Trends of Pars Plana Vitrectomy Rates in South Korea: A Nationwide Cohort Study

Blood inflammatory biomarkers in participants with idiopathic epiretinal membrane: A retrospective case series study

The objective was to evaluate the levels of monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with idiopathic epiretinal membrane (iERM). This retrospective case series study comprised of participants with iERM and participants with cataract. The values of MLR, NLR, PLR and from participants' peripheral blood were assessed among groups. The best cutoff value of MLR, NLR, and PLR in iERM was found by performing a receiver operating characteristic curve analysis and determining the optimum cutoff value for each variable. In total, 95 participants with iERM were included in the study group, and 61 participants with senile cataract were included as controls. The lymphocyte count in the iERM group was significantly lower than the control group (1.69 ± 0.63 vs. 1.95 ± 0.53, P = .003). The monocyte count in the iERM group was significantly higher than the control group (0.39 ± 0.11 vs. 0.31 ± 0.10, P < .001). The area under the curve of MLR, NLR, and PLR in differentiating patients with IERM and controls was 0.782, 0.645, and 0.657, respectively, according to receiver operating characteristic. The best cutoff value of MLR was > 0.18, with sensitivity and specificity of 74.7% and 75.4%, respectively. The NLR was > 2.06, with a sensitivity and specificity of 50.5% and 83.6%, respectively. The PLR was > 95.89, with a sensitivity and specificity of 86.3% and 41.0%, respectively. The findings of this study suggest that systemic inflammation may be associated with iERM. IERM patients may be prone to have high MLR, NLR, and PLR values.

DEEP LEARNING-BASED PREDICTION OF OUTCOMES FOLLOWING NONCOMPLICATED EPIRETINAL MEMBRANE SURGERY

PURPOSE

We used deep learning to predict the final central foveal thickness (CFT), changes in CFT, final best corrected visual acuity, and best corrected visual acuity changes following noncomplicated idiopathic epiretinal membrane surgery.

METHODS

Data of patients who underwent noncomplicated epiretinal membrane surgery at Severance Hospital from January 1, 2010, to December 31, 2018, were reviewed. Patient age, sex, hypertension and diabetes statuses, and preoperative optical coherence tomography scans were noted. For image analysis and model development, a pre-trained VGG16 was adopted. The mean absolute error and coefficient of determination (R 2 ) were used to evaluate the model performances. The study involved 688 eyes of 657 patients.

RESULTS

For final CFT, the mean absolute error was the lowest in the model that considered only clinical and demographic characteristics; the highest accuracy was achieved by the model that considered all clinical and surgical information. For CFT changes, models utilizing clinical and surgical information showed the best performance. However, our best model failed to predict the final best corrected visual acuity and best corrected visual acuity changes.

CONCLUSION

A deep learning model predicted the final CFT and CFT changes in patients 1 year after epiretinal membrane surgery. Central foveal thickness prediction showed the best results when demographic factors, comorbid diseases, and surgical techniques were considered.

Nationwide Trends in Vitreoretinal Procedures within Australia

PURPOSE

To investigate Australian age stratified nationwide trends in vitreoretinal procedures.

METHODS

Nationwide retrospective analysis of vitreoretinal procedures in Australia over 2001-2019 using Australian National Hospital Morbidity Database for public and private hospitals. Age and gender-specific trends in selected procedures including pars plana vitrectomy for retinal detachment (PPV for RD), scleral buckle, intravitreal injections, and PPV unrelated to RD were analysed using negative binomial regression.

RESULTS

Total included procedures increased from 8102 in 2001 to 136430 in 2019. Between 2001 and 2019, the incidence per 100,000 persons of PPV for RD increased from 7.5 to 20.7, whilst scleral buckling decreased from 10.5 to 4.0. Similarly, the incidence per 100,000 persons of PPV unrelated to RD increased from 18.4 to 67.1, and intravitreal injections increased from 5.6 to 446.0. The rate of scleral buckling decreased by 6% annually (p < .001), most pronounced in those 40 years and above. In contrast, PPV for RD increased by 5% annually (p < .001), also most pronounced in those aged 40 and above. PPV unrelated to RD increased by 7% annually (p < .001), and intravitreal injections increased by 210% annually (p < .001).

CONCLUSION

Between 2001 and 2019, the rate of scleral buckling declined compared to an increase in PPV for RD. Our analysis suggests an increasing trend to PPV over scleral buckling for RD repair in Australia over the last two decades. Additionally, rates of PPV unrelated to RD and intravitreal injections increased across all age groups. Overall, these trends mirror those seen internationally and reflect changing practice patterns over time.

Vitrectomy and All-Cause and Cause-Specific Mortality in Elderly Patients With Vitreoretinal Diseases: A Nationwide Cohort Study

Purpose

To determine the all-cause and cause-specific mortality in elderly patients with vitreoretinal diseases based on vitrectomy status.

Methods

Elderly patients (aged ≥ 60 years) diagnosed with vitreoretinal diseases between 2003 and 2012 using the Korean National Health Insurance Service-Senior cohort (2002–2015) were included in this nationwide population-based retrospective cohort study. The exposure of interest was vitrectomy, and information on mortality from patient inclusion until December 2015 was obtained. Cox regression modeling was used to assess the association between vitrectomy and mortality. An additional subgroup analysis was performed to investigate the effects of the underlying retinal disease characteristics and comorbidities on mortality.

Results

The study cohort included 152,283 patients (3,313 and 148,970 in the vitrectomy and non-vitrectomy groups, respectively). The adjusted model showed vitrectomy was associated with a decreased risk of pulmonary-cause mortality [hazard ratio (HR), 0.51; P < 0.001]; however, no association was observed for all-cause mortality (HR, 0.93; P = 0.325). Vitrectomy was associated with increased mortality risk (all-cause: HR, 1.26; P < 0.001 and vascular causes: HR, 1.41; P = 0.003) among patients with retinal vascular diseases and decreased mortality risk (all-cause: HR, 0.64; P < 0.001 and pulmonary causes: HR, 0.35; P = 0.011) among patients with macular diseases. There were significant interactions between age and vitrectomy with respect to all-cause mortality among patients with either vitreoretinal disease.

Conclusions

In elderly patients with retinal diseases, the vitrectomy group showed the lower mortality from pulmonary causes with no association for all-cause mortality.

Analysis of vitreoretinal surgery activity in metropolitan France in 2016: impact on training capacities

PURPOSE

The purpose of the study was to describe vitreoretinal surgery activity and vitreoretinal surgeons in private or public practice in metropolitan France over the year 2016 to anticipate surgical training needs.

METHODS

Patients aged ≥20 years who had undergone vitreoretinal surgery, alone or combined with cataract surgery were included using the French National Healthcare system database. For surgery performed by ophthalmologists carrying out ≥50 procedures during the year, the incidence per 100 000 of population ≥ 20 years of age, the number and mean age of surgeons and the number of surgeons aged >55 years were calculated.

RESULTS

Overall, 57 947 posterior segment surgical procedures were included, 40% in the public sector and 49% in the private sector for private surgeons and/or public centres performing ≥50 procedures/year. The remaining 11% of procedures were from private surgeons and/or public centres performing <50 procedures/year. The analysis included 356 surgeons with a mean age of 41 ± 10 years (39% female) in the public sector and 47 ± 10 years (14% female) in the private sector. The majority of urgent surgery was for retinal detachment (n = 30 290 [52% of total surgical procedures]). Scheduled surgery involved surgery for macular holes and epiretinal membranes (n = 16 454 [28% of total surgical procedures]). Combined vitrectomy-phacoemulsification surgery (n = 10 120) represented 17% of all vitreoretinal surgery. University regions with the fewest surgeons and regions with surgeons >55 years of age were identified, to anticipate the training need for new surgeons.

CONCLUSION

This study demonstrated disparities in the geographic distribution of vitreoretinal surgery in France and identified regions that need increased training capacities to ensure a sufficient number of surgeons.

The incidence and presumed aetiologies of fourth cranial nerve palsy in Korea: a 10-year nationwide cohort study

AIMS

To investigate the incidence and presumed aetiologies of fourth cranial nerve (CN4) palsy in Korea METHODS: Using the nationally representative dataset of the Korea National Health Insurance Service-National Sample Cohort from 2006 to 2015, newly developed CN4 palsy cases confirmed by a preceding disease-free period of ≥4 years were identified. The presumed aetiology of CN4 palsy was evaluated based on comorbidities around the CN4 palsy diagnosis.

RESULTS

Among the 1,108,292 cohort subjects, CN4 palsy newly developed in 390 patients during 10-year follow-up, and the overall incidence of CN4 palsy was 3.74 per 100,000 person-years (95% confidence interval, 3.38-4.12). The incidence of CN4 palsy showed a male preponderance in nearly all age groups, and the overall male-to-female ratio was 2.30. A bimodality by age-group was observed, with two peaks at 0-4 years and at 75-79 years. The most common presumed aetiologies were vascular (51.3%), congenital (20.0%), and idiopathic (18.5%). The incidence rate of a first peak for 0-4 years of age was 6.17 per 100,000 person-years, and cases in this group were congenital. The second peak incidence rate for 75-79 years of age was 11.81 per 100,000 person-years, and the main cause was vascular disease. Strabismus surgery was performed in 48 (12.3%) patients, most of whom (72.9%) were younger than 20 years.

CONCLUSION

The incidence of CN4 palsy has a male predominance in Koreans and shows bimodal peaks by age. The aetiology of CN4 palsy varies according to age-groups.

Characteristics of secondary epiretinal membrane due to peripheral break

This study aimed to investigate morphological differences between idiopathic epiretinal membrane (ERM) and secondary ERM due to peripheral break (SEPB) and to identify clinical characteristics in eyes with SEPB to facilitate peripheral retinal examination. The retrospective cross-sectional study involved 93 consecutive eyes in 91 patients who underwent ERM removal surgery. Eyes were divided into two groups: the macular pucker group and the idiopathic ERM group. En-face Optical Coherence Tomography (OCT) images, fundus photographs, severity of metamorphopsia (M-score) and clinical characteristics of each group were compared. ERM extent and eccentricity (ratio of the shortest and longest distances from the foveal center to the boundary) were obtained through en-face OCT imaging. Fundus photographs were used to judge whether the membrane was turbid or not. Patients with SEPB were younger than patients with idiopathic ERM (61.3 ± 7.5 vs. 66.6 ± 8.3 years; p < 0.05). Preoperative M-score and myopic refractive error, axial length were also significantly higher in the macular pucker group than in the idiopathic ERM group (all p < 0.05). There was no difference in ERM extent between the two groups. The incidence of ERM eccentricity was 23 of the 34 eyes (67.6%) in the SEPB group and 26 of the 59 eyes (44.1%) in the idiopathic ERM group (p < 0.05). The incidence of turbid ERM was 18 of the 34 eyes (52.9%) in the SEPB group and 10 of the 59 eyes (16.9%) in the idiopathic ERM group (p < 0.01). The SEPB group, compared with the idiopathic ERM group, tended to have eccentric, turbid ERM at a younger age and with more severe metamorphopsia and myopic refractive error.

Recent trends in vitreoretinal surgery: a nationwide database study in Japan, 2010-2017

PURPOSE

We clarified recent trends in vitreoretinal surgery in Japan, which is a rapidly aging country.

STUDY DESIGN

Retrospective cohort study.

METHODS

We used the Diagnostic Procedure Combination database (2010-2017), a national inpatient database in Japan. Patients undergoing vitreoretinal surgery were included. We measured the number of surgeries stratified by procedures, diagnoses, age categories, and combined cases of cataract surgery per fiscal year. We also considered changes in the Japanese population.

RESULTS

From 2010 to 2017, the total number of vitreoretinal surgeries per fiscal year increased by 7.8% (from 36,988 to 39,873). Among the diagnoses categories, epiretinal membrane (ERM) increased by 71%, rhegmatogenous retinal detachment (RRD) with pars plana vitrectomy (PPV) by 50%, and macular hole (MH) by 12% throughout the observed period. Diabetic retinopathy (DR) decreased by 20%, RRD with scleral buckling (SB) by 40%, and vitreous hemorrhage (VH) by 10%. We observed remarkable increases in ERM among patients in their 60s and 70s, in MH in their 70s and 80s, and in RRD with PPV in their 50s and 60s. We observed remarkable decreases in RRD with SB in patients in their 20s-70s, in DR in their 60s, and in VH in their 60s and 70s. These findings did not change greatly when population changes were considered. All age groups from the 30 to 80s showed significant increases in the proportions of combined vitreoretinal and cataract surgery.

CONCLUSION

The total number of cases of vitreoretinal surgery per fiscal year increased throughout the period. The increases in ERM and RRD with PPV and the decreases in DR and RRD with SB were remarkable.