National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. I. Sample and methods

Abstract

outcome of primary surgery for rhegmatogenous retinal detachment. I. Sample and methods AbstractPurpose This national study was designed to audit anatomical outcome and complications relating to primary surgery for rhegmatogenous retinal detachments. This paper presents survey methods, characteristics of participating consultants and the demographic and clinical characteristics of the patient sample. Methods Two surveys were undertaken. The first identified consultants who at the time performed retinal detachment surgery in the National Health Service. These surgeons formed the sampling frame for a nationwide cross-sectional clinical study that audited the outcomes of primary surgery for rhegmatogenous retinal detachments. Consultants selected patients according to the study eligibility criteria and data were collected by self-administered postal questionnaires. A validation exercise was carried out to examine selection bias and reporting accuracy. Results Only 256/671 (38%) of UK consultants, who responded to the first survey, indicated that they performed retinal detachment surgery on NHS patients. Annual activity varied between 0 and 400 primary procedures for rhegmatogenous retinal detachments. Seven hundred and sixty-eight eligible patients from 167 consultants were recruited for the clinical study. Twenty per cent of patients had a single retinal break with less than one quadrant of associated detachment and 45% had single or multiple breaks within the same quadrant and/or less than two quadrants of associated retinal detachment. Over 50% patients had single or multiple horseshoe tears. Validation studies suggested that there was no significant bias from the selection of patients or inaccuracy in reporting outcomes. Conclusions This large unselected group of primary rhegmatogenous retinal detachments provides a representative sample for considering variations in re-attachment rates.

National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes

“…The sample met the audit standards 12 for retinal incarceration and unplanned sub-retinal fluid drainage and there was no significant difference between specialists and non-specialists. Other complications reported included corneal abrasion (five patients), scleral rupture (two patients), elevated intra-ocular pressure requiring intervention (eight patients), and iatrogenic break (six patients).…”

“…The methodology and validation studies have been described in detail in our previous paper 12 but in summary, clinical data were collected in a national cross-sectional survey of all consultants who performed retinal detachment surgery in the National Health Service. Consultants selected patients undergoing primary surgery for simple rhegmatogenous retinal detachments according to study eligibility criteria and supplied data on patients' pre-operative factors, type of surgery, anatomical outcome and complications.…”

“…These were compared to pre-determined audit standards set by the steering committee. 12 Detachments were graded into four categories for subgroup analysis. 12 …”

“…The sample met the audit standards 12 for endophthalmitis. Other reported complications in the early post-operative period included diplopia (six patients), elevated intra-ocular pressure (13 patients), choroidal effusion (four patients), cataract (four patients), plomb problems (four patients) and vitreous haemorrhage (four patients).…”

“…For most detachments in the study, the primary surgeon was a consultant. A non-consultant was the primary surgeon for relatively few detachments and with the exception of fellows their results fall below the standards for the audit, 12 whether supervised by a consultant or not. Reattachment rates for each grade of surgeon are given in Table 4.…”