Experience and Outcomes of Pneumatic Retinopexy Performed by Vitreoretinal Fellows in the United States

Abstract

Purpose : Use of pneumatic retinopexy (PR) varies widely among retinal specialists and clinical practices, possibly due to disparity in their exposure to the procedure during fellowship training. Here, we evaluate the experience of vitreoretinal fellows performing PR and the surgical outcomes of patients who underwent fellow-performed PR at academic centers across the United States.

Methods : This is a retrospective, multicenter, consecutive case series of 483 patients with primary retinal detachments who underwent PR by 49 vitreoretinal fellows from 6 U.S. training sites between 2002 and 2016. We reviewed medical records of patients and recorded baseline clinical characteristics, visual and anatomic outcomes at 3-months, as well as fellow training level and procedure experience. We measured the overall single-procedure anatomic success and visual acuity of patients at 3-months follow-up, and the association of these outcomes with clinical and training-related factors using univariate and multivariate regression analyses.

Results : Vitreoretinal fellows performed a variable number of PR, with a median of 7 cases per fellow (range 1 to 24 cases). Single-procedure anatomic success was 66.8%, and mean LogMAR visual outcome was 0.43 (Snellen equivalent 20/54) at 3 months. Single-procedure outcome was associated with phakic lens status (P = 0.01), smaller size of retinal detachment (P = 0.02), and greater procedure experience of the fellow (P = 0.01), but not year of fellowship training (P = 0.16). Visual outcome was associated with baseline visual acuity (P < 0.001), but not with training-related factors.

Conclusions : Vitreoretinal fellows perform a variable number of pneumatic retinopexies, with outcomes comparable to reported rates by experienced specialists. Anatomic success improves with greater experience with the procedure, but visual outcomes are not affected.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.