Management of uncomplicated rhegmatogenous retinal detachments: a comparison of practice patterns and clinical outcomes in a real-world setting

Ong, Sally S.; Ahmed, Ishrat; Gonzales, Anthony; Aguwa, Ugochi T.; Arévalo, J. Fernando; Dai, Xi; Pham, Alex T; Shah, Yesha; Arsiwala, Lubaina Tayeb; Wang, Jiangxia; Handa, James T.

doi:10.1038/s41433-022-02028-z

Cited by 15 publications

(12 citation statements)

References 27 publications

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“…The Wilmer Eye Institute worked to quantify these changes in practice patterns and recently published their 10‐year data for the management of uncomplicated retinal detachments. This showed a change from a predominance of SB procedures in 2008–2011 to that of PPV by 2015–2017 36 . Despite this change, the number of eyes that underwent combined PPV and scleral buckling remained stable over time 36 .…”

Section: Scleral Bucklementioning

confidence: 99%

“…36 This change in surgical decision-making proved to be driven primarily by surgeon choice and not by patient and detachment characteristics. 36 Indeed, surgeons who were more early in their careers were more likely to choose PPV over scleral buckling when compared with their more senior colleagues. 36 Still the debate remained whether these choices resulted in any significant difference in visual outcomes for patients.…”

Section: Scleral Bucklementioning

confidence: 99%

“…36 Indeed, surgeons who were more early in their careers were more likely to choose PPV over scleral buckling when compared with their more senior colleagues. 36 Still the debate remained whether these choices resulted in any significant difference in visual outcomes for patients.…”

Section: Scleral Bucklementioning

confidence: 99%

“…This showed a change from a predominance of SB procedures in 2008–2011 to that of PPV by 2015–2017 36 . Despite this change, the number of eyes that underwent combined PPV and scleral buckling remained stable over time 36 . This change in surgical decision‐making proved to be driven primarily by surgeon choice and not by patient and detachment characteristics 36 .…”

Section: Scleral Bucklementioning

confidence: 99%

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Rhegmatogenous retinal detachment surgery: A review

Warren

Wang

Lim

2023

Clinical Exper Ophthalmology

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Rhegmatogenous retinal detachment (RRD) is a serious surgical condition with significant ocular morbidity if not managed properly. Once untreatable, approaches to the repair of RRD have greatly evolved over the years, leading to outstanding primary surgical success rates. The management of RRD is often a topic of great debate. Scleral buckling, vitrectomy and pneumatic retinopexy have been used successfully for the treatment of RRD. Several factors may affect surgical success and dictate a surgeon's preference for the technique employed. In this review, we provide an overview and supporting literature on the options for RRD repair and their respective preoperative and postoperative considerations in order to guide surgical management.

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Section: Scleral Bucklementioning

confidence: 99%

Section: Scleral Bucklementioning

confidence: 99%

Section: Scleral Bucklementioning

confidence: 99%

Section: Scleral Bucklementioning

confidence: 99%

See 2 more Smart Citations

Rhegmatogenous retinal detachment surgery: A review

Warren

Wang

Lim

2023

Clinical Exper Ophthalmology

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“…From complex retinal detachments to primary rhegmatogenous retinal detachment, PPV is currently the preferred technique for retinal reattachment. 17 …”

Section: Introductionmentioning

confidence: 99%

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

Pimentel¹,

Shih²,

Wu³

2022

OPTH

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Scleral buckling (SB) remains an important technique to master for those interested in treating rhegmatogenous retinal detachment (RRD). Several ways to repair RRD include pneumatic retinopexy (PR), pars plana vitrectomy (PPV), SB or a combination of these. There is a growing worldwide trend that favors PPV as the preferred method for retinal reattachment of primary uncomplicated RRD. Reimbursement issues, operating room access, and technological advances in PPV that improve retinal visualization and less exposure to SB during fellowship training may explain this trend. As the number of SB cases decreases over time, there is a risk that SB becomes a dying art and surgeons in training may not be trained in SB. SB is preferred in eyes with no posterior vitreous detachment and retinal dialysis. SB with minimal gas vitrectomy may be indicated for eyes with inferior pathology. Non-contact wide-angled visualization with chandelier assisted SB may be well suited for teaching new generations of aspiring vitreoretinal surgeons. Its functional and anatomic results compare favorably with conventional SB for primary uncomplicated primary RRD. The main advantage of this technique is the improved visualization even through small pupils. Better visualization ensures treatment of all breaks while avoiding complications during drainage of subretinal fluid and a safer placement of intrascleral sutures for scleral fixation of the buckling element. Recordings of the procedure are easily performed, allowing the surgeons involved to review the case and learn from it. The main disadvantage is the cost involved with the chandelier and the need to have a microscope or a 3D system with a wide angle viewing system. Photoreceptor re-alignment following retinal re-attachment is an important determinant of the post-operative functional outcomes. Different methods of retinal re-attachment apparently result in different degrees of photoreceptor re-alignment. SB may hold an advantage over PPV in this regard.

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Neighborhood-Level Social Determinants of Health and Presenting Characteristics for Rhegmatogenous Retinal Detachments

Ong,

Tran,

Westlund

et al. 2024

JAMA Ophthalmol

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ImportanceFunctional outcomes after repair of rhegmatogenous retinal detachments (RRDs) are highly dependent on baseline visual acuity and foveal status. Adverse social determinants of health (SDOH) can present barriers to timely presentation for repair and limit vision outcomes.ObjectiveTo evaluate the association between neighborhood-level SDOH with baseline severity (visual acuity and fovea status) of RRD.Design, Setting, and ParticipantsThis was a retrospective cohort study that included adult patients 18 years and older who underwent primary repair of uncomplicated RRD at the Wilmer Eye Institute from January 2008 to December 2018. Study data were analyzed from December 2023 to April 2024.ExposuresThe census block group of patient home addresses were matched to multiple neighborhood-level SDOH including the Area Deprivation Index (ADI), per capita income, percentage of renters, percentage of rent burden, percentage of people using a food assistance program, percentage of uninsured individuals, mode of transportation to work, distance to the nearest transit stop, total road density, National Walkability Index, Index of Medical Underservice score, and aggregate cost of medical care.Main Outcomes and MeasuresOdds of presenting with vision worse than 20/40 or fovea-involving RRD using multivariable logistic regression adjusting for age, sex, race and ethnicity, and insurance.ResultsA total of 700 patients (mean [SD] age, 57.9 [12.4] years; 432 male [61.7%]) were included. Every decile increase in ADI, indicating more socioeconomic disadvantage, was associated with an increased odds of presenting with worse visual acuity and fovea-involving RRD (odds ratio [OR], 1.14; 95% CI, 1.04-1.24; P = .004 and OR, 1.13; 95% CI, 1.04-1.22; P = .005, respectively). Each $1000 increase in per capita income was associated with lower odds of presenting with worse vision (OR, 0.99; 95% CI, 0.98-0.99; P = .001). Every 1% increase in percentage of workers who drove to work was associated with an increased odds of presenting with worse vision and fovea-involving RRD (OR, 1.02; 95% CI, 1.01-1.03; P = .005 and OR, 1.01; 95% CI, 1.00-1.03; P = .04, respectively).Conclusions and RelevanceResults of this cohort study suggest that patients with a residence in neighborhoods with more socioeconomic deprivation or a higher percentage of workers who drove to work were more likely to present with more severe RRD even after accounting for multiple individual-level characteristics. These findings support consideration of public policy changes to address the barriers faced by patients residing in certain neighborhoods who seek prompt surgical intervention for RRD to reduce health disparities in RRD outcomes.

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Management of uncomplicated rhegmatogenous retinal detachments: a comparison of practice patterns and clinical outcomes in a real-world setting

Cited by 15 publications

References 27 publications

Rhegmatogenous retinal detachment surgery: A review

Rhegmatogenous retinal detachment surgery: A review

Scleral Buckling: A Look at the Past, Present and Future in View of Recent Findings on the Importance of Photoreceptor Re-Alignment Following Retinal Re-Attachment

Neighborhood-Level Social Determinants of Health and Presenting Characteristics for Rhegmatogenous Retinal Detachments

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