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Tailor PD, Dalvin LA, Chen JJ, Iezzi R, Olsen TW, Scruggs BA, Barkmeier AJ, Bakri SJ, Ryan EH, Tang PH, Parke DW, Belin PJ, Sridhar J, Xu D, Kuriyan AE, Yonekawa Y, Starr MR. A Comparative Study of Responses to Retina Questions from Either Experts, Expert-Edited Large Language Models, or Expert-Edited Large Language Models Alone. Ophthalmol Sci 2024; 4:100485. [PMID: 38660460 PMCID: PMC11041826 DOI: 10.1016/j.xops.2024.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/03/2024] [Accepted: 02/01/2024] [Indexed: 04/26/2024]
Abstract
Objective To assess the quality, empathy, and safety of expert edited large language model (LLM), human expert created, and LLM responses to common retina patient questions. Design Randomized, masked multicenter study. Participants Twenty-one common retina patient questions were randomly assigned among 13 retina specialists. Methods Each expert created a response (Expert) and then edited a LLM (ChatGPT-4)-generated response to that question (Expert + artificial intelligence [AI]), timing themselves for both tasks. Five LLMs (ChatGPT-3.5, ChatGPT-4, Claude 2, Bing, and Bard) also generated responses to each question. The original question along with anonymized and randomized Expert + AI, Expert, and LLM responses were evaluated by the other experts who did not write an expert response to the question. Evaluators judged quality and empathy (very poor, poor, acceptable, good, or very good) along with safety metrics (incorrect information, likelihood to cause harm, extent of harm, and missing content). Main Outcome Mean quality and empathy score, proportion of responses with incorrect information, likelihood to cause harm, extent of harm, and missing content for each response type. Results There were 4008 total grades collected (2608 for quality and empathy; 1400 for safety metrics), with significant differences in both quality and empathy (P < 0.001, P < 0.001) between LLM, Expert and Expert + AI groups. For quality, Expert + AI (3.86 ± 0.85) performed the best overall while GPT-3.5 (3.75 ± 0.79) was the top performing LLM. For empathy, GPT-3.5 (3.75 ± 0.69) had the highest mean score followed by Expert + AI (3.73 ± 0.63). By mean score, Expert placed 4 out of 7 for quality and 6 out of 7 for empathy. For both quality (P < 0.001) and empathy (P < 0.001), expert-edited LLM responses performed better than expert-created responses. There were time savings for an expert-edited LLM response versus expert-created response (P = 0.02). ChatGPT-4 performed similar to Expert for inappropriate content (P = 0.35), missing content (P = 0.001), extent of possible harm (P = 0.356), and likelihood of possible harm (P = 0.129). Conclusions In this randomized, masked, multicenter study, LLM responses were comparable with experts in terms of quality, empathy, and safety metrics, warranting further exploration of their potential benefits in clinical settings. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of the article.
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Affiliation(s)
| | | | - John J. Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Raymond Iezzi
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Sophie J. Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Edwin H. Ryan
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Peter H. Tang
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - D. Wilkin. Parke
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Jayanth Sridhar
- Olive View Medical Center, University of California Los Angeles, Los Angeles, California
| | - David Xu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ajay E. Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
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Tang PH, Curran CD, Salman AR, Sodhi GS, Vagaggini T, Haq Z, Mittra RA, Dev S, Emerson GG, Parke DW, Quiram PA, Belin PJ, Sastry A, Ryan EH. BILATERAL EYE PATCHING MAY IMPROVE CLINICAL OUTCOMES FOR ACUTE PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2024; 44:591-600. [PMID: 37972977 DOI: 10.1097/iae.0000000000004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE Evaluate preoperative bilateral eye patching (BEP) on subretinal fluid and vision in acute primary rhegmatogenous retinal detachments (RRDs). METHODS Retrospective nonrandomized interventional study of 335 patients with RRD undergoing BEP until surgery (BEP cohort) and separated by the percentage of full-time compliance: high (≥90%), medium (>90% but ≥50%), and low (<50%). Those declining BEP were included (control). All underwent surgery and were followed for ≥3 months. Imaging was obtained immediately before surgery. Best-corrected visual acuity was measured at the longest follow-up and immediately before surgery. SRF and foveal status immediately before surgery were analyzed. RESULTS Two hundred and forty and 95 patients were in BEP and control cohorts, respectively. Thirty patients presented immediately before surgery for analysis. High (64%) and medium (35%) compliance showed significantly greater ( P < 0.01) SRF reduction compared with low (4%) and control (3%). Mac-off RRD showed significantly greater ( P < 0.01) foveal reattachment with high (29%) and medium (8%) compliance compared with low (2%) and control (1%). Mac-on RRD demonstrated no significant differences ( P ≥ 0.51) in final best-corrected visual acuity among high (0 logarithm of the minimum angle of resolution [logMAR] [median], 20/20 Snellen), medium (0.10 logMAR, 20/25 Snellen), low (0.10 logMAR), and control cohorts (0.10 logMAR). Mac-off RRD demonstrated significantly better final best-corrected visual acuity with high compliance (0.30 logMAR, 20/40 Snellen) compared with low (0.40 logMAR, 20/50 Snellen; P = 0.04) and control (0.60 logMAR, 20/80 Snellen; P = 0.02). CONCLUSION Preoperative BEP can stabilize or improve subretinal fluid in acute primary RRD. Patients with BEP >50% of the time experienced the greatest benefits.
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Affiliation(s)
- Peter H Tang
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina; and
| | - Christian D Curran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ali R Salman
- Retina Consultants of Minnesota, Edina, Minnesota
| | | | | | - Zeeshan Haq
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Robert A Mittra
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Sundeep Dev
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Geoffrey G Emerson
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - D Wilkin Parke
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Ananth Sastry
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edwin H Ryan
- Retina Consultants of Minnesota, Edina, Minnesota
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
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Regillo CD, Nijm LM, Shechtman DL, Kaiser PK, Karpecki PM, Ryan EH, Ip MS, Yeu E, Kim T, Rafieetary MR, Donnenfeld ED. Considerations for the Identification and Management of Geographic Atrophy: Recommendations from an Expert Panel. Clin Ophthalmol 2024; 18:325-335. [PMID: 38332904 PMCID: PMC10850989 DOI: 10.2147/opth.s445755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
Newly approved treatments for patients with geographic atrophy are changing the treatment paradigm, highlighting the need for eye care providers (ECPs) to have a set of recommendations on how to best manage GA patients. Here, we outline how to identify various stages of age-related macular degeneration including geographic atrophy (GA) by examining optimal management scenarios implicating various ECPs and reviewing treatment considerations for patients with GA. Early identification of GA will lead to optimal patient outcomes, while a standardized management scenario will reduce clinical burden among ECPs treating patients with GA.
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Affiliation(s)
- Carl D Regillo
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lisa M Nijm
- Warrenville Eye Care and LASIK Center, Warrenville, IL, USA
| | | | - Peter K Kaiser
- Cole Eye Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Paul M Karpecki
- Kentucky College of Optometry, University of Pikeville, Pikeville, KY, USA
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Curran CD, Adams OE, Vagaggini T, Sodhi GS, Prairie ML, Baker MJ, Sastry A, Ryan EH, Parke DW, Mittra RA, Dev S, Tang PH. PROPHYLACTIC TREATMENT OF LATTICE DEGENERATION IN FELLOW EYES AFTER REPAIR OF UNCOMPLICATED PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2024; 44:63-70. [PMID: 37536462 DOI: 10.1097/iae.0000000000003908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
PURPOSE To evaluate prophylactic treatment (PTx) of lattice degeneration (LD) on retinal tear (RT) and rhegmatogenous retinal detachment (RRD) risk in fellow eyes of patients after primary RRD repair in the first eye. METHODS This was a consecutive case series with cohort control involving patients with RRD repair from January 1, 2013, through December 31, 2017. Patients received PTx (PTx cohort) or no PTx (No-PTx cohort) in fellow eye with 5-year follow-up. Primary outcome measure was proportion with new fellow eye RT/RRD. Secondary outcomes included logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and status of myopia, posterior vitreous detachment, and pseudophakia. RESULTS Four hundred ninety-eight patients were divided into 146 and 352 in PTx and No-PTx cohorts, respectively. PTx cohort developed significantly ( P < 0.05) fewer RT/RRD (17%) than No-PTx cohort (41%). PTx significantly ( P < 0.05) lowered RT/RRD irrespective of posterior vitreous detachment and myopia status. PTx patients undergoing phacoemulsification demonstrated significantly ( P < 0.05) less RT/RRD (22%) than No-PTx cohort (31%). There was no significant ( P = 0.96) final BCVA difference between PTx (median = 0 logMAR) and No-PTx (median = 0 logMAR) cohorts. CONCLUSION PTx of asymptomatic fellow eye LD reduced RT/RRD risk.
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Affiliation(s)
- Christian D Curran
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Olufemi E Adams
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | | | - Mikayla J Baker
- University of Minnesota Medical School, Minneapolis, Minnesota; and
| | - Ananth Sastry
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edwin H Ryan
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - David Wilkin Parke
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Robert A Mittra
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Sundeep Dev
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Peter H Tang
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Adams OE, Vagaggini T, Groth SL, Curran CD, Prairie ML, Sastry A, Ryan EH, Parke DW, Mittra RA, Dev S, Tang PH. Evaluation of Outcomes of Acute Cataract Surgery-Related Endophthalmitis Using a Novel Management Algorithm Based on Presenting Risk Factors. Semin Ophthalmol 2023; 38:648-655. [PMID: 36971452 DOI: 10.1080/08820538.2023.2194985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Develop treatment algorithm for acute endophthalmitis (AE) following cataract surgery. METHODS Retrospective single-center, non-randomized interventional study involving patients with AE divided into cohorts according to our novel scoring system, the Acute Cataract surgery-related Endophthalmitis Severity (ACES) score. Total score ≥3 points indicated need for urgent pars plana vitrectomy (PPV; within 24 hours), whereas <3 points indicated urgent PPV was unnecessary. Patients were retrospectively evaluated for visual outcomes based on whether their clinical course followed with or deviated from ACES score recommendations. Main outcome was best-corrected visual acuity (BCVA) at 6-month or longer after treatment. RESULTS Total of 150 patients were analyzed. Patients whose clinical course followed the ACES score recommendation for immediate surgery had significantly (P < 0.01) better final BCVA (median = 0.18 logMAR, 20/30 Snellen) compared to those that deviated (median = 0.70 logMAR, 20/100 Snellen). For those where the ACES score deemed urgent PPV was unnecessary, no significant (P = 0.19) difference was observed between patients that followed with (median = 0.18 logMAR, 20/30 Snellen) and those that deviated from (median = 0.10 logMAR, 20/25 Snellen) recommendation. CONCLUSIONS The ACES score may potentially provide critical and updated management guidance at presentation for when to recommend urgent PPV for patients suffering from post-cataract surgery AE.
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Affiliation(s)
- Olufemi E Adams
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Sylvia L Groth
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Nashville, TN, USA
| | - Christian D Curran
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | - Edwin H Ryan
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Retina Consultants of Minnesota, Edina, MN, USA
| | - D Wilkin Parke
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Retina Consultants of Minnesota, Edina, MN, USA
| | - Robert A Mittra
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Retina Consultants of Minnesota, Edina, MN, USA
| | - Sundeep Dev
- Retina Consultants of Minnesota, Edina, MN, USA
| | - Peter H Tang
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN, USA
- Retina Consultants of Minnesota, Edina, MN, USA
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Kaiser PK, Karpecki PM, Regillo CD, Baumal C, Ryan EH, Ip MS, Modi Y, Yeu E, Nijm L, Farid M, Rebenitsch RL, Kim T, Shechtman DL, Nichols K, Schweitzer J, Dunbar MT, Rafieetary MR, Donnenfeld ED. Geographic Atrophy Management Consensus (GA-MAC): a Delphi panel study on identification, diagnosis and treatment. BMJ Open Ophthalmol 2023; 8:e001395. [PMID: 37857560 PMCID: PMC10603481 DOI: 10.1136/bmjophth-2023-001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND/AIMS With a paradigm shift in geographic atrophy (GA) treatments now available, establishing consensus on the identification and diagnosis of the disease along with considerations for management of patients with GA will assist eye care professionals (ECP) in their day-to-day practices, leading to improved patient outcomes. METHODS A modified Delphi panel process (Geographic Atrophy Management Consensus) consisting of three total surveys and one virtual live meeting held between survey 2 and survey 3. Data were collected from July to October 2022. Participants included expert members of the eye care community that have demonstrated outstanding leadership among peers: a steering committee with three ECPs and a 15-member panel divided between five optometrists, five comprehensive ophthalmologists and five retina specialists. Consensus on statements related to the management of patients with GA was calculated using the RAND/UCLA Appropriateness Method. RESULTS At the conclusion of the third survey, consensus was reached on 91% of the 77 statements. Critical consensus topics include: (1) optical coherence tomography as the favoured method to diagnose and monitor GA, (2) preferred practice patterns regarding referral of patients to retina specialists and (3) treatment criteria given the advent of emerging therapeutics for GA. CONCLUSIONS Generating awareness of early signs of disease development, progression and identifying the best tools to evaluate GA establishes ideal management and referral strategies. Given the paradigm shift in GA management driven by approved therapies, coupled with the fact that the disease is progressive resulting in devastating vision loss, these strategies are critical to ensure best overall outcomes.
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Affiliation(s)
- Peter K Kaiser
- Ophthalmology, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, USA
| | - Paul M Karpecki
- Optometry, University of Pikeville, Pikeville, Kentucky, USA
| | - Carl D Regillo
- Mid Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Caroline Baumal
- Ophthalmology, New England Eye Center, Boston, Massachusetts, USA
| | - Edwin H Ryan
- Retina Consultants of Minnesota, VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Michael S Ip
- Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Pasadena, California, USA
| | - Yasha Modi
- Ophthalmology, New York University, New York, New York, USA
| | - Elizabeth Yeu
- Refractive Surgery, Virginia Eye Consultants, Norfolk, Virginia, USA
| | - Lisa Nijm
- Ophthalmology and Corneal Surgery, Warrenville Eye Care and LASIK Center, Warrenville, Illinois, USA
| | - Marjan Farid
- Department of Ophthalmology, University of California Irvine, Irvine, California, USA
| | | | - Terry Kim
- Duke University, Durham, North Carolina, USA
| | | | - Kelly Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Mark T Dunbar
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
| | | | - Eric D Donnenfeld
- OCLI VIsion, Cornea, Laser Cataract, and Refractive Surgery, Garden City, New York, USA
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Curran CD, Masters TC, Engel KC, Lee MS, Davies JB, Ryan EH, Parke DW, Mittra RA, Dev S, Tang PH. Advanced Diabetic Retinopathy May Promote Ocular Neovascularization after Central Retinal Artery Occlusion. Ophthalmol Retina 2023; 7:932-933. [PMID: 37390939 DOI: 10.1016/j.oret.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Christian D Curran
- Department of Ophthalmology, Hennepin Healthcare, Minneapolis, Minnesota; Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Thomas C Masters
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Kevin C Engel
- Department of Ophthalmology, Hennepin Healthcare, Minneapolis, Minnesota; Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michael S Lee
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Edwin H Ryan
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota; Retina Consultants of Minnesota, Edina, Minnesota
| | - David Wilkin Parke
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota; Retina Consultants of Minnesota, Edina, Minnesota
| | - Robert A Mittra
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota; Retina Consultants of Minnesota, Edina, Minnesota
| | - Sundeep Dev
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Peter H Tang
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota; Retina Consultants of Minnesota, Edina, Minnesota.
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Fujimoto S, Kokame GT, Ryan EH, Johnson MW, Hirakata A, Shirriff A, Ishikawa H, Adams OE, Bommakanti N. Macular Retinoschisis from Optic Disc without a Visible Optic Pit or Advanced Glaucomatous Cupping (No Optic Pit Retinoschisis [NOPIR]). Ophthalmol Retina 2023; 7:811-818. [PMID: 37271192 DOI: 10.1016/j.oret.2023.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To review eyes with peripapillary and macular retinoschisis without a visible optic pit or advanced glaucomatous optic atrophy, or No Optic Pit Retinoschisis (NOPIR). DESIGN Retrospective multicenter case series. SUBJECTS The study included 11 eyes of 11 patients. METHODS Retrospective study of eyes with macular retinoschisis without a visible optic pit, advanced optic nerve head cupping, or macular leakage on fluorescein angiography. MAIN OUTCOME MEASURES Visual acuity (VA), retinoschisis resolution, months to resolution, and recurrence of retinoschisis RESULTS: The mean age was 68.1 ± 17.6 years, mean intraocular pressure was 17.4 ± 3.8 mmHg, and the mean spherical equivalent refractive error was -3.1 ± 2.9 diopters. No subject had pathologic myopia. Seven subjects were treated for glaucoma, and 9 subjects had nerve fiber layer defects on OCT. All eyes had retinoschisis in the outer nuclear layer (ONL) in the nasal macula and extending to the edge of the optic disc, and 8 subjects had fovea-involving retinoschisis. Three nonfoveal and 4 fovea-involved eyes were observed, and 4 fovea-involved eyes with vision loss underwent surgery. Surgery involved preoperative juxtapapillary laser followed by vitrectomy and membrane and internal limiting membrane peeling with intraocular gas and face-down position. The mean baseline VA was significantly worse in the surgery group than that in the observation group (P = 0.020). Retinoschisis resolved and vision improved in all surgical cases. The mean resolution time for the surgery group was 2.75 ± 0.96 months, which was shorter than that for the observation group (28.0 ± 21.2 months; P = 0.014). No eye developed recurrence of the retinoschisis after surgery. CONCLUSIONS Peripapillary and macular retinoschisis can develop in eyes without a visible optic pit or advanced glaucomatous cupping. Eyes without foveal involvement and those with foveal involvement but only mild decrease in vision can be observed for spontaneous resolution. If there is persistent foveal involvement with vision loss, surgery can improve vision by resolving the macular retinoschisis. Surgery for fovea-involved macular retinoschisis without a visible optic pit resulted in faster anatomic resolution and better vision recovery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - Gregg T Kokame
- Hawaii Macula and Retina Institute, Aiea, Hawaii; University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii.
| | | | - Mark W Johnson
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Akito Hirakata
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ashley Shirriff
- University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Hiroshi Ishikawa
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Nikhil Bommakanti
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
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Bansal A, Naidu SC, Marafon SB, Kohler JM, In S, Mahendrakar PA, Garima, Kashyap H, Susavar P, Bhende M, Ryan EH, Muni RH. Retinal Displacement after Scleral Buckle versus Combined Buckle and Vitrectomy for Rhegmatogenous Retinal Detachment: ALIGN Scleral Buckle versus Pars Plana Vitrectomy with Scleral Buckle. Ophthalmol Retina 2023; 7:788-793. [PMID: 37217137 DOI: 10.1016/j.oret.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE To assess the risk of retinal displacement after scleral buckle (SB) versus pars plana vitrectomy with SB (PPV-SB). DESIGN Multicenter prospective nonrandomized clinical trial. METHODS The study took place at VitreoRetinal Surgery in Minneapolis, Minnesota, Sankara Nethralaya in Chennai, India, and St. Michael's Hospital in Toronto, Canada from July 2019 to February 2022. Patients who underwent successful SB or PPV-SB for fovea-involving rhegmatogenous retinal detachment with gradable postoperative fundus autofluorescence (FAF) imaging were included in the final analysis. Two masked graders assessed FAF images 3 months postoperatively. Metamorphopsia and aniseikonia were assessed with M-CHARTs and the New Aniseikonia Test, respectively. The primary outcome was the proportion of patients with retinal displacement detected with retinal vessel printings on FAF in SB versus PPV-SB. RESULTS Ninety-one eyes were included in this study, of which 46.2% (42 of 91) had SB and 53.8% (49 of 91) underwent PPV-SB. Three months postoperatively, 16.7% (7 of 42) in the SB group and 38.8% (19 of 49) in the PPV-SB group had evidence of retinal displacement (difference = 22.1%; odds ratio = 3.2; 95% confidence interval [CI], 1.2-8.6; P = 0.02) on FAF. The statistical significance of this association increased after adjustment for extent of retinal detachment, baseline logarithm of the minimum angle of resolution, lens status, and sex in a multivariate regression analysis (P = 0.01). Retinal displacement was detected in 22.5% (6 of 27) of patients in the SB group with external subretinal fluid drainage and 6.7% (1 of 15) of patients without external drainage (difference = 15.8%; odds ratio = 4.0; 95% CI, 0.4-36.9; P = 0.19). Mean vertical metamorphopsia, horizontal metamorphopsia (MH), and aniseikonia were similar between patients in the SB and PPV-SB groups. There was a trend to worse MH in patients with retinal displacement versus those without retinal displacement (P = 0.067). CONCLUSIONS Scleral buckle is associated with less retinal displacement compared with PPV-SB, indicating that traditional PPV techniques cause retinal displacement. There is a trend toward increased risk of retinal displacement in SB eyes that underwent external drainage compared with SB eyes without drainage, which is consistent with our understanding that the iatrogenic movement of subretinal fluid, such as that which occurs intraoperatively during external drainage with SB, may induce retinal stretch and displacement if the retina is then fixed in the stretched position. There was a trend to worse MH at 3 months in patients with retinal displacement. 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)
- Aditya Bansal
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Sumana C Naidu
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Samara B Marafon
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - James M Kohler
- VitreoRetinal Surgery in Minneapolis, Minneapolis, Minnesota
| | - Shilpa In
- Bhagwan Mahavir Vitreoretinal services, Medical Research Foundation, Sankara Netralaya, Chennai, India
| | - Priyanka A Mahendrakar
- Bhagwan Mahavir Vitreoretinal services, Medical Research Foundation, Sankara Netralaya, Chennai, India
| | - Garima
- Bhagwan Mahavir Vitreoretinal services, Medical Research Foundation, Sankara Netralaya, Chennai, India
| | - Himanshu Kashyap
- Bhagwan Mahavir Vitreoretinal services, Medical Research Foundation, Sankara Netralaya, Chennai, India
| | - Pradeep Susavar
- Bhagwan Mahavir Vitreoretinal services, Medical Research Foundation, Sankara Netralaya, Chennai, India
| | - Muna Bhende
- Bhagwan Mahavir Vitreoretinal services, Medical Research Foundation, Sankara Netralaya, Chennai, India
| | - Edwin H Ryan
- VitreoRetinal Surgery in Minneapolis, Minneapolis, Minnesota
| | - Rajeev H Muni
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Kensington Vision and Research Centre, University of Toronto, Canada; Keenan Research Centre for Biomedical Science/ Li Ka Shing Knowledge Institute, Toronto, Canada.
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Hussein M, Adeleye O, Adams OE, Sodhi GS, Haq Z, Quiram PA, Tang PH, Ryan EH. Spontaneous Improvement of Myopic Retinoschisis Following a Long-term Observational Period: A Case Series. Retin Cases Brief Rep 2023:01271216-990000000-00186. [PMID: 37463473 DOI: 10.1097/icb.0000000000001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE To highlight spontaneous resolution or improvement of myopic retinoschisis (MR) in actively surveilled patients. METHODS Case series of five patients diagnosed with MR who did not undergo pars-plana vitrectomy and were carefully monitored by a single retina specialist. Ocular and medical history were reviewed, and clinical characteristics including visual acuity, and the status of the MR were monitored with spectral domain ocular coherence tomography (SD-OCT) at each clinic visit. RESULTS Five patients with were identified to have MR without vitreomacular traction, or macular hole formation. Two patients exhibited spontaneous and complete resolution of MR without surgical intervention over an average observation time of 52.5 months. In these cases, a clinical posterior vitreous detachment (PVD) was documented preceding the resolution of MR over an average time of 26.5 months. Snellen best corrected visual acuity (BCVA) in these patients were improved (Case 1 from 20/50 to 20/40, Case 2 from 20/30 to 20/25). The remaining three patients were monitored for an average of 52 months and showed improvement of MR via OCT imaging. Snellen BCVA either remained stable or improved from baseline (Case 3 stable at 20/30, Case 4 improved from 20/40 to 20/30, and Case 5 stable at 20/20). CONCLUSION These findings suggest that conservative management of MR with observation can be considered especially in patients with challenging co-morbidities (such as monocular status), and with a clinically identified posterior vitreous detachment without vitreomacular traction.
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Affiliation(s)
- Musse Hussein
- University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455
| | - Olufunmilola Adeleye
- Mayo Clinic Alix School of Medicine, 13400 E Shea Boulevard, Scottsdale, AZ, 85259
| | - Olufemi E Adams
- University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455
| | - Guneet S Sodhi
- Retina Consultants of Minnesota, 3601 West 76th Street, Suite 300 & 325 Edina, MN 55435
| | - Zeeshan Haq
- Retina Consultants of Minnesota, 3601 West 76th Street, Suite 300 & 325 Edina, MN 55435
| | - Polly A Quiram
- Retina Consultants of Minnesota, 3601 West 76th Street, Suite 300 & 325 Edina, MN 55435
| | - Peter H Tang
- Retina Consultants of Minnesota, 3601 West 76th Street, Suite 300 & 325 Edina, MN 55435
| | - Edwin H Ryan
- Retina Consultants of Minnesota, 3601 West 76th Street, Suite 300 & 325 Edina, MN 55435
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Adams OE, Sodhi GS, Vagaggini T, Haq Z, Curran CD, Prairie ML, Montezuma SR, Koozekanani DD, Ryan EH, Parke DW, Mittra RA, Tang PH. CLINICAL OUTCOMES OF ACUTE ENDOPHTHALMITIS AFTER INTRAVITREAL DELIVERY OF VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS VERSUS STEROIDS. Retina 2023; 43:947-954. [PMID: 36727783 DOI: 10.1097/iae.0000000000003748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare patients with acute endophthalmitis after intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors vs. steroids. METHODS Retrospective single-center, nonrandomized interventional study from 2013 to 2021.Patients underwent vitreous biopsy before initiating treatment and were divided into the following cohorts: (1) anti-VEGF managed medically (T&I-anti-VEGF), (2) anti-VEGF managed by immediate pars plana vitrectomy (PPV-anti-VEGF), and (3) steroid therapy and managed medically or by pars plana vitrectomy (steroid). RESULTS A total of 141 patients were analyzed. The steroid cohort demonstrated significantly worse presenting (median = 2.80 logarithm of the minimum angle of resolution [logMAR]; P ≤ 0.01) and final (median = 2.30 logMAR) best-corrected visual acuity compared with T&I-anti-VEGF (presenting: median = 2.00 logMAR; final: median = 0.40 logMAR) and pars plana vitrectomy-anti-VEGF cohorts (presenting: median = 2.30 logMAR; final: median = 0.48 logMAR). There was no significant ( P = 0.33) difference in the final best-corrected visual acuity between T&I-anti-VEGF and pars plana vitrectomy-anti-VEGF cohorts. There were no significant ( P ≥ 0.63) differences among cohorts in best-corrected visual acuity before acute endophthalmitis diagnosis (T&I-anti-VEGF: median = 0.40 logMAR; pars plana vitrectomy-anti-VEGF: median = 0.40 logMAR; steroid: median = 0.44 logMAR). Microbial cultures revealed similar profiles for all cohorts. CONCLUSION Acute endophthalmitis after intravitreal injection steroid therapy had worse outcomes compared with anti-VEGF therapy.
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Affiliation(s)
- Olufemi E Adams
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN
| | | | | | - Zeeshan Haq
- Retina Consultants of Minnesota, Edina, MN; and
| | - Christian D Curran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN
| | | | - Sandra R Montezuma
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN
| | - Dara D Koozekanani
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN
| | - Edwin H Ryan
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN
- Retina Consultants of Minnesota, Edina, MN; and
| | - David Wilkin Parke
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN
- Retina Consultants of Minnesota, Edina, MN; and
| | | | - Peter H Tang
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, MN
- Retina Consultants of Minnesota, Edina, MN; and
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Vagaggini T, Adams OE, Curran CD, Prairie ML, Baker MJ, Sastry A, Ryan EH, Parke DW, Mittra RA, Tang PH. Clinical Factors and Outcomes of Acute-Onset Endophthalmitis Following Small-Gauge Pars Plana Vitrectomy Surgery. Ophthalmic Surg Lasers Imaging Retina 2023:1-6. [PMID: 37418667 DOI: 10.3928/23258160-20230614-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Describe risk factors, findings, and outcomes of acute endophthalmitis (AE) following small-gauge pars plana vitrectomy (PPV). PATIENTS AND METHODS This was a retrospective single-center, nonrandomized study of post-PPV AE patients from 2013 to 2021. All received vitreous biopsy before treatment. Patients were divided into cohorts: 1) PPV within 3 days of diagnosis (Urgent-PPV), and 2) no urgent PPV (Other-treatment [Tx]). Main outcome was best-corrected visual acuity (BCVA) at 6 months. RESULTS Twenty-one patients were analyzed. Epiretinal membrane was most common indication for PPV (48%). Incidence was 0.074%. Culture-positive rate was 57%. For final BCVA, there was no significant (P = 0.85) difference between Urgent-PPV (median = 0.40 logMAR) and Other Tx cohorts (median = 0.35 logMAR). Sclerotomy wounds were not sutured in 71% of patients. Approximately 24% and 38% of patients analyzed had either no tamponade or partial tamponade, respectively. CONCLUSION Tamponade agents and sclerotomy suturing may be important factors when evaluating post-small-gauge PPV-associated AE. Further studies are necessary for clarification. [Ophthalmic Surg Lasers Imaging Retina 2023;54:xx-xx.].
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Starr MR, Ryan EH, Yonekawa Y. Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18. Curr Opin Ophthalmol 2023; 34:211-217. [PMID: 36866845 DOI: 10.1097/icu.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW To highlight the recent work published from the Primary Retinal Detachment Outcomes (PRO) Study Group. RECENT FINDINGS The PRO database was a large dataset made up of patients with primary rhegmatogenous retinal detachments (RRD) who had surgical repair during 2015. The database was constituted of nearly 3000 eyes from 6 centers across the United States and included 61 vitreoretinal surgeons. Nearly 250 metrics were collected for each patient, creating one of the richest datasets of patients with primary rhegmatogenous detachments and their outcomes. The importance of scleral buckling was demonstrated, particularly for phakic eyes, elderly patients, and those with inferior breaks. 360° laser may result in poorer outcomes. Cystoid macular edema was common, and risk factors were identified. We also found risk factors for vision loss in eyes presenting with good vision. A PRO Score was devised, to predict outcomes based on presenting clinical characteristics. We also identified characteristics of surgeons with the highest single surgery success rates. Overall, there were no major outcome differences between viewing systems, gauges, buckles sutured vs. scleral tunnels, drainage method, and techniques to address proliferative vitreoretinopathy. All incisional techniques were found to be very cost-effective treatment modalities. SUMMARY Numerous studies resulted from the PRO database that significantly added to the literature regarding the repair of primary RRDs in the current era of vitreoretinal surgery.
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Affiliation(s)
| | - Edwin H Ryan
- Retina Consultants of Minnesota, Minneapolis, Minnesota
| | - Yoshihiro Yonekawa
- The Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
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15
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Cai LZ, Lin J, Starr MR, Obeid A, Ryan EH, Ryan C, Forbes NJ, Arias D, Ammar MJ, Patel LG, Capone A, Emerson GG, Joseph DP, Eliott D, Gupta OP, Regillo CD, Hsu J, Yonekawa Y. PRO score: predictive scoring system for visual outcomes after rhegmatogenous retinal detachment repair. Br J Ophthalmol 2023; 107:555-559. [PMID: 34815237 DOI: 10.1136/bjophthalmol-2021-320440] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To compare risk factors for poor visual outcomes in patients undergoing primary rhegmatogenous retinal detachment (RRD) repair and to develop a scoring system. METHODS Analysis of the Primary Retinal detachment Outcomes (PRO) study, a multicentre interventional cohort of consecutive primary RRD surgeries performed in 2015. The main outcome measure was a poor visual outcome (Snellen VA ≤20/200). RESULTS A total of 1178 cases were included. The mean preoperative and postoperative logMARs were 1.1±1.1 (20/250) and 0.5±0.7 (20/63), respectively. Multivariable logistic regression identified preoperative risk factors predictive of poor visual outcomes (≤20/200), including proliferative vitreoretinopathy (PVR) (OR 1.26; 95% CI 1.13 to 1.40), history of antivascular endothelial growth factor (VEGF) injections (1.38; 1.11 to 1.71), >1-week vision loss (1.17; 1.08 to 1.27), ocular comorbidities (1.18; 1.00 to 1.38), poor presenting VA (1.06 per initial logMAR unit; 1.02 to 1.10) and age >70 (1.13; 1.04 to 1.23). The data were split into training (75%) and validation (25%) and a scoring system was developed and validated. The risk for poor visual outcomes was 8% with a total score of 0, 17% with 1, 29% with 2, 47% with 3, and 71% with 4 or higher. CONCLUSIONS Independent risk factors were compared for poor visual outcomes after RRD surgery, which included PVR, anti-VEGF injections, vision loss >1 week, ocular comorbidities, presenting VA and older age. The PRO score was developed to provide a scoring system that may be useful in clinical practice.
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Affiliation(s)
- Louis Z Cai
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeffrey Lin
- Biostatistics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Matthew R Starr
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony Obeid
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edwin H Ryan
- Department of Ophthalmology, VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Claire Ryan
- Department of Ophthalmology, VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Nora J Forbes
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Diego Arias
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael J Ammar
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Luv G Patel
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | | | | | - Dean Eliott
- Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Omesh P Gupta
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yoshihiro Yonekawa
- Department of Ophthalmology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Wagley S, Ryan EH. Feasibility of Dynamic Video Scanning Laser Ophthalmoscopy for Evaluation of Vitreous Opacities. Ophthalmic Surg Lasers Imaging Retina 2022; 53:714-716. [PMID: 36547957 DOI: 10.3928/23258160-20221018-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To explore the feasibility of confocal scanning laser ophthalmoscope video for evaluation and quantification of vitreous opacities. Descriptive study outlining the utilization of dynamic confocal scanning laser ophthalmoscope video technology to capture movement of vitreous opacities. By having the patient perform a saccade followed by refixation, the vitreous gel was set in motion and the shadowing and movement of the vitreous opacities was easily visualized. The whole process of recording the images took less than a minute. Qualitative analysis showed dense shadowing from the vitreous opacities tracking over the central visual axis in some patients. Video scanning laser ophthalmo-scope can be a useful tool in documenting the presence and degree of vitreous opacities. This technology can be applied for clinical decision-making as well as educating patients. [Ophthalmic Surg Lasers Imaging Retina 2022;53:714-716.].
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Ryan EH, Mittra RA. Surgeon Judgment and the Role of Scleral Buckle in Addition to Vitrectomy in Eyes with Retinal Detachments. Ophthalmol Retina 2022; 6:869-870. [PMID: 36192088 DOI: 10.1016/j.oret.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 10/14/2022]
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Ashkenazy N, Patel NA, Sridhar J, Yannuzzi NA, Belin PJ, Kaplan R, Kothari N, Benitez Bajandas GA, Kohly RP, Roizenblatt R, Pinhas A, Mundae R, Rosen RB, Ryan EH, Chiang A, Chang LK, Khurana RN, Finn AP. Hemi- and Central Retinal Vein Occlusion Associated with COVID-19 Infection in Young Patients without Known Risk Factors. Ophthalmol Retina 2022; 6:520-530. [PMID: 35278727 PMCID: PMC8907133 DOI: 10.1016/j.oret.2022.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Venous thromboembolic complications have been reported in association with coronavirus disease 2019 (COVID-19) infection. We raised awareness regarding a potential temporal association between COVID-19 infection and retinal vein occlusion (RVO). DESIGN Multicenter, retrospective, nonconsecutive case series. SUBJECTS Patients presenting with hemi-RVO (HRVO) or central RVO (CRVO) between March 2020 and March 2021, with confirmed COVID-19 infection, were included. The exclusion criteria were as follows: age >50 years, hypertension, diabetes, glaucoma, obesity, underlying hypercoagulable states, and those requiring intubation during hospitalization. METHODS This was a multicenter, retrospective, nonconsecutive case series including patients presenting with hemi-RVO (HRVO) or central RVO (CRVO) between March 2020 and March 2021, with confirmed COVID-19 infection. The exclusion criteria were as follows: age >50 years, hypertension, diabetes, glaucoma, obesity, underlying hypercoagulable states, and those requiring intubation during hospitalization. MAIN OUTCOME MEASURES Ophthalmic findings, including presenting and final visual acuity (VA), imaging findings, and clinical course. RESULTS Twelve eyes of 12 patients with CRVO (9 of 12) or HRVO (3 of 12) after COVID-19 infection were included. The median age was 32 years (range, 18-50 years). Three patients were hospitalized, but none were intubated. The median time from COVID-19 diagnosis to ophthalmic symptoms was 6.9 weeks. The presenting VA ranged from 20/20 to counting fingers, with over half (7 of 12) having a VA of ≥20/40. OCT revealed macular edema in 42% of the eyes; of these, 80% (4 of 5) were treated with anti-VEGF injections. Ninety-two percent (11 of 12) had partial or complete resolution of ocular findings at final follow-up. Four eyes (33%) had retinal thinning, as determined using OCT, by the end of the study interval. The final VA ranged from 20/20 to 20/60, with 11 of the 12 (92%) eyes achieving a VA of ≥20/40 at a median final follow-up period of 13 weeks (range, 4-52 weeks). CONCLUSIONS Although we acknowledge the high seroprevalence of COVID-19 and that a causal relationship cannot be established, we reported this series to raise awareness regarding the potential risk of retinal vascular events due to a heightened thromboinflammatory state associated with COVID-19 infection.
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Affiliation(s)
- Noy Ashkenazy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nimesh A Patel
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | | | | - Radha P Kohly
- Department of Ophthalmology, Sunnybrook Health Sciences Center, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | | | - Alexander Pinhas
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Rusdeep Mundae
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Edwin H Ryan
- VitreoRetinal Surgery, PLLC, Minneapolis, Minnesota
| | - Allen Chiang
- Mid Atlantic Retina, Wills Eye Hospital Retina Service, Philadelphia, Pennsylvania
| | - Louis K Chang
- Northern California Retina Vitreous Associates, Mountain View, California
| | - Rahul N Khurana
- Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, California
| | - Avni P Finn
- Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee.
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Gopal AD, Starr MR, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE, Yonekawa Y. Predictors of Vision Loss after Surgery for Macula-Sparing Rhegmatogenous Retinal Detachment. Curr Eye Res 2022; 47:1209-1217. [PMID: 35608082 DOI: 10.1080/02713683.2022.2081980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine factors associated with loss of good vision (defined as Snellen visual acuity [VA] < 20/40) after surgery among eyes presenting with macula-on primary rhegmatogenous retinal detachment (RRD) with initial VA ≥20/40. MATERIALS AND METHODS Multicenter, retrospective, cohort study of eyes undergoing scleral buckle (SB), pars plana vitrectomy (PPV), or combined pars plana vitrectomy/scleral buckle (PPV/SB) for non-complex macula-on RRD with initial VA ≥20/40. RESULTS Among 646 eyes with macula-on RRDs with initial VA ≥20/40, 106 (16.4%) had VA <20/40 (i.e. lost good vision) at final follow-up. Eyes losing good vision had slightly worse pre-operative logMAR VA (mean 0.15 ± 0.10 [20/28]) compared to eyes that preserved good vision (mean 0.11 ± 0.10 [20/26]) (p = 0.004). RRDs extending greater than 6 clock-hours were more likely to lose good vision than smaller detachments (multivariate OR 4.57 [95% CI 1.44-14.51]; p = 0.0099). Compared to eyes repaired with SB alone, eyes undergoing PPV (multivariate OR 7.22 [95% CI 2.10-24.90]; p = 0.0017) or PPV/SB (multivariate OR 10.74 [95% CI 3.20-36.11]; p = 0.0001) were each more likely to lose good vision. Eyes requiring further RRD-related (multivariate OR 8.64 [95% CI 1.47-50.66]; p < 0.017) and non-RRD related vitreoretinal surgery (multivariate OR 14.35 [95% CI 5.39-38.21]; p <0.0001) were more likely to lose good vision. CONCLUSION Among macula-on RRDs, loss of good vision was associated with worse vision on presentation, vitrectomy-based procedures, greater extent of detachment, and lack of single surgery success. Understanding predictors of visual outcome in macula-on RRD repair may guide pre-operative counseling regarding visual prognosis.
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Affiliation(s)
- Anand D Gopal
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Ajay E Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA
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Mundae R, Wagley S, Ryan EH, Parke DW, Mittra RA, Tang PH. COVID-19 vaccination hesitancy and its association with altered presentation of primary rhegmatogenous retinal detachment. Am J Ophthalmol 2022; 242:7-17. [PMID: 35609676 PMCID: PMC9122843 DOI: 10.1016/j.ajo.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Evaluate factors associated with coronavirus 2019 (COVID-19) vaccine hesitancy and clinical trends in primary rhegmatogenous retinal detachments (RRDs) during the first year of vaccine availability. DESIGN Single-center, clinical cohort study. METHODS Consecutive patients from December 14, 2020, to December 12, 2021, presenting vaccinated (Prior-), subsequently vaccinated (Later-), or remaining unvaccinated (Never-Vax). Primary outcome was proportion with macula-off (mac-off) RRD. Secondary outcomes included logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), primary proliferative vitreoretinopathy (PVR), proportion lost to follow-up, and distance traveled. RESULTS 1047 patients were divided into 391 Prior-, 252 Later-, and 404 Never-Vax cohorts. Significantly greater proportions of Later- and Never-Vax cohorts presented with mac-off RRDs (Prior-Vax = 44.5%; Later-Vax = 54%, P < .0001; Never-Vax = 57.9%, P < .0001) and primary PVR (Prior-Vax = 4.3%; Later-Vax = 13.6%, P < .0001; Never-Vax = 17.1%, P < .0001) compared to Prior-Vax cohort. Significantly greater proportion of Never-Vax cohort (7.7%, P < .0001) were lost to follow-up compared to Prior- (2.3%) and Later-Vax (2.2%) cohorts. Never-Vax cohort (median = 35 miles) traveled farther compared to Prior- (median = 22.3 miles; P < .0001) and Later-Vax cohorts (25.45 miles; P = .0038). Prior-Vax cohort had significantly better (P < .05) initial (median = 0.30 logMAR) and final (0.18 logMAR) BCVA compared to Later- (Initial: 0.54 logMAR; Final: 0.30 logMAR) and Never-Vax (Initial: 0.70 logMAR; Final: 0.40 logMAR) cohorts. CONCLUSIONS COVID-19 vaccine hesitancy is associated with worse clinical presentation and outcomes for primary RRD.
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Affiliation(s)
- Rusdeep Mundae
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Sushant Wagley
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Edwin H Ryan
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - D Wilkin Parke
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Robert A Mittra
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA
| | - Peter H Tang
- From the Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School (R.M., E.H.R., D.W.P., P.H.T.), and VitreoRetinal Surgery, PLLC (S.W., E.H.R., D.W.P., R.A.M., P.H.T.), Minneapolis, Minnesota, USA..
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21
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Peck TJ, Starr MR, Yonekawa Y, Khan MA, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE. Outcomes of Primary Rhegmatogenous Retinal Detachment Repair in Eyes With Preoperative Grade B or C Proliferative Vitreoretinopathy. Journal of VitreoRetinal Diseases 2022; 6:194-200. [PMID: 37008548 PMCID: PMC9976120 DOI: 10.1177/24741264211046770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose: This work evaluates the anatomic and functional outcomes of primary rhegmatogenous retinal detachments (RRDs) with preoperative grade B and C proliferative vitreoretinopathy (PVR) vs eyes without PVR. Methods: As a multi-institutional, interventional, retrospective study of all patients undergoing primary RRD surgical procedures from January 1, 2015, through December 31, 2015, this study evaluated the visual acuity (VA) outcomes and single-surgery anatomic success rates (SSAS) of patients with primary grade B and C PVR at the time of RRD repair. Results: A total of 2486 eyes underwent primary RD surgery during the study period, of which 153 eyes (6.2%) had documented preoperative PVR grade B or C. Eyes without PVR had better SSAS compared with eyes with grade B or C PVR (87% vs 83% vs 75%, respectively, P < .0001). Eyes without PVR also had better final mean (SD) logMAR VA (0.35 [0.47]; 20/45 Snellen equivalent) than eyes with PVR of grade B (0.50 [0.56]; 20/63 Snellen equivalent) or grade C ( P < .0001). In only eyes with preoperative PVR, there were no significant differences in final VA or SSAS on multivariate analysis based on surgical approach or use of retinectomy or membrane peeling alone in the intraoperative management of PVR. Conclusions: Eyes with primary preoperative grade B and C PVR appear to have significantly worse VA outcomes and lower surgical success rates. Surgical approach and management of PVR membranes did not appear to affect VA or success rates, indicating that preoperative PVR severity may dictate these outcomes.
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Affiliation(s)
- Travis J. Peck
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
- T.J.P. and M.R.S. are first co-authors of this work
| | - Matthew R. Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
- T.J.P. and M.R.S. are first co-authors of this work
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - M. Ali Khan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Luv G. Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Carl D. Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Omesh P. Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ajay E. Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
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22
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Mundae R, Velez A, Sodhi GS, Belin PJ, Kohler JM, Ryan EH, Tang PH. Trends in the Clinical Presentation of Primary Rhegmatogenous Retinal Detachments During the First Year of the COVID-19 Pandemic. Am J Ophthalmol 2022; 237:49-57. [PMID: 34801509 PMCID: PMC8603252 DOI: 10.1016/j.ajo.2021.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Purpose To evaluate the effect of 1 full year of the coronavirus disease 2019 (COVID-19) pandemic on clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD). Design Single-center, retrospective observational cohort study. Methods Patients were divided into 2 cohorts: consecutive patients treated for primary RRD during the COVID-19 pandemic (March 9, 2020, to March 7, 2021; pandemic cohort) and patients treated during the corresponding time in previous year (March 11, 2019, to March 8, 2020; control cohort). Main outcome measures: Proportion of patients presenting with macula-involving (mac-off) or macula-sparring (mac-on) RRD. Results A total of 952 patients in the pandemic cohort and 872 patients in the control cohort were included. Demographic factors were similar. Compared with the control cohort, a significantly greater number of pandemic cohort patients presented with mac-off RRDs ([60.92%] pandemic, [48.17%] control, P = .0001) and primary proliferative vitreoretinopathy ([15.53%] pandemic, [6.9%] control, P = .0001). Pandemic cohort patients (10.81%) had significantly higher rates of lost to follow-up compared with the control cohort (4.43%; P = .0001). Patients new to our clinic demonstrated a significant increase in mac-off RRDs in the pandemic cohort (65.35%) compared with the control cohort (50.40%; P = .0001). Pandemic cohort patients showed worse median final best-corrected visual acuity (0.30 logarithm of the minimum angle of resolution) compared with the control cohort (0.18 logarithm of the minimum angle of resolution; P = .0001). Conclusions Patients with primary RRD during the first year of the COVID-19 pandemic were more likely to have mac-off disease, present with primary proliferative vitreoretinopathy, be lost to follow-up, and have worse final best-corrected visual acuity outcomes.
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Belin PJ, Yannuzzi NA, Wagley S, Smiddy WE, Ryan EH. COST ANALYSIS OF SCLERAL BUCKLE, PARS PLANA VITRECTOMY, AND PARS PLANA VITRECTOMY WITH SCLERAL BUCKLE FOR RETINAL DETACHMENT REPAIR. Retina 2022; 42:33-37. [PMID: 34483317 DOI: 10.1097/iae.0000000000003298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the cost and utility of scleral buckle (SB), pars plana vitrectomy (PPV), and PPV with SB (PPV/SB) for moderately complex rhegmatogenous retinal detachment repair. METHODS Cost-utility analysis using data from the Primary Retinal Detachment Outcomes Study. The model estimated costs, lifetime utility, and lifetime cost per quality-adjusted life year for treatment of moderately complex rhegmatogenous retinal detachment with SB, PPV, or PPV/SB. Data from the Centers for Medicare and Medicaid Services were used to calculate costs in hospital and ambulatory surgery center settings. RESULTS Total costs (2020 US dollars) for repair of a moderately complex rhegmatogenous retinal detachment in hospital (ambulatory surgery center) settings were $5,975 ($3,774) for the SB group, $8,125 ($5,082) for the PPV group, and $7,551 ($4,713) for the PPV/SB group. The estimated lifetime quality-adjusted life years gained were 5.4, 4.7, and 4.7 in the SB, PPV, and PPV/SB groups, respectively. The cost per quality-adjusted life year for hospital and ambulatory surgery center settings was $1,106 a ($699) for the SB group, $1729 ($1,081) for the PPV group, and $1,607 ($1,003) for the PPV/SB group. CONCLUSION Scleral buckle, PPV, and PPV/SB yielded very favorable cost-utility results for the repair of moderately complex rhegmatogenous retinal detachment, with slightly better results for SB, compared with current willingness to pay standards.
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Affiliation(s)
- Peter J Belin
- VitreoRetinal Surgery, PLLC, Minneapolis, Minnesota; and
| | | | - Sushant Wagley
- VitreoRetinal Surgery, PLLC, Minneapolis, Minnesota; and
| | | | - Edwin H Ryan
- VitreoRetinal Surgery, PLLC, Minneapolis, Minnesota; and
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25
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Starr MR, Hsu J, Yonekawa Y, Mittra RA, Ryan C, Forbes NJ, Ammar M, Patel LG, Obeid A, Capone A, Emerson GG, Joseph DP, Eliott D, Gupta OP, Regillo CD, Ryan EH. Surgical techniques for primary rhegmatogenous retinal detachments between surgeons with high versus low single surgery success rates. Acta Ophthalmol 2021; 99:e1501-e1508. [PMID: 33720540 DOI: 10.1111/aos.14821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/25/2020] [Accepted: 02/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS To identify differences in preoperative characteristics and intraoperative approaches between surgeons with higher versus lower single surgery success rates (SSSR) for repair of rhegmatogenous retinal detachments (RRDs). METHODS This study is a sub-analysis of subjects who underwent RRD repair in the Primary Retinal Detachment Outcomes (PRO) study, a multi-institutional, retrospective comparative interventional study. The PRO study examined consecutive primary RRD surgeries from January 1, 2015 through December 31, 2015. The primary outcome was variations in surgical approach to different types of RRDs with secondary analyses of pre and intraoperative metrics for surgeons with SSSR > 90% compared to those <80% who performed at least 40 operations during the study period. RESULTS A total of 689 surgeries were included in the analysis. The mean SSSR was 94% for the higher tier and 75% for the lower tier (p < 0.0001). Surgeons with >90% SSSR were more likely to have graduated fellowship more recently (p = 0.0025), use less perfluorocarbon liquid (p < 0.0001), perform less 360 degree laser retinopexy (p < 0.0001), and perform a higher percentage of primary buckles and combined PPV/SB (p < 0.0001). For pseudophakic eyes there was no difference between PPV and PPV/SB use (p = 0.6211). CONCLUSION Surgeons with high SSSR typically performed SB as well as combination PPV/SB for more RRDs. Similar numbers of PPV and PPV/SB were performed for pseudophakic eyes, suggesting that the difference in SSSR between the two groups may be related to a combination of preoperative and intraoperative decisions as well as differences in technique.
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Affiliation(s)
- Matthew R. Starr
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Jason Hsu
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | | | | | | | - Michael Ammar
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Luv G. Patel
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Anthony Obeid
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Antonio Capone
- Associated Retinal Consultants Oakland University William Beaumont School of Medicine Royal Oak MI USA
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear Harvard Medical School Boston MA USA
| | - Omesh P. Gupta
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
| | - Carl D. Regillo
- Wills Eye Hospital Mid Atlantic Retina Thomas Jefferson University Philadelphia PA USA
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26
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Wagley S, Belin PJ, Ryan EH. UTILIZATION OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY TO IDENTIFY POSTERIOR VITREOUS DETACHMENT IN PATIENTS WITH RETINAL DETACHMENT. Retina 2021; 41:2296-2300. [PMID: 33990115 DOI: 10.1097/iae.0000000000003209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare posterior vitreous detachment (PVD) identification rate between clinical examination versus spectral domain optical coherence tomography in patients with retinal detachment (RD). METHODS Data from the Primary Retinal Detachment Outcomes Study were used for this retrospective cross-sectional study of 506 patients. Spectral domain optical coherence tomography scans were reviewed to detect the separation of the posterior hyaloid face from the retina and the optic nerve on all 31 raster cuts of a 30 × 30 scan. Statistical analysis was performed to compare spectral domain optical coherence tomography-identified PVD with PVD identified on slit-lamp biomicroscopy. RESULTS There was a significant difference in the rate of PVD identification by clinical examination versus spectral domain optical coherence tomography in patients with RD. Clinical examination identified 51.58% of patients with PVD, whereas spectral domain optical coherence tomography identified 78.42% of patients with PVD. In patients with macula-on RD, 61.68% were found to have PVD on clinical examination versus 83.90% by imaging. Spectral domain optical coherence tomography identified larger number of PVD in patients with macula-off RD compared with clinical examination, 46.28% versus 75.43%, respectively. There was low agreement between the two methods (kappa score = 0.137). There was a significant difference in surgical procedure type chosen in those with versus without PVD. CONCLUSION Knowledge about the posterior hyaloid anatomy is important before undergoing RD repair. Spectral domain optical coherence tomography can better identify PVD than clinical examination in patients with RD.
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Affiliation(s)
- Sushant Wagley
- VitreoRetinal Surgery, PLLC, Pennsylvania, Edina, Minnesota
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27
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Kokame GT, Yannuzzi NA, Shantha JG, Yamane M, Relhan N, Gross J, Ryan EH, Flynn HW. INVOLUTION OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AFTER ENDOPHTHALMITIS. Retin Cases Brief Rep 2021; 15:495-499. [PMID: 30932994 PMCID: PMC6765457 DOI: 10.1097/icb.0000000000000866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To report patients who demonstrated an alteration in the clinical and optical coherence tomography features of neovascular age-related macular degeneration after resolution of endophthalmitis. METHODS Retrospective case series of the subsequent changes in the macula and need for anti-vascular endothelial growth factor therapy in patients with neovascular age-related macular degeneration who developed endophthalmitis after intravitreal injection. RESULTS The study included seven eyes of seven patients with follow-up ranging between 3 months and 11 years. The vitreous cultures (n = 7) before intravitreal antibiotic injection were the following: culture-negative (4) and coagulase-negative Staphylococcus (3). Initial treatment included vitreous tap and injection (4) and pars plana vitrectomy (3). In 5/7 eyes, the optical coherence tomography showed resolution of subretinal fluid and serous pigment epithelial detachment, and there was no additional anti-vascular endothelial growth factor treatment administered. CONCLUSION After successful treatment of endophthalmitis in patients with neovascular age-related macular degeneration, there was relative involution of the maculopathy and reduced anti-vascular endothelial growth factor treatment burden in this series.
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Affiliation(s)
- Gregg T Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii
- The Retina Center at Pali Momi, Aiea, Hawaii
- Retina Consultants of Hawaii, Aiea, Hawaii
- Hawaii Macula and Retina Institute, Aiea, Hawaii
- John A. Burns School of Medicine, University of Hawaii School of Medicine, Honolulu, Hawaii
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jessica G Shantha
- The Retina Center at Pali Momi, Aiea, Hawaii
- Retina Consultants of Hawaii, Aiea, Hawaii
- Hawaii Macula and Retina Institute, Aiea, Hawaii
- Department of Ophthalmology, University of California San Francisco, Francis I. Proctor Foundation, San Francisco, California
| | - Maya Yamane
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeffrey Gross
- Carolina Retina Center, Columbia, South Carolina; and
| | | | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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28
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Wang JC, Ryan EH, Ryan C, Kakulavarapu S, Mardis PJ, Rodriguez M, Stefater JA, Forbes NJ, Gupta O, Capone A, Emerson GG, Joseph DP, Eliott D, Yonekawa Y. FACTORS ASSOCIATED WITH THE USE OF 360-DEGREE LASER RETINOPEXY DURING PRIMARY VITRECTOMY WITH OR WITHOUT SCLERAL BUCKLE FOR RHEGMATOGENOUS RETINAL DETACHMENT AND IMPACT ON SURGICAL OUTCOMES (PRO STUDY REPORT NUMBER 4). Retina 2021; 40:2070-2076. [PMID: 31876884 DOI: 10.1097/iae.0000000000002728] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine factors associated with 360-degree laser retinopexy (360LR) during primary pars plana vitrectomy ± scleral buckle for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. METHODS This is a multicenter, retrospective, interventional study. Patients undergoing primary pars plana vitrectomy or primary pars plana vitrectomy + scleral buckle for noncomplex primary RRD in 2015 were evaluated. Primary outcomes were single surgery anatomical success (SSAS) and final anatomical success. Secondary outcomes included final logarithm of the minimum angle of resolution visual acuity, epiretinal membrane formation, cystoid macular edema development, and number of subsequent vitrectomies. Multivariate regressions were performed. RESULTS Two thousand two hundred and forty-eight surgeries by 61 surgeons were included; of which, 516 underwent 360LR. Younger age (P = 0.01), more retinal breaks (P = 0.01), more extensive RRD (P < 0.001), and surgeon ID (P < 0.001) were significantly associated with 360LR. No significant associations between 360LR and single surgery anatomical success (P = 0.44), epiretinal membrane formation (P = 0.14), cystoid macular edema development (P = 0.28), or number of subsequent vitrectomies (P = 0.41) were found. Controlling for case complexity, 360LR was significantly associated with lower final anatomical success (P < 0.001) and worse final logarithm of the minimum angle of resolution visual acuity (P < 0.001). CONCLUSION Multiple factors influenced whether 360LR was performed during primary pars plana vitrectomy ± scleral buckle for RRD. However, 360LR was not associated with improved surgical outcomes, and in fact, it may be associated with poorer outcomes.
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Affiliation(s)
- Jay C Wang
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | | | - Claire Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota
| | - Srividya Kakulavarapu
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | | | | | - James A Stefater
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | | | - Omesh Gupta
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Yoshihiro Yonekawa
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Starr MR, Yonekawa Y, Gupta OP, Ryan EH. Reply to Letter to the Editor: PRO Study Report No. 7: Macular Hole in RRD. Ophthalmic Surg Lasers Imaging Retina 2021; 52:418-419. [PMID: 34410187 DOI: 10.3928/23258160-20210805-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | | | - Omesh P Gupta
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Xu D, Belin PJ, Staropoli PC, Yannuzzi NA, Vangipuram G, Chiang A, Shah GK, Townsend JH, Ryan EH, Klufas MA. Clinical Outcomes in Sequential, Bilateral Rhegmatogenous Retinal Detachment: A Multicenter, Paired-Eye Analysis. Ophthalmol Retina 2021; 5:797-804. [PMID: 33197679 DOI: 10.1016/j.oret.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To assess the clinical outcomes in patients with sequential, bilateral rhegmatogenous retinal detachment (RRD) by using a paired-eye comparison. DESIGN Multicenter, retrospective cohort study. PARTICIPANTS Patients with sequential, bilateral RRD treated with pars plana vitrectomy (PPV), scleral buckle (SB), or PPV plus SB over an 11-year period (October 2008-April 2019) from 4 vitreoretinal practices were included. METHODS Data were collected on patient demographics, anatomic characteristics of the RRD, surgical procedures, and best-corrected visual acuity (VA). These variables, along with single-operation anatomic success (SOAS) and type and number of surgical procedures, were assessed with a paired-eye comparison. MAIN OUTCOME MEASURES Single-operation anatomic success between the initial-eye and subsequent-eye RRD. RESULTS Five hundred four eyes of 252 patients were included. The mean interval between RRD in either eye was 13.6 ± 13.4 months. Single-operation anatomic success in the initial eye was 82.5% with a mean of 1.2 surgeries (range, 1-4 surgeries). Single-operation anatomic success in the subsequent eye was 83.7% (P = 0.80) with a mean of 1.2 surgeries (range, 1-4 surgeries; P = 0.68). Visual acuity was better in the subsequent eye at presentation (mean, 20/62 vs. 20/149; P < 0.001) and postoperative month 6 (mean, 20/41 vs. 20/49; P = 0.03), but final VA was similar (20/36 vs. 20/37; P = 0.68). Macular detachment was less prevalent (34.1% vs. 56.0%; P < 0.001) with fewer quadrants detached (mean, 1.9 quadrants vs. 2.0 quadrants; P = 0.010) in the subsequent eye. Mean duration of symptoms was shorter in the subsequent eye (mean, 5.9 days vs. 7.5 days; P = 0.008). In patients who underwent a different surgical technique in each eye, PPV plus SB yielded a higher SOAS of 89.7% compared with 69.0% for PPV alone in 116 eyes (P = 0.010). CONCLUSIONS In this study of sequential, bilateral RRD, the SOAS was similar for each eye. The second eye was more likely to be treated earlier and to have less macular involvement, but the final VA outcomes were similar. Pars plana vitrectomy plus SB yielded a significantly higher SOAS than PPV or SB alone.
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Affiliation(s)
- David Xu
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
| | | | - Patrick C Staropoli
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | - Nicolas A Yannuzzi
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Allen Chiang
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | | | - Justin H Townsend
- Retina Service, Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | | | - Michael A Klufas
- Retina Service, Wills Eye Physicians-Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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Starr MR, Ryan EH, Obeid A, Ryan C, Gao X, Madhava ML, Maloney SM, Adika AZ, Peddada KV, Sioufi K, Patel LG, Ammar MJ, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Yonekawa Y, Study Group FTPRDOP. Scleral Buckling for Primary Retinal Detachment: Outcomes of Scleral Tunnels versus Scleral Sutures. J Ophthalmic Vis Res 2021; 16:377-383. [PMID: 34394866 PMCID: PMC8358744 DOI: 10.18502/jovr.v16i3.9434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose There are primarily two techniques for affixing the scleral buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): scleral tunnels or scleral sutures. Methods This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using scleral sutures versus scleral tunnels. Pre- and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus Results The mean preoperative logMAR VA for the belt loop cohort was 1.05 ± 1.06 (Snellen 20/224) and for the scleral suture cohort was 1.03 ± 1.04 (Snellen 20/214, p = 0.846). The respective mean postoperative logMAR VAs were 0.45 ± 0.55 (Snellen 20/56) and 0.46 ± 0.59 (Snellen 20/58, p = 0.574). The single surgery success rate for the tunnel cohort was 87.3% versus 88.6% for the suture cohort (p = 0.601). Three patients (1.0%) in the scleral tunnel cohort developed postoperative strabismus, but only one patient (0.1%) in the suture cohort (p = 0.04, multivariate p = 0.76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0.02). There were no differences in vision, anatomic success, or strabismus between scleral tunnels versus scleral sutures in eyes that underwent primary SB. Conclusion Scleral tunnels and scleral sutures had similar postoperative outcomes. Combined PPV/SB in eyes with scleral tunnels might be a risk for strabismus post retinal detachment surgery.
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Affiliation(s)
- Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | - Adam Z Adika
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Krishi V Peddada
- Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, USA
| | | | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael J Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA
| | - For The Primary Retinal Detachment Outcomes Pro Study Group
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, USA.,VitreoRetinal Surgery, Minneapolis, MN, USA.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, USA.,Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.,The Retina Center, Minneapolis, MN, USA.,The Retina Institute, St. Louis, MO, USA.,Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Starr MR, Obeid A, Ryan EH, Gao X, Matsunaga D, Madhava ML, Maloney SM, Adika AZ, Peddada KV, Sioufi K, Ammar M, Patel LG, Ryan C, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Yonekawa Y, Gupta OP. Surgical Outcomes of Primary RRD With and Without Concurrent Full-Thickness Macular Hole (PRO Study Report No. 7). Ophthalmic Surg Lasers Imaging Retina 2021; 51:500-505. [PMID: 32955589 DOI: 10.3928/23258160-20200831-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Non-causal macular holes (MHs) can occur concurrently with rhegmatogenous retinal detachments (RRDs). The visual outcomes and surgical approach for these eyes are variable. PATIENTS AND METHODS This was a multi-institutional, retrospective review of all primary retinal detachment surgeries from January 1, 2015, through December 31, 2015. Pre-, intra-, and postoperative metrics were recorded. RESULTS There were 2,242 eyes that had pars plana vitrectomy for primary RRD, 43 (1.9%) of which had a MH at the time of surgery. The mean postoperative logMAR visual acuity (VA) for the MH cohort was 0.87 ± 0.64 (20/148) and for eyes without a MH was 0.47 ± 0.63 (20/59; P < .0001). The single-surgery re-attachment rate for the MH cohort and no MH cohort was 86.1% and 84.9%, respectively (P = 1.0000). CONCLUSIONS Patients with noncausal MHs and RRD had significantly worse VA than patients without a MH. Preoperative counseling is imperative in patients with both RRD and MH. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:500-505.].
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Kokame GT, Johnson MW, Lim J, Flynn HW, de Carlo T, Yannuzzi N, Ryan EH, Omizo JN, Sridhar J, Staropoli P, Goldhagen B, Lian R. Closure of Full-Thickness Macular Holes Associated with Macular Edema with Medical Therapy. Ophthalmologica 2021; 245:179-186. [PMID: 34182564 DOI: 10.1159/000516018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Gregg T Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
| | - Mark W Johnson
- Kellogg Eye Center of the University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Jennifer Lim
- Illinois Eye and Ear Infirmary of the University of Chicago College of Medicine, Chicago, Illinois, USA
| | - Harry W Flynn
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Talisa de Carlo
- Illinois Eye and Ear Infirmary of the University of Chicago College of Medicine, Chicago, Illinois, USA
| | - Nicolas Yannuzzi
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Edwin H Ryan
- Vitreoretinal Surgery, PA, Minneapolis, Minnesota, USA
| | - Jase N Omizo
- Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Patrick Staropoli
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Brian Goldhagen
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Rebecca Lian
- Division of Ophthalmology, Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
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Starr MR, Obeid A, Gao X, Ryan EH, Shah GK, Ryan C, Madhava ML, Maloney SM, Adika AZ, Peddada KV, Sioufi K, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Yonekawa Y. Prophylactic internal limiting membrane peeling during rhegmatogenous retinal detachment surgery. Acta Ophthalmol 2021; 99:e619-e620. [PMID: 32749767 DOI: 10.1111/aos.14560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Matthew R. Starr
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | - Anthony Obeid
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | - Xinxiao Gao
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | | | | | - Claire Ryan
- VitreoRetinal Surgery Minneapolis Minnesota USA
| | - Malika L. Madhava
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | - Sean M. Maloney
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | - Adam Z. Adika
- Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Krishi V. Peddada
- Department of Ophthalmology Drexel University College of Medicine Philadelphia Pennsylvania USA
| | - Kareem Sioufi
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | - Michael Ammar
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | - Luv G. Patel
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | | | - Antonio Capone
- Oakland University William Beaumont School of Medicine Royal Oak Michigan USA
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts USA
| | - Carl D. Regillo
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | - Jason Hsu
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | - Omesh P. Gupta
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital Mid Atlantic RetinaThomas Jefferson University Philadelphia Pennsylvania USA
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Starr MR, Cai L, Obeid A, Ryan EH, Eliott D, Ryan C, Forbes NJ, Ammar M, Patel LG, Capone A, Emerson GG, Joseph DP, Gupta OP, Regillo CD, Hsu J, Yonekawa Y. Risk Factors for Presence of Cystoid Macular Edema following Rhegmatogenous Retinal Detachment Surgery. Curr Eye Res 2021; 46:1867-1875. [PMID: 33979556 DOI: 10.1080/02713683.2021.1929330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Cystoid macular edema (CME) following cataract surgery is a well-known entity. Less is known regarding the risk factors of developing CME following repair of rhegmatogenous retinal detachments (RRD).Methods: This was a multi-institutional study of primary RRD surgeries from 1/1/2015 through 12/31/2015. The primary outcome was the development of postoperative CME following RRD surgery. Post-operative optical coherence tomography imaging and 3 months of follow-up following RRD repair were required.Results: There were 1,466 eyes that met the inclusion criteria, and 140 (9.6%) developed postoperative CME following primary RRD repair. On multivariate analysis, the statistically significant metrics were older patient age (OR 1.03 per year, 95% CI 1.01 to 1.05), pre-operative proliferative vitreoretinopathy (PVR, OR 1.74, 95% 1.03 to 2.95), and cataract surgery following RRD repair (OR 2.18, 95% CI 1.47 to 3.25). Single surgery success was protective against CME (OR 0.20 (95% CI 0.14-0.30). Seventy-six (9.0%) of the phakic eyes and 60 (9.9%) of the pseudophakic eyes developed post-operative CME. Multivariate analysis showed that cataract surgery following RRD repair (p < .0001) for phakic eyes and older age (p = .0075) for pseudophakic eyes were risk factors. In eyes that underwent successful retinal reattachment with one surgery, post-operative cataract surgery (p = .0005) and pre-operative PVR (p = .0011) were risk factors for CME in this subgroup.Conclusion: CME occurred in nearly 10% of the eyes following RRD repair. The biggest risk factors were recurrent RRD, preexisting PVR, older age, and cataract surgery following RRD repair.
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Affiliation(s)
- Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Louis Cai
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edwin H Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Claire Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota, USA
| | | | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | | | | | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Abstract
PURPOSE OF REVIEW Symptomatic vitreous opacities are increasingly recognized as a significant burden to patient well-being. There is growing interest in the use of vitrectomy or laser treatment to address these problems. This review is intended to update current assessment, management, and risks of treatment for persistent severely symptomatic vitreous opacities. RECENT FINDINGS Despite studies showing the value of quantitative ultrasound, reading speed measurements, and contrast sensitivity for assessing dysfunction caused by vitreous opacities, the decision of whether to proceed with surgery remains a very subjective, clinical one. Visual Function Questionnaire-25 score studies show a very large improvement postvitrectomy consistent with relief from symptoms and patient satisfaction. The risk of retinal tear and detachment appears to be higher than in most conditions treated with vitrectomy. SUMMARY Vitrectomy for the management of severe vitreous opacities is increasingly accepted because of the tremendous relief of symptoms reported by patients. The risks of retinal tear and detachment remain a concern, particularly in patients who have an attached posterior hyaloid. Yttrium-aluminum-garnet laser treatment of floaters may offer benefit in a subset of patients but appears to be less definitive than vitrectomy, and also may carry significant risk.
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Affiliation(s)
- Edwin H Ryan
- 3601 West 76th Street, Suite 300, Edina, Minnesota, USA
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Emerson GG, Ryan EH. Superior Retinal Reattachment Outcomes with Scleral Buckle Vitrectomy Compared with Vitrectomy Alone. Ophthalmol Retina 2021; 5:176-177. [PMID: 33549202 DOI: 10.1016/j.oret.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 10/22/2022]
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Starr MR, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Gupta OP, Regillo CD, Hsu J, Yonekawa Y. RETINAL DETACHMENT WITH INFERIOR RETINAL BREAKS: Primary Vitrectomy Versus Vitrectomy With Scleral Buckle (PRO Study Report No. 9). Retina 2021; 41:525-530. [PMID: 33600131 DOI: 10.1097/iae.0000000000002917] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Rhegmatogenous retinal detachments with inferior retinal breaks are believed to have a higher risk of recurrent rhegmatogenous retinal detachment. This study compared anatomic and visual outcomes between primary pars plana vitrectomy (PPV) and combination PPV with scleral buckle (PPV/SB) for rhegmatogenous retinal detachments with inferior retinal breaks. METHODS This is an analysis of the Primary Retinal Detachment Outcomes study, a multi-institutional cohort study of consecutive primary rhegmatogenous retinal detachment surgeries from January 1, 2015, through December 31, 2015. The primary outcome was single-surgery success rate. Only eyes with inferior retinal breaks (one break in the detached retina between five and seven o'clock) were included. RESULTS There were 238 eyes that met the inclusion criteria, 95 (40%) of which underwent primary PPV and 163 (60%) that underwent combined PPV/SB. The single-surgery success rate was 76.8% for PPV and 87.4% for PPV/SB (P = 0.0355). This remained significant on multivariate analysis (P = 0.01). Subgroup analysis showed that a superior single-surgery success rate of PPV/SB was especially noted in phakic eyes (85.2% vs. 68.6%; P = 0.0464). CONCLUSION Retinal detachment with inferior retinal breaks had a higher single-surgery success rate if treated with PPV/SB compared with PPV alone, particularly in phakic eyes.
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Affiliation(s)
- Matthew R Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anthony Obeid
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Claire Ryan
- VitreoRetinal Surgery, Minneapolis, Minnesota
| | - Michael Ammar
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Luv G Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Antonio Capone
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Omesh P Gupta
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
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Starr MR, Yonekawa Y, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE. Comparison of Visual and Anatomic Outcomes Following RRD Surgery Using 23-Gauge Versus 25-Gauge Vitrectomy: PRO Study Report No. 12. Ophthalmic Surg Lasers Imaging Retina 2021; 52:70-76. [PMID: 33626167 DOI: 10.3928/23258160-20210201-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Most surgeons now utilize small-gauge (23- or 25-gauge) pars plana vitrectomy (PPV) with or without scleral buckling for repair of rhegmatogenous retinal detachments (RRD), in addition to primary scleral buckle (SB), but comparative data between the two gauges are limited. PATIENTS AND METHODS This study is an analysis of primary RRD repairs comparing 23- versus 25-gauge vitrectomy for PPV or combination PPV/SB from January 1, 2015, through December 31, 2015, across multiple institutions. The primary outcome was single-surgery success and secondary outcomes included postoperative complications. RESULTS There were 1,932 eyes that met inclusion criteria. There was no statistically significant difference in single-surgery success (82.9% vs. 83.8%; P = 0.6329). There were similar rates of postoperative hypotony, endophthalmitis, vitreous hemorrhage, and choroidal detachment. The findings were similar when analyzing only eyes that underwent primary PPV without SB. CONCLUSION Both 23- and 25-gauge vitrectomy systems have similar anatomic and visual outcomes in the primary repair of RRD. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:70-76.].
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Vo LV, Ryan EH, Ryan CM, Shah GK, Gupta OP, Capone A, Eliott D, Yonekawa Y, Bhavsar AR, Emerson MV, Jones JM, Emerson GG. Posterior Retinotomy vs Perfluorocarbon Liquid to Aid Drainage of Subretinal Fluid During Primary Rhegmatogenous Retinal Detachment Repair (PRO Study Report No. 10). Journal of VitreoRetinal Diseases 2020; 4:494-498. [PMID: 37007660 PMCID: PMC9976063 DOI: 10.1177/2474126420941372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work compares posterior retinotomy vs perfluorocarbon liquid (PFCL) for subretinal fluid (SRF) drainage during pars plana vitrectomy for primary rhegmatogenous retinal detachment (RRD). Methods: In this large, multicenter, retrospective comparative study, 2620 patients underwent pars plana vitrectomy (with or without scleral buckle) for uncomplicated RRD. Patients for whom SRF was drained via the primary break without retinotomy or PFCL were excluded; those who required both retinotomy and PFCL were similarly excluded. Remaining patients were separated into “retinotomy” and “PFCL” cohorts. Subgroup analysis was conducted for macula-on and macula-off subgroups. Postoperative outcomes were analyzed and compared. Results: A total of 760 eyes (82.7%) had retinotomy and 159 eyes (17.3%) had PFCL for drainage of SRF, and baseline characteristics between the 2 groups were similar. Postoperative analysis showed similar outcomes between the retinotomy and PFCL cohorts, including final visual acuity ( P = .19), redetachment rate ( P = .30), anatomic success ( P = .28), presence of postoperative epiretinal membrane ( P = .75), and other macular pathologies ( P > .99). Subgroup analysis yielded similar outcomes for macula-on and macula-off subgroups. Postoperative presence of retained PFCL was 2.4%, possibly a factor in the slightly higher number of subsequent surgical procedures ( P = .03) in the PFCL cohort. Conclusions: Postoperative outcomes for retinotomy vs PFCL during RRD repair are comparable, aside from slightly greater number of subsequent surgical procedures needed in the PFCL cohort. Our analysis suggests both techniques are reasonable tools in the repair of macula-on or macula-off RRD.
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Affiliation(s)
- Loi V. Vo
- Retina Center of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Omesh P. Gupta
- Mid Atlantic Retina, Wills Eye Hospital, Philadelphia, PA, USA
| | - Antonio Capone
- Associated Retinal Consultants of Michigan, Royal Oak, MI, USA
| | - Dean Eliott
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Ryan EH, Lam LA, Pulido CM, Bennett SR, Calabrèse A. Reading Speed as an Objective Measure of Improvement Following Vitrectomy for Symptomatic Vitreous Opacities. Ophthalmic Surg Lasers Imaging Retina 2020; 51:456-466. [DOI: 10.3928/23258160-20200804-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
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Ryan EH, Ryan CM, Forbes NJ, Yonekawa Y, Wagley S, Mittra RA, Parke DW, Joseph DP, Emerson GG, Shah GK, Blinder KJ, Capone A, Williams GA, Eliott D, Gupta OP, Hsu J, Regillo CD. Primary Retinal Detachment Outcomes Study Report Number 2. Ophthalmology 2020; 127:1077-1085. [DOI: 10.1016/j.ophtha.2020.03.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/23/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022] Open
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Ryan EH, Joseph DP, Ryan CM, Forbes NJ, Yonekawa Y, Mittra RA, Parke DW, Ringeisen A, Emerson GG, Shah GK, Blinder KJ, Capone A, Williams GA, Eliott D, Gupta OP, Hsu J, Regillo CD. Primary Retinal Detachment Outcomes Study: Methodology and Overall Outcomes—Primary Retinal Detachment Outcomes Study Report Number 1. ACTA ACUST UNITED AC 2020; 4:814-822. [DOI: 10.1016/j.oret.2020.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 02/09/2023]
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Tieger MG, Rodriguez M, Wang JC, Obeid A, Ryan C, Gao X, Kakulavarapu S, Mardis PJ, Madhava ML, Maloney SM, Adika AZ, Peddada KV, Sioufi K, Stefater JA, Forbes NJ, Capone Jr. A, Emerson GG, Joseph DP, Regillo C, Hsu J, Gupta O, Eliott D, Ryan EH, Yonekawa Y. Impact of contact versus non-contact wide-angle viewing systems on outcomes of primary retinal detachment repair (PRO study report number 5). Br J Ophthalmol 2020; 105:410-413. [DOI: 10.1136/bjophthalmol-2020-315948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/04/2022]
Abstract
Background/aimsVitrectomy to repair retinal detachment is often performed with either non-contact wide-angle viewing systems or wide-angle contact viewing systems. The purpose of this study is to assess whether the viewing system used is associated with any differences in surgical outcomes of vitrectomy for primary non-complex retinal detachment repair.MethodsThis is a multicenter, interventional, retrospective, comparative study. Eyes that underwent non-complex primary retinal detachment repair by either pars plana vitrectomy (PPV) alone or in combination with scleral buckle/PPV in 2015 were evaluated. The viewing system at the time of the retinal detachment repair was identified and preoperative patient characteristics, intraoperative findings and postoperative outcomes were recorded.ResultsA total of 2256 eyes were included in our analysis. Of those, 1893 surgeries used a non-contact viewing system, while 363 used a contact lens system. There was no statistically significant difference in single surgery anatomic success at 3 months (p=0.72), or final anatomic success (p=0.40). Average postoperative visual acuity for the contact-based cases was logMAR 0.345 (20/44 Snellen equivalent) compared with 0.475 (20/60 Snellen equivalent) for non-contact (p=0.001). After controlling for numerous confounding variables in multivariable analysis, viewing system choice was no longer statistically significant (p=0.097).ConclusionThere was no statistically significant difference in anatomic success achieved for primary retinal detachment repair when comparing non-contact viewing systems to contact lens systems. Postoperative visual acuity was better in the contact-based group but this was not statistically significant when confounding factors were controlled for.
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Joseph DP, Ryan EH, Ryan CM, Forbes NJK, Wagley S, Yonekawa Y, Mittra RA, Parke DW, Emerson GG, Shah GK, Blinder KJ, Capone A, Williams GA, Eliott D, Gupta OP, Hsu J, Regillo CD. Primary Retinal Detachment Outcomes Study: Pseudophakic Retinal Detachment Outcomes: Primary Retinal Detachment Outcomes Study Report Number 3. Ophthalmology 2020; 127:1507-1514. [PMID: 32437865 DOI: 10.1016/j.ophtha.2020.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE This study evaluates outcomes of comparable pseudophakic rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB). DESIGN Multicenter, retrospective, interventional cohort study. PARTICIPANTS Data were gathered from patients from multiple retina practices in the United States with RRD in 2015. METHODS A large detailed database was generated. Pseudophakic patients with RRD managed with PPV or PPV-SB were analyzed for anatomic and visual outcomes. Eyes with proliferative vitreoretinopathy, giant retinal tears, previous invasive glaucoma surgery, and ≤90 days of follow-up were excluded from outcomes analysis. Single surgery anatomic success (SSAS) was defined as retinal attachment without ongoing tamponade and with no other RRD surgery within 90 days. MAIN OUTCOME MEASURES Single surgery anatomic success and final Snellen visual acuity (VA). RESULTS A total of 1158 of 2620 eyes (44%) with primary RRD were pseudophakic. A total of 1018 eyes had greater than 90 days of follow-up. Eyes with proliferative vitreoretinopathy, previous glaucoma surgery, and giant retinal tears were excluded, leaving 893 pseudophakic eyes eligible for outcome analysis. A total of 461 (52%) were right eyes. A total of 606 patients (67%) were male, with a mean age of 65±11 years. Pars plana vitrectomy and PPV-SB as the first procedure were performed on 684 eyes (77%) and 209 eyes (23%), respectively. The mean follow-up was 388±161 days, and overall SSAS was achieved in 770 eyes (86%). Single surgery anatomic success was 84% (577/684) for PPV and 92% (193/209) for PPV-SB. The difference in SSAS between types of treatment was significant (P = 0.009). In eyes with macula-on RRD, SSAS was 88% in eyes treated with PPV and 100% in eyes treated with PPV-SB (P = 0.0088). In eyes with macula-off RRD, SSAS was 81% in eyes treated with PPV and 89% in eyes treated with PPV-SB (P = 0.029). Single surgery anatomic success was greater for PPV-SB than PPV for inferior (96% vs. 82%) and superior (90% vs. 82%) detachments. Mean final VA was similar for PPV (20/47) and PPV-SB (20/46; P = 0.805). CONCLUSIONS In pseudophakic RRDs, SSAS was better in patients treated with PPV-SB compared with PPV alone, whereas visual outcomes were similar for both groups.
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Affiliation(s)
| | - Edwin H Ryan
- VitreoRetinal Surgery PA, Minneapolis, Minnesota
| | | | | | | | - Yoshihiro Yonekawa
- The Retina Service of Wills Eye Hospital, Mid-Atlantic Retina, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | - Dean Eliott
- Massachusetts Eye and Ear, Boston, Massachusetts
| | - Omesh P Gupta
- The Retina Service of Wills Eye Hospital, Mid-Atlantic Retina, Philadelphia, Pennsylvania
| | - Jason Hsu
- The Retina Service of Wills Eye Hospital, Mid-Atlantic Retina, Philadelphia, Pennsylvania
| | - Carl D Regillo
- The Retina Service of Wills Eye Hospital, Mid-Atlantic Retina, Philadelphia, Pennsylvania
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Drouin KL, Mariano AJ, Ryan EH, Laurindo LC. Lagrangian simulation of oil trajectories in the Florida Straits. Mar Pollut Bull 2019; 140:204-218. [PMID: 30803636 DOI: 10.1016/j.marpolbul.2019.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
A Lagrangian floating oil trajectory model is developed to simulate a continuous surface spill in the Florida Straits. The trajectories are initiated at locations representative of exploratory drilling sites around Cuba's Exclusive Economic Zone and integrated for ten days. The simulation is initialized for different seasons, using leeway-corrected observed winds, ocean currents, different climatologies, and a first-order Markov Lagrangian Stochastic Model. A Monte-Carlo scheme is used to parameterize oil weathering processes collectively. Overall, the simulations exhibit a strong seasonal dependence, where the Florida coast is most affected during the summer and the Cuban coast in the winter. Drilling sites at the center of the Straits show the largest impact on Florida. Cuba is most affected by shoreline locations. A significant amount of oil reaches the Florida coastline within two to ten days, and Cuba is potentially affected within hours. Many simulations project impacts for the Florida Keys, South Florida, and the north shore of Cuba.
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Affiliation(s)
- K L Drouin
- Rosenstiel School of Marine & Atmospheric Science, University of Miami, 4600 Rickenbacker Causeway, Miami, FL 33149, USA.
| | - A J Mariano
- Rosenstiel School of Marine & Atmospheric Science, University of Miami, 4600 Rickenbacker Causeway, Miami, FL 33149, USA.
| | - E H Ryan
- Rosenstiel School of Marine & Atmospheric Science, University of Miami, 4600 Rickenbacker Causeway, Miami, FL 33149, USA.
| | - L C Laurindo
- Rosenstiel School of Marine & Atmospheric Science, University of Miami, 4600 Rickenbacker Causeway, Miami, FL 33149, USA.
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Xu K, Chin EK, Bennett SR, Williams DF, Ryan EH, Dev S, Mittra RA, Quiram PA, Davies JB, Parke DW, Johnson JB, Cantrill HL, Almeida DRP. Endophthalmitis after Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitors: Management and Visual Outcomes. Ophthalmology 2018; 125:1279-1286. [PMID: 29477689 DOI: 10.1016/j.ophtha.2018.01.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/13/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022] Open
Abstract
PURPOSE We describe the presentation of patients developing endophthalmitis after intravitreal injection with vascular endothelial growth factor (VEGF) inhibitors. Moreover, we evaluate the management by comparing the outcomes of immediate tap and injection of intravitreal antibiotics (TAI) versus initial surgical pars plana vitrectomy (PPV). Finally, we analyze the predictive factors of visual outcomes at 6-month follow-up. DESIGN Retrospective, single-center, nonrandomized interventional study. PARTICIPANTS Patients developing endophthalmitis after receiving an intravitreal injection of anti-VEGF agent between 2006 and 2016. METHODS All patients received a vitreous biopsy sent for cultures before the initiation of treatment: TAI group versus PPV with intravitreal antibiotics (PPV group). MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) at 6-month follow-up after treatment for endophthalmitis. RESULTS A total of 258 357 intravitreal injections occurred over the course of the 10-year period, of which 40 patients (0.016%) had endophthalmitis within 3 weeks after injection. In total, 34 patients (85.0%) had pain and 25 patients (62.5%) had hypopyon on initial examination. Among 24 culture-positive cases, 66.7% of the causative organisms were coagulase-negative Staphylococcus, followed by Streptococcus species (10.0%). The best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]) at 6-month follow-up was significantly worse for patients who had a positive culture for Streptococcus species (4.0; standard deviation [SD], 0.8) (approximately light perception) compared with those who had a positive culture for coagulase-negative Staphylococcus (0.4; SD, 0.3) (∼20/50) (P < 0.0001). Compared with the TAI group, a higher proportion of samples were culture-positive in the PPV group (90.9% vs. 48.3%, P = 0.03). There was no statistically significant difference in BCVA at 6-month follow-up between the TAI and PPV groups. Younger age (<85 years) and lower intraocular pressure (IOP) (≤25 mmHg) at presentation were predictive of achieving a BCVA of 20/400 or better at 6-month follow-up after treatment. Initial management (TAI vs. PPV), duration of symptoms, presence of pain, presence of hypopyon, presenting BCVA, and culture status (positive vs. negative) were not found to be predictive of visual outcomes at 6-month follow-up. CONCLUSIONS No significant difference in BCVA at 6-month follow-up was detected between the TAI and PPV groups. Younger age and lower IOP at presentation were associated with better visual outcomes at 6-month follow-up.
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Affiliation(s)
- Kunyong Xu
- Department of Ophthalmology, Weill Cornell Medicine, Cornell University, New York, New York
| | - Eric K Chin
- Retina Consultants of Southern California, Redlands, California
| | | | | | - Edwin H Ryan
- VitreoRetinal Surgery PA, Minneapolis, Minnesota
| | - Sundeep Dev
- VitreoRetinal Surgery PA, Minneapolis, Minnesota
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Parke DW, Pulido CM, Ryan EH. Clinical Advantages of the 30×30-Degree Broad Scan in Spectral Domain Optical Coherence Tomography for Identifying Pathology. Int Ophthalmol Clin 2016; 56:119-25. [PMID: 27575763 DOI: 10.1097/iio.0000000000000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Spaide RF, Ryan EH. Reply. Am J Ophthalmol 2016; 163:195-196. [PMID: 26768793 DOI: 10.1016/j.ajo.2015.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/25/2022]
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Spaide RF, Ryan EH. Loculation of Fluid in the Posterior Choroid in Eyes With Central Serous Chorioretinopathy. Am J Ophthalmol 2015; 160:1211-6. [PMID: 26299534 DOI: 10.1016/j.ajo.2015.08.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate potential accumulation of fluid in the outer choroid in eyes with central serous chorioretinopathy. DESIGN Retrospective observational case series. METHODS Patients in 2 community-based retinal practices were evaluated for hyporeflective areas in the outer choroid consistent with collections of fluid using enhanced depth imaging optical coherence tomography. Eligible patients were examined over the preceding 2 years, had a history of central serous chorioretinopathy, and did not have a history of choroidal neovascularization or photodynamic therapy. RESULTS In the New York group there were 131 eyes of 70 patients who had a mean age of 56.3 (± 12.5) years, and 88 (67.2%) had hyporeflective regions consistent with posterior loculation of fluid in the macular region. In the Minnesota data set there were 91 eyes of 48 patients who had a mean age of 47.9 (± 9.9) years and hyporeflective regions consistent with posterior loculation of fluid was present in 59 (64.8%). In the entire group the mean subfoveal choroidal thickness of those without loculated fluid was 344 μm, as compared with 498 μm with loculated fluid (P < .001). The areas of loculated fluid were hyporeflective, were larger topographically than the large choroidal vessels, had an angular inner border, and did not have a bounding vascular wall. CONCLUSIONS Posterior loculation of fluid is a common finding in central serous chorioretinopathy, but it has a different pattern and distribution than do collections of fluid in the outer choroid and suprachoroidal space as seen in other forms of choroidal effusion.
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