Two-year outcomes of different subretinal fluid drainage techniques during vitrectomy for fovea-off rhegmatogenous retinal detachments: ELLIPSOID-2 Study

BACKGROUND

The purpose of the study is to compare visual acuity, complications and outer retinal integrity following subretinal fluid (SRF) drainage from the peripheral retinal breaks (PRBs) versus posterior retinotomy (PR) versus perfluorocarbon liquid (PFCL) for macula-off rhegmatogenous retinal detachments (RRDs) at 2 years post-surgery.

METHODS

Retrospective analysis of 300 consecutive patients with primary RRD undergoing 23-gauge pars plana vitrectomy with SRF drainage through (1) PRB (n=100), (2) PR (n=100) or (3) with PFCL (n=100). Primary outcomes were visual acuity (best-corrected visual acuity (BCVA)) and complications (cystoid macular oedema (CMO) and epiretinal membrane (ERM)). Secondary outcomes were discontinuity of the external limiting membrane (ELM), ellipsoid zone (EZ) and interdigitation zone (IDZ) at 2 years post-surgery.

RESULTS

Mean (±SD) logMAR BCVA at 24 months was better in the PRB compared with PR and PFCL, with PFCL having the worst BCVA (PRB 0.5±0.6; PR 0.7±0.5; PFCL 0.9±0.7, p=0.001). CMO was higher with PFCL (PRB 29.7%; PR 30.2%; PFCL 45.9%, p=0.0015) and ERM formation was higher in PR (PRB 62.6%; PR 93.0%; PFCL 68.9%, p=0.002). There were no differences in ELM or EZ discontinuity. However, IDZ discontinuity was higher in PFCL (PRB 34%; PR 27%; PFCL 46%, p=0.002) at 2 years.

CONCLUSIONS

Visual acuity was worse and discontinuity of the IDZ and CMO was greater in eyes with PFCL-assisted drainage compared with PRB or PR. Drainage technique may impact long-term visual acuity and photoreceptor integrity.

Evaluation of Subretinal fluid Drainage Techniques during Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment - ELLIPSOID study

PURPOSE

To compare visual acuity and photoreceptor integrity following vitrectomy (PPV) with drainage from the peripheral retinal break(s) (PRB) vs. posterior retinotomy (PR) vs. perfluorocarbon liquid (PFCL) for macula-off rhegmatogenous retinal detachment (RRD).

DESIGN

Retrospective consecutive interventional comparative clinical study.

METHODS

300 consecutive patients (300 eyes) with primary macula-off RRD underwent 23-gauge PPV with SRF drainage through 1) PRB (n=100), 2) PR (n=100), or 3) with PFCL (n=100). Visual acuity and SD-OCT were performed preoperatively and at 3, 6, and 12 months postoperatively. Primary outcomes were visual acuity and discontinuity of the external limiting membrane, ELM; ellipsoid zone, EZ; interdigitation zone, IDZ; and retinal pigment epithelium, RPE at 1-year.

RESULTS

Baseline characteristics were similar. Single-operation reattachment rates were: PRB 86%; PR 85%; PFCL 83%,p=0.9. Mean(±SD) logMAR visual acuity at 1-year was greater with PRB and PR compared to PFCL (PRB=0.6±0.5;PR=0.7±0.6;PFCL=0.9±0.6,p=0.002). There was an association between drainage technique and discontinuity of the ELM (PRB 26%,PR 24%,PFCL 44%,p=0.001), EZ (PRB 29%,PR 31%,PFCL 49%,p<0.001) and IDZ (PRB 43%,PR 39%,PFCL 56%, p=0.004). There was an association between drainage technique and risk of cystoid macular edema (CME) (PRB 28%,PR 39%,PFCL 46%,p=0.003) and ERM (PRB 64%,PR 90%,PFCL 61%,P<0.001).

CONCLUSIONS

PFCL-assisted drainage is associated with worse visual acuity and greater risk of outer retinal band discontinuity and CME compared with PRB or PR. PR had a greater risk of ERM compared with PRB and PFCL. PRB had the best outcomes overall. Drainage technique may impact long-term anatomic and functional outcomes.

A Systematic Review of Classification Systems for Cervical Ossification of the Posterior Longitudinal Ligament

DESIGN

Systematic review.

OBJECTIVE

To conduct a systematic review to (1) summarize various classification systems used to describe cervical ossification of the posterior longitudinal ligament (OPLL) and (2) evaluate the diagnostic accuracy of various imaging modalities and the reliability of these classification systems.

METHODS

A search was performed to identify studies that used a classification system to categorize patients with OPLL. Furthermore, studies were included if they reported the diagnostic accuracy of various imaging modalities or the reliability of a classification system.

RESULTS

A total of 167 studies were deemed relevant. Five classification systems were developed based on X-ray: the 9-classification system (0.60%); continuous, segmental, mixed, localized or focal, circumscribed and others (92.81%); hook, staple, bridge, and total types (2.40%); distribution of OPLL (2.40%); and K-line classification (4.19%). Six methods were based on computed tomography scans: free-type, contiguous-type, and broken sign (0.60%); hill-, plateau-, square-, mushroom-, irregular-, or round-shaped (5.99%); rectangular, oval, triangular, or pedunculate (1.20%); centralized or laterally deviated (1.80%); plank-, spindle-, or rod-shaped (0.60%); and rule of nine (0.60%). Classification systems based on 3-dimensional computed tomography were bridging and nonbridging (1.20%) and flat, irregular, and localized (0.60%). A single classification system was based on magnetic resonance imaging: triangular, teardrop, or boomerang. Finally, a variation of methods was used to classify OPLL associated with the dura mater (4.19%).

CONCLUSIONS

The most common method of classification was that proposed by the Japanese Ministry of Health, Labour and Welfare. Other important methods include K-line (+/-), signs of dural ossification, and patterns of distribution.

Message in a bottle: the discovery of a young medical officer’s map from the 1917 Battle of Hill 70

Summary

We report the serendipitous discovery of a map drawn by an army surgeon during the First World War. The map, entitled “Loos 36° NW3,’”was drawn by 24-year-old Captain Alexander Edward MacDonald in fall 1917 and was found in his old surgery textbook. MacDonald’s map depicts the positions of Canadian frontlines and medical units after the Battle of Hill 70. During the battle, Dr. MacDonald tended to the wounded in an aid post that he constructed in a ruined coal mine near the Front. MacDonald would go on to serve with distinction in the Battle of Passchendaele and Canada’s Hundred Days, and he received the Military Cross for gallantry. He maintained a passionate interest in cartography throughout his life and eventually became an authority among map collectors. Artifacts such as MacDonald’s map remind us of the realities of war and the sacrifices of our surgeon predecessors.