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Gargi D. Khare, Netan Choudhry, Robert Weir, Demetrios G. Vavvas; Retrospective Review of Anatomic and Visual Outcomes of Retinal Detachment Repair: A Training Institution's Perspective. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6163.
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The purpose of this study was to establish single surgery success rates of primary retinal detachments (RD) repaired by vitreoretinal fellow surgeons in a training institution with a single attending supervisor. We also described anatomical and visual outcomes.
This retrospective case series reviewed 190 primary RD cases under a single attending supervisor from January 2006 to August 2010. All fellow-performed uncomplicated primary retinal detachments were identified and included. Medical records were reviewed for surgical techniques [N = 88 total: 23 gauge (n = 54) and 25 (n = 21) gauge pars plana vitrectomy (PPV) and scleral buckle repair (SB) (n = 13)] for consecutive primary RDs, including IOP and best corrected ETDRS visual acuity at 1 (n = 88), 3 (n = 64), 6 (n = 48), and 12 (n = 33) months. Patient demographics, duration of symptoms, macular detachment status and complications were also collected. Data were analyzed using correlation, ANOVA, and ANCOVA at a significance threshold of P < 0.05.
Anatomical reattachment was achieved in 96.6%, with 3 out of 75 PPVs failing to attach. Primary surgical success was 87.5%, with 9.1% requiring a second surgery. No significant difference was detected at any time point in best corrected LogMAR visual functional outcomes between the three techniques studied using ANOVA (p < 0.58) or when co-varying out the possible effects of age, sex, IOP, duration of symptoms, days from diagnosis to surgery, pre-operative vision, or macular detachment via ANCOVA (p < 0.86). Visual outcomes significantly correlated at 3 and 6 months post-surgery with macular detachment (p < 0.003, p < 0.005) and with pre-operative vision at each time point (p < 0.02, p < 0.0001, p < 0.0001, p < 0.0001), but not with other measures.
Clinical outcomes were similar across surgical techniques and similar to other published data. Visual outcomes were significantly correlated with macular detachment and with pre-operative vision. Duration of symptoms and days from diagnosis to surgery were not related to visual or anatomical outcomes regardless of technique. These findings indicate that 23 and 25 gauge PPV techniques and scleral buckle techniques are safely and effectively taught in a vitreoretinal fellowship training program.
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