Surgical techniques for primary rhegmatogenous retinal detachments between surgeons with high versus low single surgery success rates

Starr, Matthew R.; Hsu, Jason; Yonekawa, Yoshihiro; Mittra, Robert A.; Ryan, Claire; Forbes, Nora J.; Ammar, Michael; Patel, Luv; Obeid, Anthony; Capone, Antonio; Emerson, Geoffrey G.; Joseph, Daniel P.; Eliott, Dean; Gupta, Omesh P.; Regillo, Carl D.; Ryan, Edwin H.

doi:10.1111/aos.14821

Cited by 12 publications

(7 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Amongst pseudophakic eyes, higher performing surgeons had graduated fellowship more recently, were less likely to use a drainage retinotomy, less likely to use PFCL, and less likely to use 360° laser retinopexy. This study suggests that there may be ‘surgeon factors’ that play a role in the success rate of primary RRD repair, and these factors may be more prominent in the repair of pseudophakic RRDs [23 ▪ ].…”

Section: Introductionmentioning

confidence: 85%

Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18

Starr

Ryan²,

Yonekawa³

2023

Current Opinion in Ophthalmology

Self Cite

View full text Add to dashboard Cite

Purpose of reviewTo highlight the recent work published from the Primary Retinal Detachment Outcomes (PRO) Study Group. Recent findingsThe 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. 3608 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. SummaryNumerous 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.

show abstract

Section: Introductionmentioning

confidence: 85%

Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18

Starr

Ryan²,

Yonekawa³

2023

Current Opinion in Ophthalmology

Self Cite

View full text Add to dashboard Cite

show abstract

“…More recently, Starr et al 32 performed a multi-institutional, retrospective study of 689 rhegmatogenous retinal detachments to evaluate the differences in preoperative characteristics and intraoperative approaches between surgeons with higher versus lower single surgery success rates. The investigators reported that those surgeons with higher single surgery success rates ( > 90%) perform a higher percentage of both primary buckles and combined PPV/buckle compared with surgeons with a lower single surgery success rate (<75%).…”

Section: Outcomes Of Scleral Buckling Versus Ppvmentioning

confidence: 99%

“…27,38 These authors maintain that break localization is critical to the successful placement of the scleral buckle, and in those studies in which no difference was shown between PPV and a PPV/scleral buckle combined procedure, the buckle tends to be an encircling band placed arbitrarily at the equator. 27 It is noteworthy that in their study evaluating the techniques employed by those surgeons with high and low single surgery success rates, Starr et al 32 report that the most successful surgeons tended to both perform both more scleral buckles and more combined PPV/scleral buckle procedures than the less successful surgeons. '…”

Section: Outcomes Of Scleral Buckling Versus Ppvmentioning

confidence: 99%

Scleral Buckling: History and Current Indications

Foulsham

Orlin

2022

International Ophthalmology Clinics

View full text Add to dashboard Cite

“… 27 Interestingly, the PRO Study Group recently reported that surgeons with a high single surgery success rate were more likely to use an SB as part of their armamentarium in the repair of RRD compared to surgeons with a low single surgery success rate. 28 As the number of SB cases performed decrease over time, there is a risk that SB becomes a dying art and vitreoretinal surgeons in training may not be trained in SB. Non-contact wide-angled visualization with chandelier assisted SB under microscope or digitally assisted 3D surgery in addition to the new findings regarding SB and photoreceptor re-alignment may help reverse this trend.…”

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

View full text Add to dashboard Cite

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.

show abstract

Surgical techniques for primary rhegmatogenous retinal detachments between surgeons with high versus low single surgery success rates

Cited by 12 publications

References 45 publications

Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18

Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18

Scleral Buckling: History and Current Indications

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

Contact Info

Product

Resources

About