j.oret.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE To study the relationship between positioning and rhegmatogenous retinal detachment (RRD) progression before surgery in patients with a fovea-on RRD. DESIGN Prospective, single-cohort study. SUBJECTS Patients with fovea-on RRD admitted to hospital for bedrest before surgical treatment were recruited. METHODS Primary outcome was the shortest distance from the foveal center to the retinal detachment border on OCT. Secondary outcomes were measured with a head-mounted positioning sensor and included measures of head movement (linear acceleration and angular velocity) as well as measures of positioning regimen compliance. MAIN OUTCOME MEASURES Distance from the fovea to the retinal detachment border. RESULTS Overall, 50 patients with fovea-on positioned before RRD repair. One patient (1/50, 2%) progressed from fovea-on to fovea-off. Of the positioning measures, angular velocity demonstrated the strongest correlation with RRD border movement, whereas measures of positioning compliance showed nonsignificant correlation. After defining 3 movement groups: stable, intermediate, and mobile RRDs, we found that a doubling of head movement (angular velocity) correlated with a median RRD border progression of -6 μm/h, -75 μm/h, and -219 μm/h in the 3 groups, respectively. CONCLUSIONS Rhegmatogenous retinal detachment border movement is correlated to angular velocity of the head, whereas compliance with our current positioning regimen does not have a significant impact on RRD border movement. Not all RRDs progress rapidly toward the fovea, but those that do seem to be highly influenced by head movement. For limiting RRD progression, a reduced movement positioning regimen may be superior to our current gravity-based approach. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Mark Alberti
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
| | - Christian Ilsby
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | | | | | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
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Haq Z, Mittra RA, Parke DW, Yonekawa Y, Hsu J, Gupta O, Williams GA, Shah GK, Ryan EH. IMPACT OF FOVEAL STATUS AND TIMING OF SURGERY ON VISUAL OUTCOME IN RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2024; 44:88-94. [PMID: 37603408 DOI: 10.1097/iae.0000000000003913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
PURPOSE To investigate the impact of surgical timing on visual acuity outcomes in retinal detachments based on the preoperative foveal status. METHODS A retrospective multicenter cohort study was conducted. Cases were stratified into fovea-on, fovea-split, and fovea-off groups. Days to surgery was defined as the time between the preoperative examination and surgery. The main outcome measure was the final postoperative visual acuity. RESULTS 1,675 cases were studied. More than 80% of fovea-on/fovea-split and fovea-off cases had surgery within 1 and 3 days, respectively. The mean final postoperative visual acuity did not differ significantly between the fovea-on and fovea-split groups (Snellen equivalent [SE] 20/33 ± 20/49 and 20/32 ± 20/39, P = 1.000) and did not change significantly based on days to surgery in either group. The mean final postoperative visual acuity was lowest in the fovea-off group (Snellen equivalent = 20/56 ± 20/76, P < 0.001) and was significantly lower in cases where surgery was performed after two or more days when compared with cases performed within 1 day (Snellen equivalent 20/74 ± 20/89 vs. 20/46 ± 20/63, P < 0.001). CONCLUSION Fovea-on and fovea-split retinal detachments demonstrated comparable visual outcomes. Fovea-off RDs demonstrated worse visual outcomes, which declined further when surgery was delayed by two or more days.
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Affiliation(s)
- Zeeshan Haq
- Retina Consultants of Minnesota, Edina, Minnesota
| | | | | | - Yoshihiro Yonekawa
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsyl'nia
| | - Jason Hsu
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsyl'nia
| | - Omesh Gupta
- Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsyl'nia
| | - George A Williams
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | | | - Edwin H Ryan
- Retina Consultants of Minnesota, Edina, Minnesota
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Effect of Changes in Surgical Strategies for the Treatment of Primary Rhegmatogenous Retinal Detachment on Functional and Anatomical Outcomes: A Retrospective Analysis of 812 Cases from the Years 2004 to 2012. J Clin Med 2023; 12:jcm12062278. [PMID: 36983279 PMCID: PMC10057392 DOI: 10.3390/jcm12062278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background: At the Department of Ophthalmology and Optometry at the MUV surgical method (scleral buckling, vitrectomy, combined vitrectomy/scleral buckling) and timing (daytime, nighttime) for the treatment of primary rhegmatogenous retinal detachment (RRD) changed continuously in the years 2004 to 2012. This study aims to evaluate changes in surgical strategies over time including their impact on functional and anatomical outcomes. Methods: Retrospective evaluation of patients operated on primary RRD between the years 2004 and 2012. Baseline demographic data, month 3 best-corrected visual acuity (BCVA), surgical method, single success surgery, surgical timing, and intraoperative complications were analyzed. Results: Overall, 812 eyes of 812 patients with a mean (±SD) age of 58.1 ± 13.3 years were included. A total of 413 (51%) patients presented with macula-on and 359 (44%) with macula-off RRD. Month 3 BCVA increased over time, both in macula-on or macula-off groups (p < 0.001). The rate of complete retinal reattachment 3 months postoperatively increased significantly from 65% in 2004 to 83% in 2012 in both groups. Scleral buckling surgeries decreased continuously from 95% to 16% with an appropriate increase in vitrectomies as well as a decrease in surgeries during nighttime (68% in 2004, 6% in 2012) with equal or better visual and functional outcomes. Conclusion: Our data showed that improving functional and single-success surgery outcomes in patients operated on for primary RRD. In the years 2004 to 2012, surgical techniques shifted from scleral buckling to primary vitrectomy and were increasingly scheduled during the daytime.
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How should we report the foveal status in eyes with "macula-off" retinal detachment? Eye (Lond) 2023; 37:228-234. [PMID: 35505112 PMCID: PMC9873750 DOI: 10.1038/s41433-022-02074-7] [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: 12/10/2021] [Revised: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 01/28/2023] Open
Abstract
Whilst pre- and postoperative multimodal imaging technologies including optical coherence tomography (OCT) have investigated the morphological correlates of worsened visual outcomes in rhegmatogenous retinal detachment (RRD) with foveal involvement, the nomenclature has adhered to the traditional ophthalmoscopy-based and rather vague term "macula-off". This article appraises the current literature with regard to the preoperative assessment and nomenclature of the foveal status in macula involving retinal detachment (MIRD). A literature review of recent publications assessing functional or morphological outcomes in MIRD was conducted, using the search terms "fovea-off" or "macula-off". The search date was April 28th, 2021. Original studies in English language were included. Case reports, review articles or letters were excluded. Forty relevant articles (range of publication dates: July 29th, 2020 - April 18th, 2021) were reviewed to assess the diagnostic modalities used, morphological parameters assessed, and any specific nomenclature introduced to specify the extent of macular detachment. The results suggest widespread variability and inconsistencies with regard to the preoperative assessment, diagnostic modalities and nomenclature used to describe the foveal status in eyes with RRD termed "macula-off". The extent of macular detachment may be classified by a wide range of morphological parameters, including the height of foveal detachment and the ETDRS grid as overlay tool in OCT devices. There is a scientific and clinical need for an updated nomenclature for eyes with "macula-off" RRD. Preoperative OCT findings should be reported on a regular and standardized basis in order to establish a consensus how to report the foveal status in eyes with MIRD.
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Sothivannan A, Eshtiaghi A, Dhoot AS, Popovic MM, Garg SJ, Kertes PJ, Muni RH. Impact of the Time to Surgery on Visual Outcomes for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis. Am J Ophthalmol 2022; 244:19-29. [PMID: 35932819 DOI: 10.1016/j.ajo.2022.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine the relationship between time from symptom onset or presentation to repair and visual outcomes for macula-on and macula-off rhegmatogenous retinal detachment (RRD). DESIGN Meta-analysis. METHODS We searched MEDLINE, EMBASE, and Cochrane Library for randomized controlled trials and observational studies comparing best-corrected visual acuity (BCVA) based on time to RRD repair. Study identifiers, baseline characteristics, intervention characteristics, and visual outcomes were extracted. We conducted a random effects meta-analysis. Sensitivity analyses included leave-1-out and influence analyses. Primary outcomes included mean difference (MD) in final BCVA, MD between preoperative and final BCVA (∆BCVA), and relative risk of final BCVA <0.4 logMAR for macula-off RRD repair in 0-3 vs 4-7 days and macula-on RRD repair in 0-24 vs >24 hours. Secondary outcomes assessed other time points. RESULTS Twenty observational studies reported on 1929 patients. Macula-off RRD repair in 0-3 days from symptom onset was superior to 4-7 days for final BCVA (MD -0.06 [95% CI -0.09, -0.03], P < .001) but was not different for ∆BCVA (P > .05). Macula-on repair in 0-24 hours from presentation was superior to >24 hours for final BCVA (MD -0.02 [95% CI -0.03, -0.01], P < .05) but was not different for ∆BCVA (P > .05). CONCLUSIONS Macula-off RRD repair in 0-3 days from symptom onset may have better final BCVA compared to repair in 4-7 days. Macula-on RRD repair in 0-24 hours of presentation may have better final BCVA compared to repair in >24 hours. These results were supported by moderate- and low-quality evidence, respectively, and may have been influenced by differences in baseline BCVA.
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Affiliation(s)
- Amirthan Sothivannan
- From the Michael G. DeGroote Faculty of Medicine, McMaster University (A.S.), Hamilton, Ontario, Canada
| | - Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto (A.E., A.S.D.), Toronto, Ontario, Canada
| | - Arjan S Dhoot
- Faculty of Medicine, University of Toronto (A.E., A.S.D.), Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto (M.M.P., P.J.K., R.H.M.), Toronto, Ontario, Canada
| | - Sunir J Garg
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto (M.M.P., P.J.K., R.H.M.), Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre (P.J.K.), Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto (M.M.P., P.J.K., R.H.M.), Toronto, Ontario, Canada; Department of Ophthalmology, St Michael's Hospital/Unity Health Toronto (R.H.M.), Toronto, Ontario, Canada.
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Vest A, Keilani C, Chaumet-Riffaud P, Barale PO, Tuil E, Ayello-Scheer S, Koch E, Abada S, Giocanti-Auregan A, Durand-Zaleski I, Delbarre M, Froussart-Maille F, Beaugrand A, Tadayoni R, Sahel JA, Paques M. Incidence and characteristics of rhegmatogenous retinal detachment during coronavirus-19 pandemic: A French study. Eur J Ophthalmol 2022; 32:3644-3649. [PMID: 35172628 PMCID: PMC8859482 DOI: 10.1177/11206721221080810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose To assess the impact of the Covid-19 pandemic and subsequent lockdown on the number and clinical characteristics of patients with retinal detachment (RD) in a French public university eye hospital. Methods Single-center, retrospective non-interventional study. Patients consulting at the emergency room (ER) of Quinze-Vingts Hospital (France) for rhegmatogenous RD before and after instauration of the lockdown were reviewed. We compared the characteristics of patients with RD between the containment period (March17th - April27th,2020) and the period preceding the lockdown (February18th - March16th,2020). We compared the number of RD surgeries performed between the first month of lockdown (March17th - April19th,2020) and the corresponding period of 2019. Number of cases, delay between diagnosis and surgery, visual acuity was measured. Results During the first month of lockdown, 59 RDs were operated on, compared to 107 in the corresponding period in 2019 (-44,8%). Mean time from first symptoms to surgery was significantly higher during the lockdown 12.7 (11.3) days vs 7.6 (7.8) days (p = 0.031) before. During the lockdown, the mean BCVA was lower albeit the difference did not reach statistical significance (1.16 (0.9) during pre-containment vs 1.5 (0.9) during containment; p = 0.09). Reasonsfor delayed consultation were: fear of Covid-19 (31%; p = 0.0001), absence of referral doctor (31%; p = 0.003) and difficulties in getting to public transport (10.3%;p = 0.859). Conclusion Despite maintaining accessto emergency eye care facilitiesin our hospital, the lockdown affected visual health. Should the lockdown be reinstated, we postulate that a better information about eye care access for non-Covid emergencies may attenuate its effect on visual health.
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Affiliation(s)
- Agathe Vest
- Department of Ophthalmology IV, 55862Quinze-Vingts National HospitalParis, France.,Faculty of Medicine Hyacinthe Bastaraud, University of the French West Indies and French Guiana, Pointe-à-Pitre, France
| | - Chafik Keilani
- Department of Ophthalmology IV, 55862Quinze-Vingts National HospitalParis, France.,Department of ophthalmology, Percy Military Hospital, Clamart, France.,Pôle ophtalmologique Clemenceau, Rennes, France.,Cabinet d'ophtalmologie La Visitation, Rennes, France
| | - Philippe Chaumet-Riffaud
- Service de Biophysique et Médecine Nucléaire, Hôpital de Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | | | - Eric Tuil
- Department of Ophthalmology IV, 55862Quinze-Vingts National HospitalParis, France
| | - Sarah Ayello-Scheer
- Department of Ophthalmology IV, 55862Quinze-Vingts National HospitalParis, France
| | - Edouard Koch
- Department of ophthalmology, Versailles Hospital (André Mignot), Le Chesnay, France
| | - Samir Abada
- Department of ophthalmology, 37107François-Quesnay Hospital, Mantes-la-Jolie, France
| | | | | | - Maxime Delbarre
- Department of ophthalmology, Percy Military Hospital, Clamart, France
| | | | - Amélie Beaugrand
- Department of Biomedical Informatics, 55862Quinze-Vingts National Hospital, Paris, France
| | - Ramin Tadayoni
- Department of ophthalmology, Paris University, Lariboisière Hospital, F-75010, Paris, France.,Department of ophthalmology, Rothschild Foundation, Paris, France
| | - José-Alain Sahel
- Department of Ophthalmology IV, 55862Quinze-Vingts National HospitalParis, France.,INSERM, CNRS, Institut de la Vision, Sorbonne Université, Paris, France
| | - Michel Paques
- Department of Ophthalmology IV, 55862Quinze-Vingts National HospitalParis, France.,INSERM, CNRS, Institut de la Vision, Sorbonne Université, Paris, France
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7
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Lee R, Shields RA, Maywood MJ, Nemeth C, Wa CA, Williams GA, Hassan TS, Garretson BR, Capone A, Ruby AJ, Drenser KA, Faia LJ, Randhawa S, Mahmoud TH, Wolfe JD. LONG-TERM VISUAL OUTCOMES AND THE TIMING OF SURGICAL REPAIR OF FOVEA-SPLITTING RHEGMATOGENOUS RETINAL DETACHMENTS. Retina 2022; 42:244-249. [PMID: 34469406 DOI: 10.1097/iae.0000000000003293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the visual outcomes and the affect of timing of surgical repair of fovea-splitting rhegmatogenous retinal detachments. METHOD A retrospective, consecutive cohort from multiple surgeons at a single center. Fovea status (fovea-on, fovea-splitting, or fovea-off) was classified by preoperative optical coherence tomography. The primary outcome measure was the visual acuity at the last follow-up that was further correlated with the timing of surgical repair. RESULTS One hundred and ninety-five eyes were included with 62 fovea-on, 65 fovea-splitting, and 68 fovea-off detachments. The mean preoperative logarithm of the minimum angle of resolution visual acuity for fovea-on, fovea-splitting, and fovea-off groups was 0.16 ± 0.21, 0.70 ± 0.56, and 1.67 ± 0.87, respectively (P = <0.001). Mean postoperative logarithm of the minimum angle of resolution visual acuity for fovea-on, fovea-splitting, and fovea-off groups were 0.07 ± 0.13, 0.10 ± 0.15, and 0.20 ± 0.22, respectively (P = <0.001). A statistically significant difference in mean postoperative logMAR visual acuity was found between fovea-off and fovea-on groups (P = 0.003) and between fovea-off and fovea-splitting groups (P = 0.013), however not between fovea-on and fovea-splitting groups (P = 0.827). Visual acuity improved when repair was performed earlier after presentation for fovea-on (R = 0.378, P = 0.002) and fovea-off groups (R = 0.277, P = 0.022), but not for the fovea-splitting group (R = 0.089, P = 0.481). CONCLUSION We described the favorable visual outcomes of surgery for fovea-splitting rhegmatogenous retinal detachment and correlated these with the timing of surgical repair, which may help guide the management of this urgent, vision-threatening condition.
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Affiliation(s)
- Ramon Lee
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
| | - Ryan A Shields
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
| | - Michael J Maywood
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Cire Nemeth
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
| | - Christianne A Wa
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
| | - George A Williams
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Tarek S Hassan
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Bruce R Garretson
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Antonio Capone
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Alan J Ruby
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Kimberly A Drenser
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Lisa J Faia
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Sandeep Randhawa
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Tamer H Mahmoud
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
| | - Jeremy D Wolfe
- Associated Retinal Consultants, P.C., Royal Oak, Michigan; William Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; and
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Felfeli T, Ximenes R, Naimark DMJ, Hooper PL, Campbell RJ, El-Defrawy SR, Sander B. The ophthalmic surgical backlog associated with the COVID-19 pandemic: a population-based and microsimulation modelling study. CMAJ Open 2021; 9:E1063-E1072. [PMID: 34815262 PMCID: PMC8612655 DOI: 10.9778/cmajo.20210145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Jurisdictions worldwide ramped down ophthalmic surgeries to mitigate the effects of COVID-19, creating a global surgical backlog. We sought to predict the long-term impact of COVID-19 on the timely delivery of non-emergent ophthalmology sub-specialty surgical care in Ontario. METHODS This is a microsimulation modelling study. We used provincial population-based administrative data from the Wait Time Information System database in Ontario for January 2019 to May 2021 and facility-level data for March 2018 to May 2021 to estimate the backlog size and wait times associated with the COVID-19 pandemic. For the postpandemic recovery phase, we estimated the resources required to clear the backlog of patients accumulated on the wait-list during the pandemic. Outcomes were accrued over a time horizon of 3 years. RESULTS A total of 56 923 patients were on the wait-list in the province of Ontario awaiting non-emergency ophthalmic surgery as of Mar. 15, 2020. The number of non-emergency surgeries performed in the province decreased by 97% in May 2020 and by 80% in May 2021 compared with the same months in 2019. By 2 years and 3 years since the start of the pandemic, the overall estimated number of patients awaiting surgery grew by 129% and 150%, respectively. The estimated mean wait time for patients for all subspecialty surgeries increased to 282 (standard deviation [SD] 91) days in March 2023 compared with 94 (SD 97) days in 2019. The provincial monthly additional resources required to clear the backlog by March 2023 was estimated to be a 34% escalation from the prepandemic volumes (4626 additional surgeries). INTERPRETATION The estimates from this microsimulation modelling study suggest that the magnitude of the ophthalmic surgical backlog from the COVID-19 pandemic has important implications for the recovery phase. This model can be adapted to other jurisdictions to assist with recovery planning for vision-saving surgeries.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont.
| | - Raphael Ximenes
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - David M J Naimark
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Philip L Hooper
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Robert J Campbell
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Sherif R El-Defrawy
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Beate Sander
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
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Statement of the German Ophthalmological Society (DOG), the Retinological Society (RG) and the Professional Association of Ophthalmologists in Germany (BVA) on the timing of treatment of rhegmatogenous retinal detachment : Dated October 2020. Ophthalmologe 2021; 118:132-134. [PMID: 34232367 DOI: 10.1007/s00347-021-01440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
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10
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Felfeli T, Murtaza F, Abueh B, Mandelcorn MS, Wong DD, Mandelcorn ED. Clinical Significance of Macula-Off Rhegmatogenous Retinal Detachment Preoperative Features on Optical Coherence Tomography. Ophthalmic Surg Lasers Imaging Retina 2021; 52:S23-S29. [PMID: 34310238 DOI: 10.3928/23258160-20210518-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the clinical significance of preoperative spectral-domain optical coherence tomography (OCT) features and their association with postoperative outcomes in eyes with primary macula-off rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS This is a retrospective case series of all consecutive cases undergoing repair of primary macula-off RRD at two tertiary care academic centers between January 2018 to January 2021. RESULTS Among 406 eyes, baseline visual acuity (β = 0.184, P = .001) and time to surgery (β = 0.009, P = .033) were predictive of postoperative visual acuity at 1-year follow-up after adjusting for age, sex and lens status, as well as presence of preoperative features on OCT such as outer retinal corrugations and height of the retinal detachment. CONCLUSION Baseline visual acuity and time to surgical repair are the best predictors of vision outcomes following macula-off RRD repair. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S23-S29.].
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Stellungnahme von DOG, RG und BVA zur zeitlichen Planung der Versorgung einer rhegmatogenen Amotio retinae. Klin Monbl Augenheilkd 2021; 238:314-316. [PMID: 33784791 DOI: 10.1055/a-1364-4747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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The urgency of surgical treatment for rhegmatogenous retinal detachment. Ophthalmologe 2021; 118:160-165. [PMID: 33751188 DOI: 10.1007/s00347-021-01364-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] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The ideal timing of surgery in patients with rhegmatogenous retinal detachment has been discussed for decades. The study situation has improved in recent years so that recommendations can now be made. When the macula is detached, surgical treatment of the retinal detachment should be undertaken within a few days. When the macula is still attached, the near fovea and bullous superotemporal detachment should be classified as an emergency. When planning the operation environmental factors must also be considered, meaning that the performance of the intervention by an experienced surgical team is usually more important for the final result than the retinal condition alone. Influencing factors are discussed in this article and recommendations for dealing with these emergency patients are discussed.
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Boden KT, Januschowski K, Szurman P, Seuthe AM, Rickmann A, Seitz B, Alsharairi M, Leers S, Wakili P. New optical coherence tomography grading system for macula-off rhegmatogenous retinal detachment: how off is off? BMJ Open Ophthalmol 2021; 6:e000419. [PMID: 33768162 PMCID: PMC7942246 DOI: 10.1136/bmjophth-2019-000419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/07/2021] [Accepted: 02/11/2021] [Indexed: 11/04/2022] Open
Abstract
Background/Aims The classification of retinal detachment is currently still based on many objective criteria such as duration of symptoms and funduscopic macular status, which leaves some important questions unanswered. The most important factor is the macular status, which is determined using direct or indirect ophthalmoscopy. Optical coherence tomography (OCT) has become a standard tool in clinical practice and enables detecting the exact extent of subretinal fluid in macula-off/on retinal detachment. We introduce a new and simple OCT-based grading system for macular detachment to provide a basis for further investigations to determine the optimal timing for surgery. Methods We retrospectively included 155 patients who were treated for retinal detachment. We defined the extent of the macular detachment in six stages based on the Early Treatment Diabetic Retinopathy Study (ETDRS) grid of the OCT scan. The outermost ring of the ETDRS grid was defined as zone 1, the middle ring as zone 2 and the inner ring as zone 3. Only zone 3 differed in the retinal detachment height grades (grade a <250 µm vs grade b >250 µm). Retinal detachment heights that could not be measured were considered grade 4 (ungradable) detachments. Results Forty-seven patients had no macular involvement (grade 0). Regarding macular detachment, 14 patients had grade 1, 20 had grade 2, 9 had grade 3a, 29 had grade 3b and 36 had grade 4. Conclusion The newly developed OCT grading system for macular involvement following retinal detachment is a crucial tool to objectively classify a retinal detachment in order to be able to make better statements in the future, like for defining the optimal time for surgical intervention. A secondary benefit of this grading system would be that it improves predicting postoperative visual acuity.
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Affiliation(s)
- Karl Thomas Boden
- Eye Clinic, Knappschaftsklinikum Saar GmbH Krankenhaus Sulzbach, Sulzbach, Germany
| | - Kai Januschowski
- Eye Clinic, Knappschaftsklinikum Saar GmbH Krankenhaus Sulzbach, Sulzbach, Germany.,Centre for Ophthalmology, University Eye Hospital Tuebingen, Tubingen, Baden-Württemberg, Germany
| | - Peter Szurman
- Eye Clinic, Knappschaftsklinikum Saar GmbH Krankenhaus Sulzbach, Sulzbach, Germany
| | - Anna-Maria Seuthe
- Eye Clinic, Knappschaftsklinikum Saar GmbH Krankenhaus Sulzbach, Sulzbach, Germany
| | - Annekatrin Rickmann
- Eye Clinic, Knappschaftsklinikum Saar GmbH Krankenhaus Sulzbach, Sulzbach, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Stephan Leers
- Eye Clinic, Saar Knappschaft Hospital Sulzbach, Sulzbach, Saarland, Germany
| | - Philip Wakili
- Eye Clinic, Knappschaftsklinikum Saar GmbH Krankenhaus Sulzbach, Sulzbach, Germany
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Functional recovery after macula involving retinal detachment and its correlation with preoperative biomarkers in optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2021; 259:2521-2531. [PMID: 33675394 PMCID: PMC8380578 DOI: 10.1007/s00417-021-05113-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
To introduce an ETDRS grid-based classification for macula involving retinal detachment (MIRD) with or without center (foveal) involvement and to identify biomarkers in preoperative optical coherence tomography (OCT) associated with a favorable postoperative functional outcome in eyes with center involving retinal detachment (CIRD). One hundred and two eyes of 102 consecutive patients (f/m: 35/67) with primary rhegmatogenous retinal detachment, preoperative evidence of MIRD (perifoveal involvement of ≤ 6.0 mm), and successful retinal surgery were included in this retrospective cohort study. Eyes were assigned to 5 grades of MIRD (G1–G5), based on the extent of detachment in the ETDRS grid. Eyes with a detached foveal status (CIRD) were assigned to G4 or G5. In CIRD, the following OCT biomarkers were quantified and correlated with mean BCVA (logMAR) at 3 months postsurgery, using univariate and multivariable regression models: grade of detachment, extent of intraretinal edema, height of foveal detachment, subretinal folds, and epiretinal membrane. Forty-one of 102 eyes (40.2%) presented with an attached foveal status, defined as either outer (G1: 11.8%) or inner (G2: 18.6%) macular involvement or fovea-threatening MIRD (G3: 9.8%). Sixty-one eyes (59.8%) showed CIRD (G4 or G5). Eyes with CIRD had significantly worse postoperative BCVA than eyes without foveal involvement (0.355 logMAR vs. 0.138 logMAR, p<0.001). If CIRD was limited to three outer ETDRS quadrants (G4), mean BCVA was better compared to CIRD involving all four ETDRS quadrants (G5) (0.254 logMAR vs. 0.522 logMAR, p<0.001). Reading ability (BCVA ≤ 0.4 logMAR) was restored in 97.6% of eyes with G1–G3 compared to 86.9% of eyes with G4 (p=0.072) and 52.4% of eyes with G5 (p<0.001). In multivariable regression analysis of eyes with CIRD, a lower grade of detachment (G4 vs. G5: p<0.05) and lower extent of cystoid edema (focal/none vs. wide: p<0.001) were both associated with better postoperative function. The functional outcome after MIRD may be worse in the presence of foveal involvement (CIRD), but a lower grade of detachment and the absence of intraretinal edema can predict a good recovery in spite of CIRD.
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[Statement of the German Ophthalmological Society (DOG), the Retinological Society (RG) and the Professional Association of Ophthalmologists in Germany (BVA) on the timing of treatment of rhegmatogenous retinal detachment : Situation October 2020]. Ophthalmologe 2021; 118:235-238. [PMID: 33459809 DOI: 10.1007/s00347-020-01311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
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Almazyad EM, AlAkeely AG. Perspective on Intraocular Surgeries in the Era of Coronavirus Disease-19. Middle East Afr J Ophthalmol 2020; 27:69-72. [PMID: 32874037 PMCID: PMC7442087 DOI: 10.4103/meajo.meajo_308_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Enmar M Almazyad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Adel G AlAkeely
- Retina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Feltgen N, Callizo J, Hattenbach LO, Hoerauf H. Dringlichkeit der operativen Versorgung bei der rissbedingten Netzhautablösung. Ophthalmologe 2020; 117:858-865. [DOI: 10.1007/s00347-020-01191-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Major JC, Hariprasad SM, Rusakevich AM. Developments in Fovea-Sparing RRD Repair: Reconsidering the Timing of Surgery. Ophthalmic Surg Lasers Imaging Retina 2019; 50:408-410. [PMID: 31344238 DOI: 10.3928/23258160-20190703-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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de Jong JH, Vigueras-Guillén JP, Wubbels RJ, Timman R, Vermeer KA, van Meurs JC. The Influence of Prolongation of Interruptions of Preoperative Posturing and Other Clinical Factors on the Progress of Macula-On Retinal Detachment. Ophthalmol Retina 2019; 3:938-946. [PMID: 31253473 DOI: 10.1016/j.oret.2019.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate whether prolongation of interruptions of preoperative posturing by sitting upright influences retinal detachment (RD) progression. The secondary objective was to find clinical factors to identify patients with a high risk for RD progression. DESIGN Prospective cohort study. PARTICIPANTS One hundred ninety-eight patients divided among 3 cohorts of patients with macula-on RD were included. Inclusion criteria were volume OCT scans of sufficient quality and smallest distance from the fovea to the detachment border of at least 1.25 mm. In the second and third cohort, 50 patients with only superior temporal RD were included. METHODS Patients were admitted to the ward in anticipation of surgery. Preoperative bed rest and positioning were prescribed. The position of the RD border was determined based on OCT imaging performed at baseline, before and after the usual interruptions for meals or toilet visits. The duration of interruptions was prolonged with sitting upright for 20 minutes in cohort 2 and for 40 minutes in cohort 3. Various secondary outcome measures were defined, such as the baseline area of subretinal fluid (SRF) as measured on ultrasound images in the third cohort. MAIN OUTCOME MEASURES The RD border displacement was determined. The worst RD progression from baseline was given by the shortest distance to the fovea in any of the OCT scans during follow-up. The worst relative RD progression from baseline was defined as the worst RD progression from baseline as a percentage of the baseline distance between RD border and fovea. RESULTS The median duration of interruptions was 22, 41, and 58 minutes in cohorts 1, 2, and 3, respectively. The median RD border displacement during interruptions in patients with superior temporal RD was not significantly different among the cohorts (P = 0.28). The correlation coefficient between the SRF area at baseline and worst relative RD progression from baseline was 0.37 (95% confidence interval, 0.04-0.66; P = 0.009). CONCLUSIONS We did not find a significant increase in RD progression after prolongation of interruptions by sitting upright. Patients with a larger area of SRF on ultrasound showed more RD progression from baseline.
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Affiliation(s)
- Jan H de Jong
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands; Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.
| | | | - René J Wubbels
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Reinier Timman
- Section of Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jan C van Meurs
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands; Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands; Department of Ophthalmology, Erasmus University Rotterdam, Rotterdam, The Netherlands
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de Jong JH, de Koning K, den Ouden T, van Meurs JC, Vermeer KA. The Effect of Compliance With Preoperative Posturing Advice and Head Movements on the Progression of Macula-On Retinal Detachment. Transl Vis Sci Technol 2019; 8:4. [PMID: 30941262 PMCID: PMC6438104 DOI: 10.1167/tvst.8.2.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/13/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of this study was to explore the relationship between compliance with preoperative posturing advice and progression of macula-on retinal detachment (RD) and to evaluate whether head positioning or head motility contributes most to RD progression. Methods Sixteen patients with macula-on RD were enrolled, admitted to the ward, and instructed to posture preoperatively. The primary outcome parameter was compliance, which was defined as the average head orientation deviation from advised positioning. Secondary outcome parameters included the average rotational and linear head acceleration. The head orientation and acceleration were measured with a head-mounted inertial measurement unit (IMU). Optical coherence tomography (OCT) imaging was performed at baseline and during natural interruptions of posturing for meals and toilet visits to measure RD progression toward the fovea. Results The Spearman correlation coefficient with RD progression was 0.37 (P = 0.001, rs2 = 0.13) for compliance, 0.52 (P < 0.001, rs2 = 0.27) for rotational acceleration, and 0.49 (P < 0.001, rs2 = 0.24) for linear acceleration. The correlation coefficient between RD progression and rotational acceleration was statistically significantly higher than the correlation coefficient between RD progression and compliance (P = 0.034). Conclusion The strength of the correlation between RD progression and compliance was moderate. However, the correlation between RD progression and rotational and linear acceleration was much stronger. Preoperative posturing is effective by reducing head movements rather than enforcing head positioning. Translational Relevance Monitoring the efficacy of preoperative posturing in macula-on RD using OCT and IMU measurements shows that a new and combined application of these technologies leads to clinically relevant insights.
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Affiliation(s)
- Jan Hendrik de Jong
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Koen de Koning
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Tom den Ouden
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Johan Casper van Meurs
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Erasmus University Rotterdam, Department of Ophthalmology, Rotterdam, The Netherlands
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Lee IT, Lampen SI, Wong TP, Major JC, Wykoff CC. Fovea-sparing rhegmatogenous retinal detachments: impact of clinical factors including time to surgery on visual and anatomic outcomes. Graefes Arch Clin Exp Ophthalmol 2019; 257:883-889. [DOI: 10.1007/s00417-018-04236-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/26/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022] Open
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Shields RA, Ludwig CA, Powers MA, Tijerina JD, Schachar IH, Moshfeghi DM. Surgical timing and presence of a vitreoretinal fellow on postoperative adverse events following pars plana vitrectomy. Eur J Ophthalmol 2018; 30:81-87. [PMID: 30426767 DOI: 10.1177/1120672118811980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To evaluate the adverse event rate following pars plana vitrectomy as a function of surgical start time and the presence of a vitreoretinal fellow. METHODS Single-institution retrospective cohort study of patients undergoing pars plana vitrectomy from 1 January 2016 to 31 December 2016 at Stanford University School of Medicine (Palo Alto, CA, USA). Records were reviewed for surgical start time, the presence of vitreoretinal fellow, and postoperative adverse events defined as any finding deviating from the expected postoperative course requiring observation or intervention. RESULTS A total of 310 pars plana vitrectomies were performed. There was no statistical difference in the rate of any adverse event when comparing cases starting after 16:01 (9/13, 69.2%) and after 12:01 (42/99, 42.4%) to a morning start time (69/198, 34.9%, adjusted p = 0.083). There was a statistically significant increase in the risk of postoperative vitreous hemorrhage with afternoon and evening cases as compared to morning cases (adjusted p = 0.021). In addition, there was no difference in any adverse event with a fellow present (93/244, 38.1%) compared to without (27/66, 40.9%, adjusted p = 0.163). There was a higher risk of postoperative hypotony when a fellow was involved (6.6% vs 0%, p = 0.028), though this difference disappeared after adjusting for confounders (adjusted p = 0.252). There was no difference in the length of surgery with and without a fellow (49 vs 54 min, respectively; p = 0.990). DISCUSSION Afternoon start time and the presence of a fellow were not independent risk factors for postoperative adverse events.
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Affiliation(s)
- Ryan A Shields
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cassie A Ludwig
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Matthew A Powers
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jonathan D Tijerina
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ira H Schachar
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Darius M Moshfeghi
- Department of Ophthalmology, Horngren Family Vitreoretinal Center, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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Alsuhaibani A, AlRajeh M, Gikandi P, Mousa A. An evidence-based medicine audit of the ophthalmic emergency services unit of King Abdulaziz University Hospital (KAUH). Int Ophthalmol 2017; 38:1923-1931. [PMID: 29019025 DOI: 10.1007/s10792-017-0678-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/01/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To improve the interventions provided for patients presenting with acute ophthalmic conditions to the ophthalmic emergency unit through applying the best available evidences from quality literature for managing such conditions. METHODS A retrospective cohort study at a tertiary eye care university hospital in Riyadh, Saudi Arabia, involving a two-phase audit of diagnosis-intervention was conducted. The first phase was done retrospectively for the duration from April 1 to May 30, 2014, after disseminating the results of the first phase to King Abdulaziz University Hospital ophthalmology department staff, and the second phase was done retrospectively for the duration from November 1 to December 30, 2015. The validity of outcomes was assessed through a literature search using Medline and the Cochrane Database of Systematic Reviews. The participants were masked on the study objectives to avoid Hawthorne's phenomenon (prescribing bias). RESULTS In the first part of the audit, 73.2% out of 355 interventions were found to be evidence based. There was notable improvement of 80.9% in the number of evidence-based interventions in the second part of the audit. This improvement was statistically significant (p = 0.017). CONCLUSION Evidence-based medicine audit can be a helpful tool to assess the performance and can lead to quality improve of the provided care by reducing the number of medical errors and refining medical decisions and interventions.
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Affiliation(s)
- Adel Alsuhaibani
- Department of Ophthalmology, College of Medicine, King Saud University, P O BOX 245, Riyadh, 11411, Saudi Arabia
| | - Mohammed AlRajeh
- Department of Surgery, Ophthalmology Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Priscilla Gikandi
- Department of Ophthalmology, College of Medicine, King Saud University, P O BOX 245, Riyadh, 11411, Saudi Arabia
| | - Ahmed Mousa
- Department of Ophthalmology, College of Medicine, King Saud University, P O BOX 245, Riyadh, 11411, Saudi Arabia.
- Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Callizo J, Pfeiffer S, Lahme E, van Oterendorp C, Khattab M, Bemme S, Kulanga M, Hoerauf H, Feltgen N. Risk of progression in macula-on rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2017; 255:1559-1564. [PMID: 28551879 DOI: 10.1007/s00417-017-3696-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To identify factors that may lead to a rapid progression in macula-on rhegmatogenous retinal detachment (RRD), in particular, those that may lead to macular involvement. METHODS Observational, prospective, single-center study. Patients referred for surgery due to primary rhegmatogenous retinal detachment with the macula on between 2009 and 2013 were included. Relevant factors analyzed included age, time delay until surgery, lens status, myopia, the detachment's location and configuration as well as number, size and type of retinal breaks. Eyes underwent optical coherence tomography to detect macular detachment. A multivariate analysis was performed to investigate the effect of several factors in the progression of retinal detachment. RESULTS A total of 116 eyes of 116 patients were included. Mean time delay between admission and surgery was 1.8 ± 1.4 days. Progression was observed in 19.8% of the eyes. Of those, 47.8% presented macular detachment. Ten of the 11 (90.9%) eyes presenting progression involving the macula also exhibited a bullous configuration, which was the only parameter that correlated significantly with detachment progression in patients with (p = 0.0036) and without (p = 0.0014) macular involvement. CONCLUSIONS For the first time in a prospective trial, a bullous configuration was found to be a highly significant predictor for progression in macula-on detachments. Our data support prompt surgery in patients diagnosed with bullous macula-on RRD.
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Affiliation(s)
- Josep Callizo
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany.
| | - Sebastian Pfeiffer
- Institute for Clinical Research GmbH, Georg-August University, Goettingen, Germany
| | - Eva Lahme
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Christian van Oterendorp
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Mohammed Khattab
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Miroslav Kulanga
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
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Preoperative Posturing of Patients with Macula-On Retinal Detachment Reduces Progression Toward the Fovea. Ophthalmology 2017; 124:1510-1522. [PMID: 28499747 DOI: 10.1016/j.ophtha.2017.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Traditionally, preoperative posturing consisting of bed rest and positioning is prescribed to patients with macula-on retinal detachment (RD) to prevent RD progression and detachment of the fovea. Execution of such advice can be cumbersome and expensive. This study aimed to investigate if preoperative posturing affects the progression of RD. DESIGN Prospective cohort study. PARTICIPANTS Ninety-eight patients with macula-on RD were included. Inclusion criteria were volume optical coherence tomography (OCT) scans could be obtained with sufficient quality; and the smallest distance from the fovea to the detachment border was 1.25 mm or more. METHODS Patients were admitted to the ward for bed rest in anticipation of surgery and were positioned on the side where the RD was mainly located. At baseline and before and after each interruption for meals or toilet visits, a 37°×45° OCT volume scan was performed using a wide-angle Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). The distance between the nearest point of the RD border and fovea was measured using a custom-built measuring tool. MAIN OUTCOME MEASURES The RD border displacement and the average RD border displacement velocity moving toward (negative) or away (positive) from the fovea were determined for intervals of posturing and interruptions. RESULTS The median duration of intervals of posturing was 3.0 hours (interquartile range [IQR], 1.8-14.0 hours; n = 202) and of interruptions 0.37 hours (IQR, 0.26-0.50 hours; n = 197). The median RD border displacement was 2 μm (IQR, -65 to +251 μm) during posturing and -61 μm (IQR, -140 to 0 μm) during interruptions, a statistically significant difference (P < 0.001, Mann-Whitney U test). The median RD border displacement velocity was +1 μm/hour (IQR, -21 to +49 μm/hour) during posturing and -149 μm/hour (IQR, -406 to +1 μm/hour) during interruptions, a statistically significant difference (P < 0.001). CONCLUSIONS By making use of usual interruptions of preoperative posturing we were able to show, in a prospective and ethically acceptable manner, that RD stabilizes during posturing and progresses during interruptions in patients with macula-on RD. Preoperative posturing is effective in reducing progression of RD.
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Mahmoudi S, Almony A. Macula-Sparing Rhegmatogenous Retinal Detachment: Is Emergent Surgery Necessary? J Ophthalmic Vis Res 2016; 11:100-7. [PMID: 27195093 PMCID: PMC4860974 DOI: 10.4103/2008-322x.180696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The status of the macula is a significant factor in determining final visual outcomes in rhegmatogenous retinal detachment (RRD) and should be considered in the timing of surgical repair. Several studies have shown that macula-involving RRDs attain similar visual and anatomic outcomes when surgery is performed within seven days as compared to emergent surgery (within 24 hours). In contrast, surgery prior to macular detachment in macula-sparing RRDs generally yields the best visual outcomes. In the case of macula-sparing RRDs, it is not clear how long the macula may remain attached, therefore, standard practice dictates emergent surgery. Timing of presentation, examination findings, case complexity, co-existing medical conditions, surgeon expertise, and timing and quality of access to operating facilities and staff, however, should all be considered in determining whether a macula-sparing RRD requires immediate intervention or if equivalent visual and possibly better overall outcomes can be achieved with scheduled surgery within an appropriate time frame.
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Hajari JN. Optimizing the treatment of rhegmatogenous retinal detachment. Acta Ophthalmol 2016; 94 Thesis 1:1-12. [PMID: 26848100 DOI: 10.1111/aos.12991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Surgical approaches for rhegmatogenous retinal detachment (RRD) have evolved rapidly in the past century. This has resulted in an increase in the anatomical success rate from zero per cent in the beginning of the 1900s to now almost 100 per cent. Rhegmatogenous retinal detachment is regarded as an acute eye disease that needs immediate treatment. With the increasing number of cataract surgeries and an increased elderly population, the numbers of RRD occurrences are increasing. The aim of this thesis is to create knowledge on how treatment and care of RRD patients can be optimized. In the first paper, data on the incidence of RRD in Denmark are presented based on data from a nation register the National Patient Registry (NPR). It was discovered that the incidence of RRD in Denmark is similar to previous reported numbers and that the incidence has been increasing due to increasing numbers of cataract surgeries and an increased elderly population. Using data from the NPR, we estimated that the risk of a RRD occurring on the fellow eye is 100 times larger than on the first eye and that middle aged men have the highest risk. Having an increase in the incidence of RRD we need to ensure that the patients are also treated in the most optimal way. To ensure this, an indicator is needed to monitor the quality at the different centres. This indicator presented in the second paper is based in the occurrence of redetachment. We define a detachment to be caused by poor surgery if the retina detaches within one year after initial surgery with pneumatic retinopexy, scleral buckling and VTX with gas, and one and a half years after surgery with VTX with oil. Also lack of oil removal within the first year is a failed operation. It is widely accepted that RRD is an acute disease but when should surgery be performed to attain the most optimal result? In the third paper, we evaluated the progression of posterior RRD with an optical coherence tomography to make an objective assessment of the movement. We found that the risk of a macula on RRD progressing to affect the fovea is small if the patient is postured appropriately. We found that the movement of the RRD is dynamic but the detachments will ultimately approach the fovea. Having an opportunity to postpone surgery without risking the outcome for the patient allows a more optimal surgery. The results of this thesis can be used by all health care systems to establish optimal conditions in the treatment of RRD.
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Affiliation(s)
- Javad Nouri Hajari
- Faculty of Health and Medical Sciences; University of Copenhagen; Denmark
- Department of Ophthalmology; Rigshospitalet-Glostrup; Glostrup Denmark
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Shin HU, Choi WS, Kwon YH. Preoperative Factors Affecting the Visual Outcome after Vitrectomy in Rhegmatogenous Retinal Detachment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.9.1378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Uk Shin
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Woo Seok Choi
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Yoon Hyung Kwon
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
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Tolou C, Mahieu-Durringer L, Cassagne M, Hamid S, Billette de Villemeur R, Gualino V, Susini A, Pagot Mathis V, Gallini A, Soler V. [Treatment delay in patients with first episode of retinal detachment in the studied eye in Midi-Pyrénées]. J Fr Ophtalmol 2015; 39:90-7. [PMID: 26707754 DOI: 10.1016/j.jfo.2015.07.013] [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: 05/21/2015] [Accepted: 07/29/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it. MATERIAL AND METHODS Observational, cross-sectional, multicentric study, carried out over a 6-month period. PRIMARY OUTCOME time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend. RESULTS One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P<0.001), or of a weekend with public holiday (P=0.023), and by macular detachment (P=0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P=0.023), and by macular detachment (P=0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery. CONCLUSION The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center.
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Affiliation(s)
- C Tolou
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France.
| | - L Mahieu-Durringer
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - M Cassagne
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - S Hamid
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - R Billette de Villemeur
- Unité de soutien méthodologique à la recherche, service d'épidémiologie, CHU de Toulouse, 31000 Toulouse, France
| | - V Gualino
- Clinique Caves, 82000 Montauban, France
| | - A Susini
- Clinique de l'Union, 31240 Saint-Jean, France
| | - V Pagot Mathis
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France
| | - A Gallini
- Unité de soutien méthodologique à la recherche, service d'épidémiologie, CHU de Toulouse, 31000 Toulouse, France
| | - V Soler
- Unité rétine, CHU Toulouse-Purpan, pavillon Pierre-Paul-Riquet, place du Docteur-Baylac, TSA 40031, 31059 Toulouse, France; Laboratoire GR2DE, EA4555, centre de physiopathologie Toulouse-Purpan, 31000 Toulouse, France
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Di Lauro S, Castrejón M, Fernández I, Rojas J, Coco RM, Sanabria MR, Rodríguez de la Rua E, Pastor JC. Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study. J Ophthalmol 2015; 2015:821864. [PMID: 26640704 PMCID: PMC4660023 DOI: 10.1155/2015/821864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/18/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD. Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n = 357); (2) macula-on patients with visual loss at the third month of follow-up (n = 53) which were further subdivided in (3) phakic eyes (n = 39); and (4) pseudophakic eyes (n = 14). Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n = 39 phakic eyes; n = 14 pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures). Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis.
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Affiliation(s)
- Salvatore Di Lauro
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Melissa Castrejón
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - Itziar Fernández
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Ciber-BBN, 47011 Valladolid, Spain
| | - Jimena Rojas
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - Rosa M. Coco
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
| | - María R. Sanabria
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Complejo Asistencial de Palencia (CAPA), 34005 Palencia, Spain
| | | | - J. Carlos Pastor
- IOBA (Eye Institute), University of Valladolid, 47011 Valladolid, Spain
- Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
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Gorovoy IR, Porco TC, Bhisitkul RB, de Juan E, Schwartz DM, Stewart JM. Same-Day Versus Next-Day Repair of Fovea-Threatening Primary Rhegmatogenous Retinal Detachments. Semin Ophthalmol 2014; 31:219-25. [PMID: 25081305 DOI: 10.3109/08820538.2014.936619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the outcomes of same-day versus next-day repair of fovea-threatening rhegmatogenous retinal detachments (FT RRD). DESIGN Retrospective, multi-surgeon observational case series. METHODS Operative reports and medical records were reviewed to evaluate a number of visual and anatomic outcomes, including presenting features, intraoperative complications, and postoperative results in the repair of primary FT RRD undergoing same-day versus next-day repair with scleral buckling, pars plana vitrectomy, or both procedures. PARTICIPANTS A total of 96 consecutive patients (43 same-day, 45 next-day, and eight two days later) were compared. RESULTS There was no statistically significant difference in visual outcomes between same-day and next-day repair at postoperative months 3 and 6 and at last follow-up (month 3 mean BCVA 20/30 same day; 20/32 next day; p = 0.82). Preoperative vision was strongly correlated with postoperative acuity. Effect of differences in length or type of visual symptoms, location of RRD, gender, or lens status on postoperative month 3 best-corrected visual acuity (BCVA) was not statistically significant. Overall, 85% of patients had a BCVA of 20/40 or better at postoperative month 3. Reoperation rate and intraoperative complications were not statistically different between the two groups. Re-attachment was achieved in all but one patient in both groups. Time in the operating room was longer for same-day surgery (2.98 ± 0.46 hours) compared to next-day surgery (2.54 ± 0.38 hours) (p < 0.001), which was statistically significant even when factoring in the type of surgery performed. However, one case did progress to a macula-off detachment in a superior RRD with breaks found in lattice degeneration. CONCLUSION Next-day surgery provided equivalent visual outcomes. Emergent, same-day surgery has logistical and resource implications as it may be more expensive, may necessitate rescheduling of previously booked cases, and may limit preoperative examination by the surgeon and perioperative team.
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Affiliation(s)
- Ian R Gorovoy
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Travis C Porco
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Robert B Bhisitkul
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Eugene de Juan
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Daniel M Schwartz
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Jay M Stewart
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
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Matlach J, Pflüger B, Hain J, Göbel W. Inner and outer central retinal findings after surgery for rhegmatogenous retinal detachment using different spectral-domain optical coherence tomography devices. Graefes Arch Clin Exp Ophthalmol 2014; 253:369-80. [PMID: 25030236 DOI: 10.1007/s00417-014-2713-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of the study was to analyse macular changes after rhegmatogenous retinal detachment (RRD) repair using spectral-domain optical coherence tomography (SD-OCT). METHODS Forty eyes with macula-on and 27 eyes with macula-off RRD underwent scleral buckling or vitrectomy and were postoperatively imaged using 2 SD-OCT devices (Cirrus® HD-OCT, RTVue-100®). Measurement of total and inner macular thickness consisting of ganglion cell layer + inner plexiform layer (GCL-IPL) using Cirrus or retinal nerve fibre layer + ganglion cell layer + inner plexiform layer (RNFL-GCL-IPL) using RTVue was performed. Results of inner macular thickness were compared with image results of 40 healthy controls. Qualitative analysis of inner and outer retinal layers was additionally assessed. RESULTS Measurement of overall retinal thickness within the 9 ETDRS sectors was highly correlated between both OCTs (Pearson's r, range 0.88-0.99; p < 0.001). Correlation of RNFL-GCL-IPL complex between OCTs was excellent in both surgery groups (Pearson's r, range 0.73-0.88; p < 0.001) and normal controls (Pearson's r, range 0.79-0.90; p < 0.001). The RNFL-GCL-IPL complex was thicker in both surgery groups compared to normal controls using Cirrus. Outer retinal findings of macula-off patients were seen in four eyes (14.8 %). Visual acuity (VA) significantly improved in both groups independent of preoperative VA or duration of symptoms. CONCLUSION Agreement between both OCTs was excellent for overall and inner retinal thickness, although RTVue measured a thicker RNFL-GCL-IPL complex. Thinning of inner retinal layers as a potential cause of poor VA was rarely detected, possibly due to tractional changes at the vitreomacular interface. VA improved even in patients with macula-involving RRD.
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Affiliation(s)
- Juliane Matlach
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Str. 11, Würzburg, 97080, Germany,
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Characteristics of rhegmatogenous retinal detachment and their relationship to visual outcome. Eye (Lond) 2013; 27:1063-9. [PMID: 23788207 DOI: 10.1038/eye.2013.136] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/17/2013] [Indexed: 11/09/2022] Open
Abstract
AIMS To examine pre-operative characteristics of rhegmatogenous retinal detachment (RRD) and their relationship to visual acuity (VA) following surgery. METHODS Review of prospectively completed electronic database. Baseline characteristics, retinal drawings and outcomes were analysed. RESULTS In all, 847 eyes from 847 patients with a mean age of 62.2 years, 60% males, and 56% right eyes were studied. Mean follow-up was 9.6 months. Preoperative VA correlated with final VA (r(2)=0.21, P<0.0001). Median postoperative VA was 6/9 (Logmar 0.18, quartiles=0.0-0.48) and was significantly related to anatomical success: 70.15% achieved 0.18 or better with fully attached retina and primary success, whereas only 8.33% achieved this when the retina was not fully attached at final follow-up (failure) (P<0.0001). Univariate analysis found multiple variables associated with achieving 0.18 postoperative vision, however, multivariate analysis revealed only primary anatomical success with surgery; absence of proliferative vitreo-retinopathy (PVR), better-presenting VA and fewer quadrants of detachment were associated with a better visual outcome (r(2)=0.26, P<0.0001). Patients with a clinically attached fovea achieved better vision than patients with a clinically detached fovea, independent of the visual loss duration. With foveal detachment however, postoperative VA was better in patients with 1-3 days of visual loss compared with 4-6 days (P=0.013). CONCLUSIONS Failure of primary surgery, PVR, extensive RRD and poor-presenting VA are risk factors for poorer visual outcome following surgery for RRD. Fovea off RRD at presentation achieved poorer postoperative VA than fovea attached and visual outcome was poorer when there was a longer duration of visual symptoms.
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Kunikata H, Yasuda M, Aizawa N, Tanaka Y, Abe T, Nakazawa T. Intraocular concentrations of cytokines and chemokines in rhegmatogenous retinal detachment and the effect of intravitreal triamcinolone acetonide. Am J Ophthalmol 2013; 155:1028-1037.e1. [PMID: 23490191 DOI: 10.1016/j.ajo.2013.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 01/08/2013] [Accepted: 01/08/2013] [Indexed: 01/23/2023]
Abstract
PURPOSE To investigate the role of intravitreal injection of triamcinolone acetonide (IVTA) in preventing photoreceptor apoptosis in eyes with rhegmatogenous retinal detachment (RRD) by measuring cytokine levels in the aqueous humor before and after IVTA. DESIGN Prospective, nonrandomized, interventional case series. METHODS setting: Institutional. patients: Nineteen eyes of 19 consecutive patients with RRD. intervention: All 19 eyes underwent IVTA 1 day before 25-gauge vitrectomy. Seventeen eyes free of retinal vascular disease served as controls. main outcome measure: Both baseline and 1 day post-IVTA measurements were made of the relative concentrations of 15 soluble factors (3 cytokines, 7 chemokines, and 5 growth factors). The associations with clinical findings, including macular status, were then analyzed. RESULTS Elevated monocyte chemotactic protein 1 (MCP-1), macrophage inflammatory protein 1β (MIP-1β), and interferon γ-induced protein 10 (IP-10) in eyes with RRD were significantly reduced after IVTA. MCP-1 levels were significantly correlated with MIP-1β and IP-10 before and after IVTA. The decreases in MCP-1, MIP-1β, and IP-10 were also closely correlated to each other. Both before and after IVTA, MCP-1 was higher in eyes with macula-off RRD than in eyes with macula-on RRD. CONCLUSIONS IVTA suppressed elevated levels of intraocular MCP-1, MIP-1β, and IP-10 in eyes with RRD. The decrease in the aqueous levels of each of these factors was significantly correlated with the others. In addition to MCP-1, MIP-1β and IP-10 might potentially be additional target molecules for RRD therapy.
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Abstract
Flashing lights (photopsia) and floaters are common visual phenomena and patients frequently present to hospital with these symptoms. This article provides a guide for the non-specialist to the different pathologies that may result in photopsia and floaters.
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