1
|
Dimakopoulou I, Mylonas G, Iby J, Sedova A, Hollaus M, Sacu S, Georgopoulos M, Schmidt-Erfurth U. Vitrectomy versus scleral buckle for retinal detachment without posterior vitreous detachment. Sci Rep 2024; 14:17141. [PMID: 39060328 PMCID: PMC11282269 DOI: 10.1038/s41598-024-67318-w] [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: 03/20/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
To compare the effectiveness and safety of scleral buckling and pars plana vitrectomy in treating retinal detachment without posterior vitreous detachment. A total of 88 eyes of 83 patients with retinal detachment without prior posterior vitreous detachment were investigated retrospectively. Group A comprised patients who underwent scleral buckling (n = 47) and Group B (n = 36) patients who were treated with pars plana vitrectomy. Anatomical success, postoperative visual acuity, and ocular adverse events were evaluated. The primary and final anatomical success rate showed a nonsignificant difference (p = 0.465 and p = 0.37 respectively). No significant difference was observed in the reoperation rate or development of epiretinal membrane between the groups (p = 0.254 and p = 0.254 respectively). However, scleral buckling resulted in significantly better visual acuity at the last follow-up (0.12 ± 0.23) compared to pars plana vitrectomy (0.37 ± 0.46, p = 0.001). The incidence of cataract progression was also significantly higher in the pars plana vitrectomy group (46%) compared to the scleral buckling group (10%, p < 0.001). Scleral buckling and pars plana vitrectomy show similar success rates in treating retinal detachment without vitreous detachment. However, due to less cataract progression and better visual acuity outcomes, scleral buckling is recommended for these cases. Determining vitreous status before surgery is crucial for optimal outcomes.
Collapse
Affiliation(s)
- Ioanna Dimakopoulou
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Georgios Mylonas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Johannes Iby
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Alexandra Sedova
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marlene Hollaus
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Georgopoulos
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| |
Collapse
|
2
|
Zheng Y, Schindler P, Druchkiv V, Schulz J, Spitzer SM, Skevas C. Comparison of treatment outcomes of 360° intraoperative laser retinopexy and focal laser retinopexy with pars plans vitrectomy in patients with primary rhegmatogenous retinal detachment. BMC Ophthalmol 2023; 23:73. [PMID: 36809995 PMCID: PMC9942399 DOI: 10.1186/s12886-023-02812-9] [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: 09/27/2022] [Accepted: 02/08/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND This study was to compare the outcomes of 360° intra-operative laser retinopexy (ILR) and focal laser retinopexy in treating patients with pars plans vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). To identify other potential risk factors for retinal re-detachment after primary PPV. METHODS This was a retrospective cohort study. Three hundred and forty-four consecutive cases of primary rhegmatogenous retinal detachment treated with PPV were included between July 2013 and July 2018. Clinical characteristics and surgical outcomes were compared between focal laser retinopexy and additional 360° intra-operative laser retinopexy groups. Both univariate and multiple variable analysis were used to identify potential risk factors for retinal re-detachment. RESULTS Median follow-up was 6.2 months (Q1, Q3:2.0, 17.2). As estimated with survival analysis, the 360º ILR group had the incidence of 9.74% and focal laser 19.54% at 6 months postoperatively. At 12 months postoperatively the difference was 10.78% vs. 25.21%. The difference in survival rates was significant (p = 0.0021). In multivariate Cox regression, the risk factors for retinal re-detachment were without additional 360° ILR, diabetes and macula off before the primary surgery (relatively OR = 0.456, 95%-CI [0.245-0.848], p < 0.05; OR = 2.301, 95% CI [1.130-4.687], p < 0.05; OR = 2.243, 95% CI [1.212-4.149], p < 0.05). CONCLUSION Additional 360° ILR group had a significantly lower rate of retinal re-detachment when compared with focal laser retinopexy group. Our study also elucidated that diabetes and macular off before the primary surgery might also be the potential risk factors for higher rate of retinal re-detachment outcome. TRIAL REGISTRATION This was a retrospective cohort study.
Collapse
Affiliation(s)
- Ying Zheng
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University, 100 Haining Road, 200080, Shanghai, China.
| | - Philip Schindler
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Department of Clínica Baviera, Valencia, Spain
| | - Jan Schulz
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Martin Spitzer
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christos Skevas
- grid.13648.380000 0001 2180 3484Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
3
|
Eshtiaghi A, Dhoot AS, Mihalache A, Popovic MM, Nichani PAH, Sayal AP, Yu HJ, Wykoff CC, Kertes PJ, Muni RH. Pars Plana Vitrectomy with and without Supplemental Scleral Buckle for the Repair of Rhegmatogenous Retinal Detachment: A Meta-analysis. Ophthalmol Retina 2022; 6:871-885. [PMID: 35227949 DOI: 10.1016/j.oret.2022.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/06/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
TOPIC It is unclear whether there are differences in safety and efficacy between pars plana vitrectomy (PPV) alone and PPV with a supplemental scleral buckle (SB; PPV-SB) for the treatment of rhegmatogenous retinal detachment. CLINICAL RELEVANCE This meta-analysis aimed to compare the safety and efficacy of these surgical procedures. METHODS In this meta-analysis, Ovid MEDLINE, Embase, and Cochrane Library were systematically searched (January 2000-June 2021). The primary outcome was the final best corrected visual acuity (BCVA), whereas the secondary outcomes were reattachment rates and complications. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized controlled trials (RCTs) and the risk of bias in nonrandomized studies of interventions tool for nonrandomized studies. RESULTS This study included 15 661 eyes from 38 studies (32 observational studies and 6 RCTs). The median follow-up duration was 6 months. The final BCVA was similar between PPV and PPV-SB (weighted mean difference [WMD], -0.03 logarithm of the minimum angle of resolution [-0.14 to 0.07]; P = 0.55). There was a significant difference in the single-operation success rate (SOSR) (88.2% versus 86.3%; relative risk [RR], 0.97 [0.95-1.00]; P = 0.03), favoring PPV-SB; however, there was no significant difference in the final reattachment rate (RR, 1.00 [0.99-1.01]; P = 0.56). Pars plana vitrectomy required a significantly higher number of operations to achieve final anatomical reattachment (WMD, 0.13 [0.02-0.24]; P = 0.02). In terms of complications, PPV was significantly less likely to be associated with macular edema (RR, 0.47 [0.25-0.88]; P = 0.02) and epiretinal membrane formation (RR, 0.70 [0.52-0.94]; P = 0.02), but these differences were no longer significant in studies published after 2010 or in RCTs. Significant proliferative vitreoretinopathy, lens status, and macular attachment status did not mediate differences in these effects. CONCLUSIONS There were no significant differences in the final visual acuity outcomes between PPV and PPV-SB. Pars plana vitrectomy with supplemental SB was associated with a greater SOSR than standalone PPV, although the magnitude of the effect was small, with a high number needed to treat. The final reattachment rate was similar. In recent studies and in RCTs, the risk of complications was similar between the procedures.
Collapse
Affiliation(s)
- Arshia Eshtiaghi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Prem A H Nichani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Aman P Sayal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hannah J Yu
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Charles C Wykoff
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
4
|
Duong RT, Elghawy O, Nigussie AB, Bogaard JD, Patrie JT, Shildkrot YE. Effect of surgical modality on visual outcomes for young patients with primary rhegmatogenous retinal detachments: a retrospective cohort study. BMJ Open Ophthalmol 2022; 7:bmjophth-2021-000894. [PMID: 36161859 PMCID: PMC9289014 DOI: 10.1136/bmjophth-2021-000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 06/19/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo examine outcomes of different surgical modalities for correcting primary rhegmatogenous retinal detachments in patients younger than 50 years of age.Methods and analysisA single-centre, retrospective, cohort study of 754 patients who underwent retinal surgery at the University of Virginia Hospital between 1 July 2012 and 1 July 2020 was conducted. Exclusion criteria were patients less than 18 or over 50 years of age, repeat detachments, second eyes of patients with bilateral detachments and follow-up less than 3 months. A multivariate regression model was used to compare overall outcomes in patients.Results86 patients met inclusion criteria and of those, 38 (44%) underwent vitrectomy, 22 (26%) underwent scleral buckling, 13 (15%) underwent pneumatic retinopexy and 13 (15%) underwent combined scleral buckle and vitrectomy repair. Comparison of eye-level parameters among the procedure groups shows difference with respect to macular involvement (p<0.05) but not regarding clock hour involvement or giant tear status (p>0.05). Preoperative visual acuity was superior in the scleral buckle group compared with vitrectomy (p<0.001). Mean postoperative visual acuity improved with all procedures and all repair procedures had comparable rates of complication. The mean overall anatomical success rate was 73% (n=63) and comparable among all modalities.ConclusionsVitrectomy, scleral buckle, pneumatic retinopexy or combined procedures are viable repair options for rhegmatogenous retinal detachments in patients younger than 50 years of age. Selection of the repair modality should be guided on baseline clinical features of the patient and detachment.
Collapse
Affiliation(s)
- Ryan T Duong
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Omar Elghawy
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Amen B Nigussie
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Joseph D Bogaard
- Ophthalmology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James T Patrie
- Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | | |
Collapse
|
5
|
Peters MC, Murray-Douglass A, Park J, Cheng SSH, Sharma AK, Sharma A, Vandeleur KW, Lee LR, Moloney TP. 360-Degree laser retinopexy in primary vitrectomy for rhegmatogenous retinal detachment: factors associated with its use and impact on surgical outcomes. Int J Retina Vitreous 2022; 8:28. [PMID: 35387685 PMCID: PMC8985359 DOI: 10.1186/s40942-022-00377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine patient and surgical factors associated with the use of 360-degree laser retinopexy during primary pars plana vitrectomy (PPV) ± scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. METHODS Patients who underwent PPV ± SB for repair of non-complex RRD at a single centre were included in this retrospective study. The primary outcome was single surgery anatomical success (SSAS). Secondary outcomes included visual acuity, epiretinal membrane formation, the presence of cystoid macular oedema, tonic pupil and corneal epithelial defects. Multiple logistic regression and multivariate regression was used. RESULTS The study included 192 cases, of which 130 received 360-degree laser. Worse preoperative logMAR visual acuity (P = 0.009), male sex (P = 0.060), higher PVR grades, supplemental SB (P = 0.0468) and silicone oil/C3F8 tamponade (P < 0.0001) were associated with 360-degree laser use. No significant associations between 360-degree laser and SSAS (P = 0.079), final logMAR visual acuity (P = 0.0623), ERM development (P = 0.8208), postoperative CMO (P = 0.5946), tonic pupil (P > 0.9999) or corneal epithelial defects (P = N/A) were found. CONCLUSIONS 360-degree laser retinopexy during primary PPV ± SB for RRD was associated with more complex cases and more extensive operations. Even when accounting for this, there was no difference in surgical outcomes or complication rates.
Collapse
Affiliation(s)
- Matthew C Peters
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Alexander Murray-Douglass
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Joseph Park
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Sean S H Cheng
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Anil K Sharma
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Abhishek Sharma
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Kevin W Vandeleur
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Lawrence R Lee
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Thomas P Moloney
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Level 8, Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia.
| |
Collapse
|
6
|
Zhaboiedov DG, Zhuk AM. MORPHOFUNCTIONAL CHANGES OF THE RETINA AFTER COMBINED SURGICAL TREATMENT OF RHEGMATOGENOUS RETINAL DETACHMENT IN COMBINATION WITH CATARACT. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2022. [DOI: 10.29254/2077-4214-2022-3-166-174-184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- D. G. Zhaboiedov
- Ministry of Health of Ukraine Bogomolets National Medical University
| | - A. M. Zhuk
- Ministry of Health of Ukraine Bogomolets National Medical University
| |
Collapse
|
7
|
Thylefors J, Zetterberg M, Jakobsson G. Anatomical outcome of retinal detachment surgery comparing different surgical approach. Acta Ophthalmol 2021; 99:e908-e913. [PMID: 33258226 DOI: 10.1111/aos.14678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/14/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the outcome of retinal detachment surgery in a population affected by rhegmatogenous retinal detachment (RRD) in southern Sweden 2011-2013. METHOD All primary retinal detachments that underwent surgery at the Skåne University Hospital were registered during the period of 2011-2013. Age, sex, lens status and the different surgical methods including type of tamponade were recorded. For outcome assessment, no reoperation within 6 months was considered as primary success with one surgery except silicone oil removal. RESULTS In total, 918 primary retinal detachments were recorded during the 3-year period. Pars plana vitrectomy (PPV) alone was used in 618 eyes (67.3%), whereas an external approach with scleral buckling (SB) was used in 184 cases (20.0%) and a combination of PPV + SB in 116 eyes (12.6%). Pars plana vitrectomy (PPV) in combination with phacoemulsification and IOL implantation was performed in 169 eyes (18.4%), which was 43.6% of the phakic eyes having a PPV procedure. A total of 346 eyes (37.7%) were pseudophakic preoperatively. The success rate of one surgery was 86.9% for the entire cohort. In 120 eyes (13.1%), there was a re-detachment during the 6-month follow-up time. Higher age at the primary surgery turned out to be correlated to an increased risk of primary failure (p = 0.018) but gender was not (p = 0.84). Preoperative lens status did not affect the risk of re-detachment (p = 0.36), and there were no differences in outcome between surgeons (p = 0.27). No surgical procedure - alone or in combination - showed superior outcome as primary surgical approach. CONCLUSIONS There were no significant differences in anatomical outcome between the various surgical procedures in this large cohort of 918 RRD cases.
Collapse
Affiliation(s)
- Joakim Thylefors
- Department of Ophthalmology Skåne University Hospital Lund Sweden
| | - Madeleine Zetterberg
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
| | - Gunnar Jakobsson
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
- Department of Ophthalmology Region Västra Götaland Sahlgrenska University Hospital Mölndal Sweden
| |
Collapse
|
8
|
Kurochkin P, Huang N, Petrela R, Rosenberg KI, Brown JS, Oellers P. Pars Plana Vitrectomy Outcomes for Rhegmatogenous Retinal Detachment Qualifying for Pneumatic Retinopexy. Clin Ophthalmol 2021; 15:1207-1214. [PMID: 33776417 PMCID: PMC7989046 DOI: 10.2147/opth.s302413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate real-world outcomes of pars plana vitrectomy (PPV) for eyes with primary rhegmatogenous retinal detachments (RRD) eligible for pneumatic retinopexy (PnR). Methods This was a single center retrospective case series looking at consecutive patients with primary RRDs. A database was created on all patients with a primary RRD from 2010 to 2018 based on billing code 67108. Eyes anatomically eligible for PnR were reviewed for preoperative, intraoperative and postoperative characteristics. The main outcome assessed was single surgery anatomical success (SSAS), final anatomical success (FAS), and postoperative LogMAR vision. Results A total of 720 eyes (age, 62.9 ± 9.1 years; 61.7% were male) met inclusion criteria for PnR and underwent PPV. SSAS was 94.0% and FAS was 99.9%. Preoperative and final LogMAR vision was 0.853 and 0.293 (P<0.001) in eyes with SSAS vs 0.714 and 0.648 (P=0.686) in eyes with primary failure. PVR was the most common etiology of primary surgical failure (n=21, 49%). Patients who failed primary repair had a mean of 1.12 additional surgeries with a median time of 45 days between surgeries. Conclusion A robust single surgery success rate with good visual outcomes was achieved across 8 years and multiple surgeons utilizing PPV to treat primary RRDs in eyes which anatomically qualified for pneumatic retinopexy in a real-world setting.
Collapse
|
9
|
Moinuddin O, Abuzaitoun RO, Hwang MW, Sathrasala SK, Chen XD, Stein JD, Johnson MW, Zacks DN, Wubben TJ, Besirli CG. Surgical repair of primary non-complex rhegmatogenous retinal detachment in the modern era of small-gauge vitrectomy. BMJ Open Ophthalmol 2021; 6:e000651. [PMID: 33718613 PMCID: PMC7908907 DOI: 10.1136/bmjophth-2020-000651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To report anatomic and visual outcomes of pars plana vitrectomy (PPV), as well as scleral buckling (SB) and PPV/SB as surgical treatments for the management of primary, non-complex rhegmatogenous retinal detachment (RRD). METHODS AND ANALYSIS Data from 751 eyes that underwent PPV, SB or combined PPV/SB as a surgical treatment for primary non-complex RRD with at least 3 months of follow-up were analysed to determine rates of single surgery anatomic success (SSAS) and final anatomic success (FAS). Patients or the public were not involved in the design, conduct or reporting of this research. RESULTS PPV accounted for 89.0% (n=668), PPV/SB for 6.8% (n=51) and SB for 4.2% (n=32) cases. Overall SSAS (91.2% PPV, 84.3% PPV/SB, 93.8% SB; p=0.267) and FAS (96.7% PPV, 94.1% PPV/SB and 100.0% SB; p=0.221) were reported for the three surgical groups. SSAS and FAS were similar for lens status, macular detachment status and the presence or absence of inferior retinal breaks for each of the PPV, PPV/SB and SB groups. CONCLUSIONS In this large, single institution, retrospective case series, we report surgical outcomes for patients with primary non-complex RRD managed with PPV, SB or PPV/SB in the modern era of small-gauge vitrectomy. We demonstrate that primary PPV without adjunct SB provides excellent anatomic and visual outcomes irrespective of lens status, macular involvement or pathology location.
Collapse
Affiliation(s)
- Omar Moinuddin
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebhi O Abuzaitoun
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Min W Hwang
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sanjana K Sathrasala
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Xing D Chen
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Stein
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mark W Johnson
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - David N Zacks
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Thomas J Wubben
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Cagri G Besirli
- Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
10
|
Wilde C, Awad M, Orr G, Kumudhan D, Saker S, Zaman A. Incidence of Clinically Significant Aniseikonia Following Encircling Scleral Buckle Surgery: An Evaluation of Refractive and Axial Length Changes Requiring Intervention. Vision (Basel) 2021; 5:vision5010007. [PMID: 33546116 PMCID: PMC7931070 DOI: 10.3390/vision5010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 11/21/2022] Open
Abstract
To evaluate the incidence of symptomatic anisometropia and aniseikonia requiring intervention following surgery with combined pars plana vitrectomy (PPV) and broad 276 style encircling scleral buckle (ESB) for the repair of rhegmatogenous retinal detachments (RRD) and to report axial length (AL) and keratometry changes, a retrospective review of consecutive RRD patients treated with combined PPV and ESB between June 2016 until September 2019 was performed. All patients with symptomatic optically induced aniseikonia requiring additional interventions or surgical procedures including clear lens exchanges, secondary intraocular lens implants or contact lenses were documented. Keratometry and AL measurements were recorded for each eye and changes calculated. In total, 100 patients underwent combined PPV, ESB and endotamponade with mean age of 59.47 years (SD 11.49). AL was significantly increased (25.39 mm [SD 1.27] to 26.54 mm [SD 1.16], p = 0.0001), with a mean change of 1.15 mm (SD 0.67). Mean corneal astigmatism increased by –0.95 D (SD 0.51) in control eyes preoperatively and –1.33 (SD 0.87) postoperatively (p = 0.03). Over half of phakic patients (39/61; 64%) developed a visually significant cataract, subsequently undergoing surgery. Six of 100 patients developed symptomatic anisometropia with aniseikonia postoperatively (6%). Four proceeded with clear lens exchange despite absence of visually significant cataract (4%). Two of these initially trialled contact lenses (2%). One was intolerant, while the other decided to proceed with clear lens exchange for convenience. Only one patient (1%), being pseudophakic in both eyes, had persistent anisometropia/aniseikonia. AL and keratometry changes induced by encirclement with broad solid silicone rubber buckles are acceptable and similar to those reported previously using narrow encircling components, being unlikely to induce troublesome symptomatic anisometropia/aniseikonia. Many patients are phakic and develop visually significant cataracts, allowing correction of changes induced with the aim of visual restoration. A minority require more prolonged methods of visual rehabilitation, such as contact lens wear or clear lens exchanges. Caution and appropriate consent should be made in patients that are pseudophakic in both eyes at presentation.
Collapse
|
11
|
Echegaray JJ, Vanner EA, Zhang L, Fortun JA, Albini TA, Berrocal AM, Smiddy WE, Flynn HW, Sridhar J, Gregori NZ, Townsend JH, Davis JL, Haddock LJ. Outcomes of Pars Plana Vitrectomy Alone versus Combined Scleral Buckling plus Pars Plana Vitrectomy for Primary Retinal Detachment. Ophthalmol Retina 2021; 5:169-175. [PMID: 32980532 DOI: 10.1016/j.oret.2020.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/29/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE We compared the outcomes of primary uncomplicated rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) alone versus combined scleral buckling plus PPV (SB+PPV). DESIGN Retrospective, observational study. PARTICIPANTS Patients with primary RRD who underwent PPV or SB+PPV from June 1, 2014, through December 31, 2017. METHODS We performed a single-institution, retrospective, observational study of 488 consecutive patients with primary RRD repaired via PPV alone or SB+PPV and gas tamponade. We excluded patients younger than 18 years and those with advanced proliferative vitreoretinopathy, giant retinal tear, trauma, or secondary forms of RRD. We performed logistic regression and Cox proportional hazard regression analyses to identify potential risk factors associated with a retinal redetachment. MAIN OUTCOME MEASURES Single-operation anatomic success (SOAS), defined as adequate retinal reattachment achieved with only 1 procedure. RESULTS The mean follow-up interval was 14.3 months. Single-operation anatomic success and final anatomic success were achieved in 425 eyes (87.1%) and 487 eyes (99.8%), respectively. Single-operation anatomic success was achieved in 90 of 111 eyes (81.1%) with PPV alone compared with 345 of 374 eyes (92.2%) with SB+PPV (P = 0.0010). Scleral buckling plus PPV showed greater SOAS than PPV alone in phakic eyes (P < 0.0001), but not in eyes with a posterior chamber intraocular lens (PCIOL). Retinal redetachments occurred on average at 1.5 and 9 months after the initial surgery. Significant best-corrected visual acuity improvement was associated with SOAS (P < 0.0001). CONCLUSIONS Scleral buckling plus PPV resulted in greater SOAS outcomes than PPV alone for primary RRD repair. Phakic eyes achieved greater surgical success with SB+PPV, whereas eyes with a PCIOL achieved similar results with both methods. Most retinal redetachments occurred within the initial postoperative 3-month period. Single-operation anatomic success was associated with statistically significant visual improvement.
Collapse
Affiliation(s)
- Jose J Echegaray
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Elizabeth A Vanner
- Department of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida
| | - Lily Zhang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jorge A Fortun
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ninel Z Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Janet L Davis
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Luis J Haddock
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| |
Collapse
|
12
|
Management of uncomplicated primary retinal rhegmatogenous detachment. Int Ophthalmol 2021; 41:1709-1716. [PMID: 33511514 DOI: 10.1007/s10792-021-01729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to compare the vitreoretinal surgery outcomes in patients with uncomplicated rhegmatogenous retinal detachment (RRD). DESIGN This was a retrospective, nonrandomized consecutive case series study. PARTICIPANTS Six hundred and eighty-three eyes with primary uncomplicated RRD between 2013 and 2017 were included in this study. METHOD Patients were treated by one of the following methods: pars plana vitrectomy (PPV), scleral buckling (SB), and combined PPV with SB (PPV + SB). The success rate was divided into an anatomical and functional one, the anatomical success rate was retinal reattachment, and the functional success rate was defined as a statistically significant improvement in BCVA patients within a 6-month follow-up period. RESULTS This study involved 683 eyes; of these, 79 eyes underwent PPV, combined PPV/SB was performed on 180 eyes, and 424 eyes underwent SB. The anatomical success rates were 83.5% for PPV and 80% for combined SB/PPV. The anatomical success rate for the SB group was 75.5%. There were no significant differences between these groups in terms of anatomical success rates (0.191) or functional success rates (p = 0.534). There was no significant difference between the PPV alone and PPV + SB in terms of the likelihood of anatomic success (p-value: 0.503) or functional success (p-value: 0.839). Preoperative worse BCVA and presence of PVR were associated with poor prognosis (p-value: 0.024, 0.013, respectively). CONCLUSION In the setting of appropriate instruments for microincision pars plana deep vitrectomy, it seems the surgical outcomes of scleral buckling and PPV are not different in patients with primary uncomplicated RRD. The supplementary band has not additional benefits in patients who underwent PPV with this type of RRD.
Collapse
|
13
|
Affiliation(s)
- Jason M Kwok
- Department of Ophthalmology and Vision Sciences (Kwok, Christakis), University of Toronto, Toronto, Ont.; School of Medicine (Yu), Queen's University, Kingston, Ont.; Department of Ophthalmology (Christakis), Toronto Western Hospital, Toronto, Ont
| | - Caberry W Yu
- Department of Ophthalmology and Vision Sciences (Kwok, Christakis), University of Toronto, Toronto, Ont.; School of Medicine (Yu), Queen's University, Kingston, Ont.; Department of Ophthalmology (Christakis), Toronto Western Hospital, Toronto, Ont
| | - Panos G Christakis
- Department of Ophthalmology and Vision Sciences (Kwok, Christakis), University of Toronto, Toronto, Ont.; School of Medicine (Yu), Queen's University, Kingston, Ont.; Department of Ophthalmology (Christakis), Toronto Western Hospital, Toronto, Ont.
| |
Collapse
|
14
|
SUPPLEMENTAL SCLERAL BUCKLE IN THE ERA OF SMALL INCISION VITRECTOMY AND WIDE-ANGLE VIEWING SYSTEMS. Retina 2019; 40:1894-1899. [DOI: 10.1097/iae.0000000000002706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
15
|
360-degree intra-operative laser retinopexy for the prevention of retinal re-detachment in patients treated with primary pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 2019; 258:249-256. [DOI: 10.1007/s00417-019-04534-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/23/2022] Open
|
16
|
Shu I, Ishikawa H, Nishikawa H, Morikawa S, Okamoto F, Sakamoto T, Sugimoto M, Kondo M, Iwasaki M, Kinoshita T, Toibana T, Mitamura Y, Takamura Y, Motohashi R, Shimura M, Sakurai Y, Takeuchi M, Gomi F. Scleral buckling versus vitrectomy for young japanese patients with rhegmatogenous retinal detachment in the era of microincision surgery: real-world evidence from a multicentre study in Japan. Acta Ophthalmol 2019; 97:e736-e741. [PMID: 30741467 DOI: 10.1111/aos.14050] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/12/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate real-world evidence for young Japanese patients with rhegmatogenous retinal detachment (RRD) by retrospectively examining surgical procedures and clinical outcomes in the Japan Clinical Retina Study group. METHODS This was a multicentre retrospective study of the medical records of 562 young patients (384 males and 178 females; mean age: 33.0 ± 11.8 years) who had been diagnosed with RRD and who underwent surgical procedures in participating centres during the period between April 2013 and August 2016. RESULTS The selected surgeries were scleral buckling (SB) for 295 eyes (49.7%) and pars plana vitrectomy (PPV) for 262 eyes (44.1%). Between the two surgical procedures, there was no significant difference in the primary anatomical reattachment rate (PARR, SB = 92.2%, PPV = 93.9%); improvements in vision were noted in both groups. The incidences of proliferative vitreoretinopathy and cataract formation within 1 year of PPV were 2.3% (p = 0.0047) and 6.5% (p = 0.0005), whereas they were 0% and 1.0% in the SB group, respectively. CONCLUSION Scleral buckling (SB) and PPV were chosen with almost equal frequency for young patients with RRD. Clinical outcomes for SB and PPV exhibited a similar PARR. The incidence of cataract formation after PPV may constitute an important limitation of the procedure.
Collapse
Affiliation(s)
- Ingen Shu
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Hyogo College of Medicine Nishinomiya Japan
| | - Hiroto Ishikawa
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Hyogo College of Medicine Nishinomiya Japan
| | - Hiroki Nishikawa
- Center for Clinical Research and Education Hyogo College of Medicine Nishinomiya Japan
| | - Shohei Morikawa
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Fumiki Okamoto
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Taiji Sakamoto
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
| | - Masahiko Sugimoto
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Mie University Tsu Japan
| | - Mineo Kondo
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Mie University Tsu Japan
| | - Masanori Iwasaki
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Sapporo City General Hospital Sapporo Japan
| | - Takamasa Kinoshita
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Sapporo City General Hospital Sapporo Japan
| | - Toshi Toibana
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Tokushima University Tokushima Japan
| | - Yoshinori Mitamura
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Tokushima University Tokushima Japan
| | - Yoshihiro Takamura
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Fukui University Yoshida Japan
| | - Ryosuke Motohashi
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Tokyo Medical University Hachioji Medical Center Hachioji Japan
| | - Masahiko Shimura
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Tokyo Medical University Hachioji Medical Center Hachioji Japan
| | - Yutaka Sakurai
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology National Defense Medical College Tokorozawa Japan
| | - Masaru Takeuchi
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology National Defense Medical College Tokorozawa Japan
| | - Fumi Gomi
- J‐CREST (Japan Clinical REtina STudy group) Kagoshima Japan
- Department of Ophthalmology Hyogo College of Medicine Nishinomiya Japan
| |
Collapse
|
17
|
Kobayashi M, Iwase T, Yamamoto K, Ra E, Hirata N, Terasaki H. Influence of submacular fluid on recovery of retinal function and structure after successful rhegmatogenous retinal reattachment. PLoS One 2019; 14:e0218216. [PMID: 31269030 PMCID: PMC6608944 DOI: 10.1371/journal.pone.0218216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine the influence of residual submacular fluid (SMF) on the recovery of function and structure of the retina after successful rhegmatogenous retinal detachment (RRD) reattachment. Methods We reviewed the medical records of all patients who had undergone successful RRD repair by scleral buckling (SB) surgery or by pars plana vitrectomy (PPV) from March 2011 to August 2014. Spectral-domain optical coherence tomographic images of the macular regions were used at 1, 2, 3, 6, 9, and 12 months following the surgery. The best-corrected visual acuities (BCVA) were evaluated at the same times. Results The eyes with a macula-off RRD that were treated by SB surgery had a significant higher incidence of residual SMF (52%) than those treated by PPV (6.8%; P <0.001). Nevertheless, the postoperative BCVA was significantly improved in the eyes that had undergone SB surgery (P = 0.007). The postoperative BCVAs were not significantly different between the groups in which the SMF was absorbed (12 eyes) and not absorbed (13 eyes) within 1 month after the SB surgery. The photoreceptor outer segment length and the presence of a foveal bulge were not significantly different between these two groups at 12 months. Multiple regression analyses showed that the presence of a foveal bulge (β = 0.531, P = 0.001) and the duration of the retinal detachment before surgery (β = 0.465, P = 0.002) but not the duration of the SMF were independent factors significantly correlated with the final BCVA. Conclusions These results suggest that the postoperative residual SMF does not significantly disrupt the functional and structural recovery of eyes with macula-off RRD treated by SB surgery.
Collapse
Affiliation(s)
- Misato Kobayashi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Iwase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- * E-mail:
| | - Kentaro Yamamoto
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eimei Ra
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norifumi Hirata
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
18
|
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
|
19
|
Loriga B, Di Filippo A, Tofani L, Signorini P, Caporossi T, Barca F, De Gaudio AR, Rizzo S, Adembri C. Postoperative pain after vitreo-retinal surgery is influenced by surgery duration and anesthesia conduction. Minerva Anestesiol 2018; 85:731-737. [PMID: 30426732 DOI: 10.23736/s0375-9393.18.13078-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The control of postoperative pain (POP) is a key component of perioperative care. POP after vitreo-retinal surgery (VRS) has been under-investigated, and its incidence remains elusive. METHODS In order to assess POP after VRS, the associated risk factors and efficacy of the analgesic protocol in use at our institution, we made a one-year retrospective study on patients undergoing VRS. Patients aged >18 years, ASA Class I-III undergoing VRS entered the study. POP was evaluated by measuring a Numerical Rating Scale (NRS), and analgesic consumption. RESULTS A total of 782 patients entered the study. Patients received locoregional (LRA) or general anesthesia (GA) with supplemental block. Twenty-two percent of patients needed analgesics (acetaminophen in 97% of cases), mostly between two and six hours after surgery. The univariate analysis showed a positive association between POP and duration of surgery (P<0.0001) and glaucoma (P=0.04), and a negative association with age (P=0.008), analgesic administration at the end of surgery (P=0.005) and the intraoperative administration of remifentanil for surgery under LRA (P=0.02); sedation to execute the block for LRA did not reduce POP. Patients treated with GA with supplemental block had less pain compared to those treated with LRA with/without remifentanil (P=0.03, P=0.002, respectively). The multivariate analysis confirmed a positive correlation between POP and duration of surgery (P=0.0007) and a negative correlation with the intraoperative remifentanil administration during LRA (P=0.04), and with GA with supplemental block (P=0.01). CONCLUSIONS The incidence of POP after VRS is low but not absent, especially for long procedures, it does not require postoperative opioids and can be modified by anesthesiologic choices.
Collapse
Affiliation(s)
- Beatrice Loriga
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessandro Di Filippo
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, Careggi University Hospital, University of Florence, Florence, Italy -
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy
| | - Patrizia Signorini
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - Tomaso Caporossi
- Department of Surgery and Translational Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Francesco Barca
- Department of Surgery and Translational Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Angelo R De Gaudio
- Department of Surgery and Translational Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Department of Surgery and Translational Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Chiara Adembri
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| |
Collapse
|