Success Rates for Retinal Detachment Repair in Alberta: A Physician Learning Program Initiative

Purpose. To evaluate the surgical outcome of scleral buckling (SB) in rhegmatogenous retinal detachment (RRD) patients associated with pars planitis.Methods. Retrospective review of RRD patients (32 eyes of pars planitis RRD and 180 eyes of primary RRD) who underwent SB. We compared primary and final anatomical success rates and visual outcomes between two groups.Results. Primary and final anatomical success were achieved in 25 (78.1%) and 31 (96.8%) eyes in the pars planitis RRD group and in 167 eyes (92.7%) and 176 eyes (97.7%) in primary RRD group, respectively. Both groups showed significant visual improvement (p<0.001) and there were no significant differences in final visual acuity. Pars planitis RRD group was associated with higher rate of postoperative proliferative vitreoretinopathy (PVR) development (12.5% versus 2.8%,p=0.031). Pars planitis and high myopia were significant preoperative risk factors and pseudophakia was borderline risk for primary anatomical failure after adjusting for various clinical factors.Conclusions. Pars planitis associated RRD showed inferior primary anatomical outcome after SB due to postoperative PVR development. However, final anatomical and visual outcomes were favorable. RRD cases associated with pars planitis, high myopia, and pseudophakia might benefit from different surgical approaches, such as combined vitrectomy and SB.

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Success Rates of Vitrectomy in Treatment of Rhegmatogenous Retinal Detachment

Journal of Ophthalmology ◽

10.1155/2016/2193518 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Yasser Helmy Mohamed ◽

Kozue Ono ◽

Hirofumi Kinoshita ◽

Masafumi Uematsu ◽

Eiko Tsuiki ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Success Rate ◽

Rhegmatogenous Retinal Detachment ◽

Multiple Logistic Regression Analysis ◽

University Hospital ◽

Success Rates ◽

Pars Plana ◽

Anatomical Success ◽

Anatomical Success Rate

Aim. To investigate the anatomical success rates of pars plana vitrectomy (PPV) after primary rhegmatogenous retinal detachment (RRD).Methods. This retrospective study was conducted between December 2008 and October 2014 at Nagasaki University Hospital. The preoperative data recorded included the lens status, location of the retinal tear, whether a tear was visualized, presence of multiple tears, macula status, presence of peripheral lattice retinal degeneration, and best-corrected visual acuity (BCVA). The primary outcome measures were anatomical (primary and final) and functional success (visual acuity better than 6/60).Results. This study evaluated 422 eyes of 411 patients with a mean age of57.7±11.2years. The single-operation reattachment rate (primary anatomical success) was 89.8%. The final anatomical success rate was 100% after 2–6 operations (mean =3.14±1.03). Functional success rate after the primary reattachment operation was 96.7%, while it was 97.2% at the end of the follow-up. Multiple logistic regression analysis of the possible risk factors for the primary anatomical failure showed a significant relation with the 25 G instruments (P=0.002) and the presence of multiple tears (P=0.01).Conclusion. The primary anatomical success of PPV for primary uncomplicated RRD was 89.8% and the final anatomical success rate was 100%.

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Montgomery and informed consent during Covid-19: Pneumatic retinopexy versus pars plana vitrectomy or scleral buckling for retinal detachment repair

Medico-Legal Journal ◽

10.1177/0025817220984009 ◽

2021 ◽

pp. 002581722098400

Author(s):

G Kiew ◽

AV Poulson ◽

DK Newman ◽

P Alexander ◽

MP Snead

Keyword(s):

Retinal Detachment ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Scleral Buckling ◽

Success Rates ◽

Retrospective Case ◽

Pneumatic Retinopexy ◽

Co Morbidity ◽

Pars Plana ◽

The Uk

Recent reports suggest that the use of an outpatient-based procedure (pneumatic retinopexy, PR) for retinal detachment repair should be encouraged within the UK, especially in light of Covid-19 and possible restrictions/competing demands on access to operating theatres. It is therefore essential that patients receive comprehensive information about the risks and benefits of this approach compared with a formal surgical repair either by pars plana vitrectomy (PPV) and/or scleral buckling (SB). We report a retrospective case series of retinal detachments (RD) satisfying the strict selection criteria for PR but who were managed with formal surgery. Single-operation success rate for PPV/SB at six months follow-up was 93.8% in our study, higher than published primary success rates for PR (60–80%). When counselling patients for possible PR, the ease, speed and potentially reduced co-morbidity of an outpatient-based procedure needs to be balanced against its significantly higher failure rate in comparison with primary PPV/SB.

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Failure of Administrative Data to Guide Asthma Care

Spectrum ◽

10.29173/spectrum27 ◽

2018 ◽

Author(s):

Joel Agarwal ◽

Jennifer LaBranche ◽

Jessica Cohen ◽

Chris De Gara ◽

Dilini Vethanayagam

Keyword(s):

Administrative Data ◽

Time Frame ◽

Chronic Inflammatory Disease ◽

Asthma Diagnosis ◽

Learning Program ◽

Diagnostic Codes ◽

Canadian Health ◽

Physician Learning ◽

Alberta Health ◽

Administrative Datasets

Rationale: Asthma is a chronic inflammatory disease of the airways that is very common (7.9% ofCanadians over the age of 12). Despite numerous clinical guidelines, education events and administrativedata reviews, there has been little change to the way asthma is managed in the Canadian health caresystem for nearly 30 years. We evaluated, through the Physician Learning Program (PLP) in Alberta,possible reasons why administrative datasets have not been able to provide meaningful information toadjust health policy. Methods: Provincial data was attained through Alberta Health Service and Alberta Health on pulmonaryfunction testing from 2005-2011 (through the PLP). The number of asthma diagnosis made during the sametime frame were then compared. Results: The preliminary results of the PLP found that spirometry was billed for roughly half as often asthe asthma diagnostic codes were utilized during the same time frame. However, the review also revealedinconsistencies in how administrative data are captured, making it difficult to determine whetherspirometry is being underutilized by physicians in making asthma diagnoses. Conclusions: Inconsistencies in how administrative data are captured in Alberta may be contributingto an incomplete picture of the rates of asthma diagnosis and physiological testing, and may explain, inpart, the limited influence of administrative datasets on guiding meaningful change within the healthcaresystem.

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Vitrectomy in Diabetic Retinopathy

European Ophthalmic Review ◽

10.17925/eor.2009.03.02.102 ◽

2009 ◽

Vol 03 (02) ◽

pp. 102

Author(s):

Sheelah Antao ◽

Paul Sullivan ◽

◽

Keyword(s):

Diabetic Retinopathy ◽

Retinal Detachment ◽

Diabetic Macular Oedema ◽

Late Complications ◽

Routine Practice ◽

Success Rates ◽

Tractional Retinal Detachment ◽

Drug Induced ◽

Diabetic Eye Disease

Pars plana vitrectomy (PPV) is integral to the management of late complications in diabetic retinopathy. As a greater understanding of the pathophysiology of diabetic eye disease has developed, so the role of PPV has evolved. This article reviews the current indications for PPV in diabetes (vitreous haemorrhage, tractional retinal detachment and combined rhegmatogenous and tractional retinal detachment) and the evidence for potential future applications, such as in diabetic macular oedema. The role of pharmacological adjuncts, such as antivascular endothelial growth factor (VEGF) agents, to reduce intraocular complications, improve success rates and minimise post-operative complications is examined. Drug-induced vitreolysis as a tool in achieving complete vitreoretinal separation, thus reducing progression of diabetic retinopathy, is discussed. It has already become routine practice for endolaser photocoagulation to be employed during PPV and, in the future, vitreolytic and antiproliferative agents may also be important as adjuncts to achieve good outcomes.

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Pneumatic retinopexy combined with scleral buckling in the management of relatively complicated cases of rhegmatogenous retinal detachment: A multicenter, retrospective, observational consecutive case series*

Journal of International Medical Research ◽

10.1177/0300060517724931 ◽

2017 ◽

Vol 46 (1) ◽

pp. 316-325 ◽

Cited By ~ 3

Author(s):

Chuandi Zhou ◽

Qiurong Lin ◽

Yuxin Wang ◽

Qinghua Qiu

Keyword(s):

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Success Rates ◽

Pneumatic Retinopexy ◽

The Mean ◽

Final Operation

Objective To evaluate the efficacy of maximal pneumatic retinopexy (PR) and subretinal fluid (SRF) drainage combined with scleral buckling (SB) in the treatment of complicated rhegmatogenous retinal detachment (RRD). Methods Patients with RRD who underwent maximal PR and SRF drainage combined with SB from June 2007 to June 2012 were included in this multicenter retrospective study. The outcome measures were the primary and final operation success rates and best-corrected visual acuity (BCVA). Results In total, 159 consecutive patients were included. The mean follow-up period was 13.76 ± 1.97 months. Primary operation success was achieved in 146/159 (91.82%) eyes. After salvage management, the final reattachment rate increased to 98.11%. All eyes had improved BCVA, with 62/159 (38.99%) attaining BCVA of ≥20/40. Conclusions Maximal PR and SRF drainage combined with SB achieved satisfactory anatomical and visual recovery in relatively complicated cases of RRD. The decreased need for vitrectomy makes this surgical approach more widely available.

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Ethnic Variation in Vitreoretinal Surgery: Differences in Clinical Presentation and Outcome

European Journal of Ophthalmology ◽

10.5301/ejo.5000894 ◽

2016 ◽

Vol 27 (3) ◽

pp. 367-371

Author(s):

Bhaskar Gupta ◽

James E. Neffendorf ◽

Roger Wong ◽

David A.H. Laidlaw ◽

Tom H. Williamson

Keyword(s):

Retinal Detachment ◽

Ethnic Groups ◽

Silicone Oil ◽

Large Population ◽

Vitreoretinal Surgery ◽

Population Based ◽

Ethnic Variation ◽

Success Rates ◽

Primary Surgery ◽

Vitreoretinal Disease

Purpose The true prevalence of retinal detachment and other vitreoretinal disorders in different ethnic groups is not well-established. Understanding differences in vitreoretinal disease prevalence is important to appropriately allocate resources to meet demand where ethnic variation in the community exists. The aim of this study is to provide hospital-based data on the proportion of people with vitreoretinal disorders in the 3 main ethnic groups in the United Kingdom: Caucasian, Afro-Caribbean, and South Asian. Methods A retrospective study was performed on 3,262 patients undergoing vitreoretinal procedures for various indications between 2001 and 2014 from a single center in London, UK. Results The majority of patients with known ethnicity were Caucasian (80.19%) followed by Afro-Caribbean (12.31%) and Asian (5.20%). The mean age of the study population was 59.64 ± 15.75 years, with 57.28% males. Rhegmatogenous retinal detachment (RRD) was the common indication for surgery across all ethnic groups (54.83%). Caucasians were older, on average, compared to other ethnic groups at the time of surgery for RRD (p<0.05) and achieved higher success rates after primary surgery and were less likely to require silicone oil as primary tamponade. Macular hole was more common in the ethnic minorities with similar closure rates. Surgery for complications of diabetic retinopathy was more common in Afro-Caribbeans and Asians compared to Caucasians (28.07%, 24.02%, and 9.40%, p<0.05). Conclusions This study presents a large population-based data analysis on ethnic variation in vitreoretinal disorders. This may assist in predicting the requirement of vitreoretinal service provision depending on local ethnic variation.

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Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000474 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000474

Author(s):

Ziyaad Nabil Sultan ◽

Eleftherios I Agorogiannis ◽

Danilo Iannetta ◽

David Steel ◽

Teresa Sandinha

Keyword(s):

Retinal Detachment ◽

Systematic Approach ◽

Rhegmatogenous Retinal Detachment ◽

Current Practice ◽

Scleral Buckling ◽

Success Rates ◽

Surgical Success ◽

Equipment Availability ◽

Surgeon Experience ◽

Surgical Options

Rhegmatogenous retinal detachment (RRD) is a common condition with an increasing incidence, related to the ageing demographics of many populations and the rising global prevalence of myopia, both well known risk factors. Previously untreatable, RRD now achieves primary surgical success rates of over 80%–90% with complex cases also amenable to treatment. The optimal management for RRD attracts much debate with the main options of pneumatic retinopexy, scleral buckling and vitrectomy all having their proponents based on surgeon experience and preference, case mix and equipment availability. The aim of this review is to provide an overview for the non-retina specialist that will aid and inform their understanding and discussions with patients. We review the incidence and pathogenesis of RRD, present a systematic approach to diagnosis and treatment with special consideration to managing the fellow eye and summarise surgical success and visual recovery following different surgical options.

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