July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Outcomes of fellow-performed retinal detachment repairs at a large county hospital
Author Affiliations & Notes
  • Varun Reddy
    Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
  • Hamza Bhalli
    Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
  • YPaul GoldenMerry
    Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
  • Brandon Winward
    Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
  • Zachary Robertson
    Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
  • Footnotes
    Commercial Relationships   Varun Reddy, None; Hamza Bhalli, None; YPaul GoldenMerry, None; Brandon Winward, None; Zachary Robertson, None
  • Footnotes
    Support  Research to Prevent Blindness
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 6583. doi:
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    • Get Citation

      Varun Reddy, Hamza Bhalli, YPaul GoldenMerry, Brandon Winward, Zachary Robertson; Outcomes of fellow-performed retinal detachment repairs at a large county hospital. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6583.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Studies have been conducted at various surgical centers regarding anatomic and visual outcomes for retinal detachment surgeries, but few studies have specifically examined outcomes of surgeries performed by vitreoretinal surgery fellows. This retrospective study aims to review outcomes for retinal detachment repairs performed by vitreoretinal surgery fellows at our institution.

Methods : Rhegmatogenous, tractional, and tractional/rhegmatogenous detachment cases between January 1, 2011 and October 1, 2017 at Parkland Memorial Hospital with at least 6 months of post-surgical follow up were reviewed. Primary anatomic success was defined as attachment at 6 months after primary surgery without any additional surgeries during that interval. The number of surgeries required to achieve anatomic success was also determined for each case. The surgery types compared were scleral buckle (SB), pars plana vitrectomy (PPV), SB/PPV, and pneumatic retinopexy (PR). All statistical comparisons of means were performed using two-sample t-tests. All statistical comparisons of proportions were performed using z-tests.

Results : 486 eyes from 435 patients were analyzed. Primary anatomic success rates were 70%, 84%, 87%, and 57% in the SB, PPV, SB/PPV, and PR groups, respectively. There was a significant difference in success rate between SB vs. PPV (p=0.04) (Figure 1). The average number of surgeries required to achieve anatomic success stratified by surgery type are 1.63, 1.28, 1.23, and 2.57 for SB, PPV, SB/PPV, and PR, respectively. There were significant differences detected between SB vs. PPV (p=0.016), SB vs. SB/PPV (p=0.014), SB vs. PR (p=0.0074), PPV vs. pneumatic retinopexy (p=1.99x10-5) and SB/PPV vs. PR (p=9.50x10-5) (Figure 2).

Conclusions : The outcomes we determined for each surgery type are comparable to the published outcomes for practicing specialists. Of note, significantly fewer surgeries were required to achieve anatomic success when SB/PPV was employed. This could be due to a more conservative approach used during training to ensure better outcomes. Finally, there may be a lower rate of success in cases that employ PR because of either suboptimal candidate selection or because fellow skills are not yet sufficient to routinely find all retinal breaks on initial examination.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Figure 1. Primary anatomic success rate 6-months after initial surgery

Figure 1. Primary anatomic success rate 6-months after initial surgery

 

Figure 2. Average number of surgeries required to achieve anatomic success

Figure 2. Average number of surgeries required to achieve anatomic success

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