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Nichani PAH, Dhoot AS, Popovic MM, Eshtiaghi A, Mihalache A, Sayal AP, Yu HJ, Wykoff CC, Kertes PJ, Muni RH. Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7212 Eyes. Ophthalmologica 2022; 245:296-314. [PMID: 35533652 DOI: 10.1159/000524888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/01/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The efficacy and safety of scleral buckling (SB) versus combination SB and pars plana vitrectomy (SB+PPV) for rhegmatogenous retinal detachment (RRD) repair remains unclear. METHODS A systematic review and meta-analysis was conducted to identify comparative studies published from Jan 2000-Jun 2021 that reported on the efficacy and/or safety following SB and SB+PPV for RRD repair. Final best-corrected visual acuity (BCVA) represented the primary endpoint, while reattachment rates and ocular adverse events were secondary endpoints. A random-effects meta-analysis was performed, and 95% confidence intervals were calculated. RESULTS Across 18 studies, 3912 SB and 3300 SB+PPV eyes were included. Final BCVA was non-significantly different between SB and SB+PPV (20/38 vs. 20/66 Snellen; WMD=-0.11 LogMAR; 95%CI [-0.29,0.07]; P=0.23). Primary reattachment rate was similar between procedures (P=0.74); however, SB alone achieved a significantly higher final reattachment rate (97.40% vs. 93.86%; RR=1.03; 95%CI [1.00,1.06]; P=0.04). Compared to SB+PPV, SB alone had a significantly lower risk of postoperative macular edema (RR=0.69; 95%CI [0.47,1.00]; P=0.05) and cataract formation (RR=0.34; 95%CI [0.12,0.96]; P=0.04). The incidence of macular hole, epiretinal membrane, residual subretinal fluid, proliferative vitreoretinopathy, elevated intraocular pressure, and extraocular muscle dysfunction were similar between SB and SB+PPV. CONCLUSIONS There was no significant difference in final BCVA between SB+PPV and SB alone in RRD. SB alone offers a slightly higher final reattachment rate along with a reduced risk of macular edema and cataract. Primary reattachment rate and the incidence of other complications were similar between the two procedures.
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Affiliation(s)
- Prem A H Nichani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada,
| | - Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hannah J Yu
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Charles C Wykoff
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
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Dhoot AS, Popovic MM, Nichani PAH, Eshtiaghi A, Mihalache A, Sayal AP, Yu H, Wykoff CC, Kertes PJ, Muni RH. Pars Plana Vitrectomy versus Scleral Buckle: A Comprehensive Meta-Analysis of 15,947 Eyes. Surv Ophthalmol 2021; 67:932-949. [PMID: 34896191 DOI: 10.1016/j.survophthal.2021.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
Pars plana vitrectomy (PPV) and scleral buckling (SB) are two of the most common surgical treatments for rhegmatogenous retinal detachment (RRD). This meta-analysis compares the efficacy and safety of PPV and SB for RRD. A systematic literature review was performed using Ovid MEDLINE, EMBASE and Cochrane CENTRAL from 2000 to June 2021. Comparative studies, randomized controlled trials and observational studies investigating PPV and SB for RRD repair were included. The primary endpoint was final best- corrected visual acuity (BCVA). Secondary endpoints were reattachment rates, total operation time, and incidence of adverse events. Subgroup analyses including phakic status, presence of PVR-C or greater at baseline, and macular attachment status were conducted. Across 41 studies (8 RCTs, 33 observational studies), 5,401 SB and 10,546 PPV eyes were included. SB achieved a statistically significant, but likely not clinically significant, better final BCVA than PPV (0.38 ± 0.53 vs. 0.33 ± 0.53 logMAR (20/48 vs. 20/43 Snellen); weighted mean difference [WMD]: 0.07; 95% confidence interval: [0.02-0.11]; P=0.005). SB had a better final BCVA compared to PPV in observational studies (P=0.007) but not in RCTs (P=0.21). SB had a lower incidence of post-operative cataract formation (P<0.00001) and iatrogenic breaks (P<0.00001), but a higher incidence of choroidal hemorrhage (P=0.007), choroidal detachment (P=0.004), and residual subretinal fluid (RSRF) (P<0.00001). Primary (86.5% vs. 84.8%; P=0.13) and final (96.7% vs. 97.7%; P=0.12) reattachment rates were similar between PPV and SB. PPV had a significantly higher primary reattachment rate in RCTs (P=0.02) but not in observational studies (P=0.30). SB was associated with a better final BCVA than PPV; however, this result was primarily driven by observational studies and phakic patients who developed cataracts. Primary and final reattachment rates were similar between the comparators. SB was associated with a significantly lower incidence of iatrogenic breaks and cataracts, while PPV was associated with a reduced risk of choroidal detachment, subretinal hemorrhage, and RSRF.
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Affiliation(s)
- Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Prem A H Nichani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Yu
- Retina Consultants of Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States of America
| | - Charles C Wykoff
- Retina Consultants of Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States of America
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.
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Moussa G, Kalogeropoulos D, Wai Ch'ng S, Lett KS, Mitra A, Tyagi AK, Sharma A, Andreatta W. The effect of supervision and out-of-hours surgery on the outcomes of primary macula-on retinal detachments operated by vitreoretinal fellows: A review of 435 surgeries. Ophthalmologica 2021; 245:239-248. [PMID: 34818241 DOI: 10.1159/000517879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- George Moussa
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom,
| | - Dimitrios Kalogeropoulos
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Soon Wai Ch'ng
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Kim Son Lett
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Arijit Mitra
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Ajai K Tyagi
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Ash Sharma
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Walter Andreatta
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
- Kantonsspital Winterthur, Winterthur, Switzerland
- University of Zurich, Zurich, Switzerland
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Radeck V, Helbig H, Barth T, Gamulescu MA, Prahs P, Maerker D. [Retinal detachment surgery: trends over 15 years]. Ophthalmologe 2021; 119:64-70. [PMID: 34137944 DOI: 10.1007/s00347-021-01430-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the changes in the treatment of patients with retinal detachment over the past 15 years. METHOD Files of all 5101 patients hospitalized for retinal detachment surgery between January 2005 and March 2020 were retrospectively analyzed. RESULTS The number of retinal detachment surgeries over the past 15 years increased continually from 150 to 600 per annum. During the summer months an increased incidence of retinal detachment of approximately 20% could be observed compared to the winter months. Anatomical success rates of emergency surgery carried out at weekends were not lower than those of scheduled routine procedures performed during the week. The relative proportion of buckle surgery decreased significantly from more than 60% down to 5% between 2005 and 2019. While initially an additional encircling buckle was employed in most cases of primary vitrectomy, this technique has almost completely disappeared in recent years without a deterioration of success rates. Liquid silicone tamponade was applied less frequently over the years. The overall anatomical success rates showed a slight trend towards improved results over the past 15 years. CONCLUSION The strategies for surgical repair of retinal detachment have changed considerably in recent years: less buckle surgery, more vitrectomy, less add-on encircling buckles and less silicone tamponade. A slight trend towards better anatomical success rates could be observed.
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Affiliation(s)
- Viola Radeck
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland.
| | - Horst Helbig
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - Teresa Barth
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - Maria-Andreea Gamulescu
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - Philipp Prahs
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
| | - David Maerker
- Augenklinik und Poliklinik, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland
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Radeck V, Helbig H, Barth T, Gamulescu MA, Maerker D, Prahs P. The learning curve of retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 2021; 259:2167-2173. [PMID: 33544177 PMCID: PMC8352825 DOI: 10.1007/s00417-021-05096-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the learning curve of vitreoretinal (VR) surgeons beginning training in retinal detachment (RD) surgery. Methods The files of all consecutive patients undergoing VR surgery for uncomplicated RD between Jan 2005 und Mar 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment within 3 months after surgery. Results Ten surgeons started their VR career during this period. Together, these 10 surgeons performed 3786 RD operations (mean 379; median 251; range 71–1053). Primary success rate after one operation was 90% (3420 of 3786). When starting to operate retinal detachments, VR surgeons had a primary success rate of about 80%. Redetachment rates steadily decreased and stabilized at just under 10% after about 200 operations. Beginners needed more than twice the time for the procedure compared to experienced surgeons. The individual learning curves varied widely. In our series, female surgeons seem to have a faster learning curve. Conclusion RD surgery performed by VR surgeons in training had acceptable results. With increasing experience, success rates continuously improve reaching stable levels after approximately 200 operations. The training of VR surgeons requires considerable resources.
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Affiliation(s)
- Viola Radeck
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - Horst Helbig
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany.
| | - Teresa Barth
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - Maria-Andreea Gamulescu
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - David Maerker
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
| | - Philipp Prahs
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, DE-93042, Regensburg, Germany
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