May 14, 2021 Conference
AM SESSION - EXCIMER BASED REFRACTIVE SURGERY
Dear NEOS Members,
Welcome to the 784th virtual Meeting of the New England Ophthalmological Society.
As we finish our completely virtual year of NEOS meetings due to the COVID pandemic, we are beginning see the finish line at the end of a very stressful and difficult year for all of us. We will soon be able to return to our regular in-person NEOS meetings sometime in the Fall which will be held at a completely new venue in the Commonwealth Hotel in Kenmore Square across the street from Fenway Park.
I would like to thank our outstanding Program Committee Chair and Committee, and moderators, speakers and GOHs who have all worked hard to provide you with the most up-to-date and unbiased content possible for this meeting.
Our Friday morning session will be on Excimer Based Refractive Surgery session moderated by Jason Brenner from Boston Vision with our outstanding GOH Mark Lobanoff, MD from Blaine Minnesota. This session will provide you the best possible refractive surgery update.
Our Friday afternoon session will be on Non-Keratoplasty Anterior Segment Surgeries and Procedures moderated by Peggy Chang and with our GOH Kathryn Colby who is now in New York city, but who started her illustrious career as Co-Director of the Mass Eye and Ear Emergency Room with me in 1997. This session is a perfect complement to our morning session and will provide you with everything you need to know about the anterior segment surgery.
Finally, make sure to check out our annual Hecht Poster contest to keep up to date on the latest basic science and clinical research in ophthalmology.
We hope that you enjoy the extremely valuable and entertaining content provided by our outstanding speakers and organizers. Please engage with us virtually by submitting questions during the meeting and participating in some of our virtual social events at the end of the meeting.
Hope you all have a wonderful summer and I hope to see you all at the Commonwealth Hotel in the Fall.
With warm regards,
Jorge G. Arroyo, MD
President of NEOS
Ectasia after LASIK and haze after PRK are two of the most dreaded complications of refractive surgery. Ectasia risk is highest with LASIK given the large amount of anterior cornea altered when compared to PRK or SMILE. Traditional pre-operative screening criteria typically considers topography, corneal thickness, residual stromal bed thickness, ablation depth, and age. However, newer screening criteria consider factors such as posterior elevation, epithelial thickness mapping, percent tissue altered, and intra-eye pachymetric progression maps. These novel methods for screening LVC candidates have greatly improved our ability to identify patients who have an unacceptably high risk of ectasia after LASIK. Haze after PRK is broadly classified into two types: immediate-onset and late-onset. Immediate onset haze is most often due to abnormal re-epithelialization during the initial post-operative period. It is also typically independent of ablation depth or UV light exposure. In contrast, late onset haze tends to occur more often in deep ablations, suboptimal MMC applications and UV light exposure. The conservative treatment approach to PRK haze varies dependent on the underlying cause. However, perioperative Vitamin C supplementation may reduce both types of haze. Additionally, superficial keratectomy with MMC application can be a very effective treatment for both types of refractory haze.
More than 20 years have passed sin the FDA approval of laser vision correction. Some absolute and relative contraindications have been examined by various investigators over the years leading to less stringent recommendations. We will review these areas of controversy.
Helen K. Wu
While LASIK is the most popular refractive surgical procedure currently, patients with high myopia may not be ideal candidates due to insufficient corneal thickness or irregularity. Surgical alternatives may include photorefractive keratectomy (PRK) and Phakic intraocular lens (IOL) implantation. PRK is approved for the correction of myopia up to -14 D and astigmatism up to 6 D, depending on the laser. Best candidates for PRK with preexisting high myopia should have appropriate corneal curvature and thickness to avoid corneas that are too flat or too thin postoperatively. Mitomycin C is an important adjunctive treatment to avoid excessive haze. Advantages to surface ablation include ease of surgical technique, ability to correct both eyes simultaneously, and the possibility of customized ablations to correct irregularities in the cornea. Disadvantages include prolonged visual recovery, postoperative discomfort and the potential for prolonged or late stromal haze in the cornea. Myopic regression is more common in eyes with high myopia as well. Results in high myopes treated with PRK and MMC show excellent refractive outcomes and a low incidence of complications. Visian ICL, the most commonly used phakic IOL in the United States, is approved for the correction of myopia up to -15 D and for the reduction of myopia from -15 to -20 D. The toric Visian ICL will correct 1 to 4 diopters of astigmatism. Candidates for phakic IOL implantation must have adequate anterior chamber depth and endothelial cell density based on age. Advantages of phakic IOL implantation include a more rapid and comfortable visual recovery, higher quality night vision compared to corneal refractive surgery, and reversibility of the procedure. Disadvantages include the risk of accelerated cataract formation and endothelial cell loss, and the risks associated with intraocular surgery, in particular including pressure elevation. Halos may occur in a minority of patients. The peripheral iridectomies may also cause dysphotopsias. Sizing of the sulcus-based lens can be unpredictable, and surgeons must be comfortable handling pupillary block and other potential complications. Results from phakic IOL studies show excellent predictability and stability over time. In summary, for appropriate candidates, PRK and phakic IOL can be excellent procedures for patients with high myopia.
Topography-guided lasik was introduced first outside the United States for repair of highly irregular corneas with abnormal topography. Originally Alcon wanted to bring topography-guided lasik to the US for the same purpose. The FDA had other ideas in mind and first wanted a study showing that the technology could be safely used in "normal" eyes. In 2013 Alcon achieved FDA approval for topography-guided lasik for primary virgin eyes. The surprise of the FDA study was the impressive results achieved for UCVA and quality of vision, the best ever for any refractive surgery procedure. The methods, devices and technology needed to perform topography-guided lasik will be reviewed.
Small incision lenticule extraction (SMILE) is a relatively new, minimally invasive keratorefractive procedure performed with the ZEISS VisuMax femtosecond laser. Current indications in the U.S. are for the treatment of -1.00 to -10.00 D of spherical myopia with -0.75 to -3.00 D of astigmatism. During SMILE, a lenticule is cut within the corneal stroma by the femtosecond laser which is then dissected and removed by the surgeon through an incision of less than 4 mm. Visual outcomes after SMILE are comparable to that of LASIK, especially once laser settings are optimized. The absence of a flap confers several potential advantages compared to LASIK. A small incision enables better preservation of the corneal nerves resulting in less reduction and quicker recovery of corneal sensation. Additionally, the anterior stroma has a significantly higher contribution to the tensile strength of the cornea than the posterior stroma. Consequently, the larger side cut required to create a LASIK flap appears to result in a greater reduction in the biomechanical strength of the cornea compared to SMILE. As the data suggest that SMILE treatment would have a comparatively lower impact on corneal biomechanics, it is hypothesized that the overall risk of post-operative ectasia is likely to be lower with SMILE than with LASIK though further studies are necessary to confirm this.
The risk of retinal detachment (RD) in the general population is 0.08%, however the risk of RD following cataract extraction is 0.7%. The increased risk is thought to be secondary to changes in the vitreous following lens extraction. These changes result in posterior vitreous detachment, which can cause retinal tear and detachment. This risk is further compounded in younger, myopic patients who may consider a clear lens extraction. The risk of RD can possibly be decreased by performing prophylactic laser to symptomatic retinal tears, avoiding posterior capsule rupture, and minimizing the need for future posterior capsulotomy. A discussion of the risks and benefits of surgery is critical in patients considering clear lens extraction.
Prior keratorefractive surgery makes accurate IOL power calculation more challenging, leading to less predictable outcomes in patients who frequently have high visual expectations. Traditional IOL power calculation formulas presume a standard curvature ratio between the anterior and posterior cornea which is disrupted by keratorefractive surgery, making these formulas less accurate. A variety of different formulas have been proposed over the past 20 years to address this problem, some of which require historical information about the refraction prior to keratorefractive surgery. However, even these formulas result in a significant percentage of refractive surprises. In the meantime, newer biometry devices have been developed to measure the anterior and posterior corneal curvature directly. Intraoperative aberrometry measures the power of the entire aphakic or pseudophakic eye rather than utilizing the power of the cornea itself. Although better than traditional formulas, even this method results in a significant percentage of refractive surprises. This talk will review the latest updates to the literature to help surgeons determine whether intraoperative aberrometry still has a useful role for post-keratorefractive IOL calculations in 2021.
Since 1995, the excimer laser has been FDA approved for therapeutic treatment of the anterior cornea for a host of conditions using phototherapeutic keratectomy (PTK). The ability to couple the excimer laser with corneal topography, commonly referred to as topography-guided ablation or TGA, was first introduced in Europe in 2003 and only recently FDA approved in 2013. Topography guided lasers attempt to reduce and neutralize corneal irregularities. This technology can now be routinely used during routine LASIK and PRK cases to optimize visual outcomes although its initially intended use was for irregular corneas. The primary current use for TGA in irregular corneas is in the clinical setting of keratoconus with corneal collagen crosslinking (CXL) to normalize or regularize the shape of the cornea to help improve visual outcomes with glasses and contact lenses. Other uses include patients with poor outcomes after refractive surgery (decentered ablations, central islands and enlarging optical zones), after penetrating keratoplasty or DALK, normalizing corneas after corneal ulcers, trauma, or previous radial keratotomy. Utilizing this technology for the irregular cornea is not straightforward as data acquisition and interpretation can be challenging. Each case much be customized, and patient expectations must be set appropriately before surgery as often as a second refractive PRK treatment might be required. This talk will highlight these issues and demonstrate the potential power of this laser technology through several examples.
When topography-guided lasik (Contoura) was first introduced in the US by Alcon, there was a lot of confusion surrounding the best way to calculate these treatments. Originally Alcon suggested that Contoura treatments should be calculated the same way as traditional lasik - by using the manifest refraction. Unfortunately, early results from US surgeons revealed that this method was fraught with errors. Newer methods were then attempted such as TMR and the 50/50 technique. A different approach was taken with Phorcides. Phorcides uses geographic imaging software to analyze the topographic features of the cornea and then contract a vector analysis of the optics of the eye by adding in information on the anterior corneal measured astigmatism, the posterior corneal astigmatism, and lenticular astigmatism. Further algorithms are then employed with the end result being a treatment recommendation for the eye. Results of three research studies have now shown that Phorcides-planned Contoura treatments yield the best results for topography-guided lasik. These studies will be discussed.
Jason Brenner, Samir Melki, Mark Lobanoff, Shilpa Desai, Helen K. Wu, Naveen Rao, Purak Parikh, Roberto Pineda, Christian Song
Discuss the controversial topics in todays talks.
Michael J. Bradbury
Michael G. Morley
Claudia U. Richter
PM SESSION - NON-KERATOPLASTY ANTERIOR SEGMENT SURGERIES AND PROCEDURES
- Learn techniques for various ocular surface procedures, including excision of ocular surface lesions, limbal stem cell transplantation, management of persistent epithelial defects, corneal perforations and scars
- Understand inclusion and exclusion criteria for corneal collagen crosslinking in managing keratoconus
- Understand the horizon of management of Fuchs’ dystrophy
H. Peggy Chang
Pterygium is a benign fibrovascular growth extending from the conjunctiva to the cornea that typically leads to irritation, redness, and eventually decreased vision from induced astigmatism, or even obscuration of the visual axis in very advance cases. Pterygium is typically found on the nasal aspect of the cornea, less commonly on the temporal aspect, and occasionally both nasally and temporally on the same eye (double pterygium). Pterygium flattens the cornea in the horizontal meridian, inducing with-the-rule astigmatism in general. Definitive treatment of pterygium can be achieved through surgical excision, but there is a risk of recurrence. Many different surgical approaches have been used, including limited versus wide excisions of conjunctiva and Tenon’s layer, primary closure of the conjunctiva, conjunctival autografts and amniotic membrane. Unacceptably high recurrence rates occur with either leaving the scleral bed bare (38-88%), or primary conjunctival closure (45-75%) after pterygium excision. The lowest recurrence rates have been reported with conjunctival autografts secured with fibrin glue (0-9.8%). Amniotic membrane grafts lead to higher recurrence rates than conjunctival autografts. However, amniotic membrane is a viable alternative in situations where conjunctival autograft harvesting is not ideal, such as in patients potentially in need of glaucoma surgery, and can be made more successful with the addition of adjuvant therapies. In eyes with double pterygium, conjunctival autografts can be used to successfully cover both defects. Evidence for the best method of treating recurrent pterygium is limited, but conjunctival autograft alone can be successful even for patients presenting with a recurrent pterygium. In aggressively recurrent cases, an argument could be made for using adjuvant therapies to minimize the risk of further recurrence. The effect of the extent of conjunctival and Tenon’s resection during pterygium surgery has yet to be fully determined. Various adjuvant treatments in pterygium surgery have been studied. Mitomycin-C is one of the most widely used of these adjuvants, but it is associated with significant risk of complication. Newer adjuvants that have been studied include anti-VEGF medications, such as bevacizumab, and topical cyclosporine, but evidence supporting their use is weak at this point. None of these adjuvant therapies are FDA-approved for pterygium surgery, and their use is considered off-label. Pterygium surgery generally leads to a reduction of any induced astigmatism, along with mild steepening of the cornea, but refractive changes can be unpredictable, and this should be taken into consideration if planning future cataract surgery. Overall, surgery is a very successful means of treating pterygium if performed according to the best available evidence.
There are two main considerations when managing patients with keratoconus – 1) vision and 2) progression. Until recently, options for patients consisted only of therapies meant to address the former – spectacles, various forms of contact lenses, intracorneal ring segments, and keratoplasty – with no reliable options for the latter. With the introduction of corneal collagen crosslinking (CXL), we now have the ability to cease the progression of corneal ectatic disorders such as keratoconus and post-refractive surgery ectasia – ideally before significant vision loss. Rubinfeld RS, Caruso C, Ostacolo C. Corneal Cross-Linking: The Science Beyond the Myths and Misconceptions. Cornea. 2019 Jun;38(6):780-790. Gomes JA, Tan D, Rapuano CJ, Belin MW, Ambrósio R Jr, Guell JL, Malecaze F, Nishida K, Sangwan VS; Group of Panelists for the Global Delphi Panel of Keratoconus and Ectatic Diseases. Global consensus on keratoconus and ectatic diseases. Cornea. 2015 Apr;34(4):359-69. Belin MW, Lim L, Rajpal RK, Hafezi F, Gomes JAP, Cochener B. Corneal Cross-Linking: Current USA Status: Report From the Cornea Society. Cornea. 2018 Oct;37(10):1218-1225.
Superficial corneal irregularities, such as those caused by Salzmann’s nodular degeneration or corneal scarring, can lead to significant degradation in vision as well as discomfort, tearing, and other dry eye symptoms. Similarly, the calcium deposition of band keratopathy can have a significant impact on a patient’s vision and/or comfort. When medical management has failed, surgical options must be explored. This presentation will discuss the most common surgical interventions for these disorders. Superficial keratectomy, phototherapeutic keratectomy, and EDTA-chelation will be reviewed.
This presentation reviews the most common etiologies, diagnostic features, and treatment options for PEDs.
H. Peggy Chang
Fuchs dystrophy is a common corneal condition. We will discuss current surgical approaches, and future directions for medical therapy.
Ocular surface tumors require specialized knowledge for optimum management.
Limbal stem cell deficiency (LSCD) occurs after destruction of the limbal stem cells and results in conjunctivalization, neovascularization, and persistent epithelial defects and inflammation of the cornea that in turn can lead to reduced vision, infection, and pain. The causes of LSCD are numerous and include genetic, iatrogenic, acquired, infectious, traumatic, and oncologic etiologies. The only potential cure for LSCD is limbal stem cell transplantation (LSCT). There are several techniques for LSCT including allogeneic (keratolimbal allograft, living-related conjunctival allograft) and autologous (conjunctival limbal autograft, cultivated limbal epithelial transplantation (CLET), and simple limbal epithelial transplantation (SLET).
We encounter blepharitis in our clinics every day. Traditional recommendations include warm compresses, lid hygiene, and artificial tears. With advancement with technology, we can offer patients more treatment options. Eyelid microexfoliation, thermal therapies, intense pulse light, and meibomian gland probing will be reviewed.
Michael E. Zegans
Loss of the corneal integrity is an ocular emergency. It can lead to severe vision loss through infection, extrusion of ocular contents or bleeding. Restoration of an intact corneal barrier is essential to preventing these complications. A therapeutic approach is determined by diagnosing the underlying cause and extent of the corneal injury. Approaches to trauma, sterile corneal melts and infectious corneal melts are discussed. Indications for use of sutures, cyanoacrylate corneal glue, fibrin glue, amniotic membrane and corneal transplantation are reviewed.
H. Peggy Chang
Cornea Session Panel Discussion with speakers and guest of honor
Karen Wai, Megan Kasetty, Rebecca Silverman, Raviv Katz, Ines Lains, Filippos Vingopoulos, Itika Garg, Joan Miller, Deeba Husain, Demetrios Vavvas, Leo Kim, John Miller
Introduction: Contrast sensitivity function (CSF) may better estimate a patient’s visual function compared to visual acuity (VA). Our study evaluates the quick contrast sensitivity function (qCSF) method to measure visual function in eyes with macular disease and good letter acuity. Methods: Patients with maculopathies (retinal vein occlusion, macula-off retinal detachment, dry age-related macular degeneration, wet age-related macular degeneration) and good letter acuity (VA?20/30) were included. The qCSF method utilizes an intelligent algorithm to measure CSF across multiple spatial frequencies. All maculopathy eyes combined and individual macular disease groups were compared with healthy control eyes. Main outcomes included area under the log contrast sensitivity function (AULCSF) and six CS thresholds ranging from 1 to 18 cycles per degree (cpd). Results: 151 eyes with maculopathy and 93 control eyes with VA?20/30 were included. Presence of a maculopathy was associated with significant reduction in AULCSF (beta coefficient: -0.174; p<0.001) and CS thresholds at all spatial frequencies except for 18 cpd (beta coefficient: -0.094 to -0.200 logCS, all p<0.01) compared to controls. Reductions in CS thresholds were most notable at low and intermediate spatial frequencies (1.5, 3, and 6 cpd). Conclusion: CSF measured with the qCSF active learning method was found to be significantly reduced in eyes affected by macular disease despite good VA compared to healthy control eyes. The qCSF method is a promising clinical tool to quantify subtle visual deficits that may otherwise go unrecognized by current testing methods.
Sila Bal, Nakul Singh, Alice Lorch
Purpose: To assess differences in cataract surgery outcomes by race and gender in order to better understand delivery of surgical care to diverse patient populations. Methods: Massachusetts Eye and Ear surgical outcomes were assessed between January 1, 2019 and December 31, 2019. Patient's gender and self-identified race/ethnicity were extracted from the medical record and collapsed into broader categories of White, Black, Hispanic, Asian, declined/unavailable, and other for race. Cataract surgery outcomes were loss to follow up, achievement of target refraction within 1 diopter, and intraoperative complications: Descemet’s tear, posterior capsule tear, vitreous loss, anterior vitrectomy, dropped lens, and zonular dialysis. Logistic regression was performed to estimate the odds ratios between categories. Results: A total of 2,874 patients underwent cataract surgery and were included in the analysis (White=2,121, Asian=212, Black=202). Overall, male patients were less likely to achieve refraction within 1 diopter of target (OR 0.76, p=0.02), as were Asian patients (OR 0.61, p=0.04) and Black patients (OR 0.59, p=0.02). When accounting for race and gender, female patients reporting their race as Black (OR 0.37, p=0.02) or Asian (OR 0.38, p=0.04) were less likely to achieve target refraction. This difference in outcome by race and gender was not significant for male patients. There was no difference in loss to follow up or intraoperative complications by gender. Conclusion: There were disparities in cataract surgery outcomes by race and gender. Black and Asian women are less likely to achieve target refraction, highlighting the need for further investigation into disparities and development of programs that improve equity of cataract care in these groups.
Donel Kelly, Tej Ganti, David Ramsey
To compare the rate of glaucoma-related diagnoses in patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).
Patients with glaucoma-related diagnoses and retinal vascular occlusion (RVO) diagnoses were identified from billing records from 2016 to 2020. Patients with bilateral dry eye syndrome, an unrelated age-related eye disease, were used as reference group age- and gender-matched 2:1. Patients were further classified by subtype of glaucoma. Records of patients without glaucoma-related diagnoses were evaluated for potential underdiagnosis, utilizing criteria of intraocular pressure (IOP) > 22mmHg as well as cup-to-disc ratio (CDR) > 0.6 and/or CDR difference between eyes > 0.2.
In the study period, 2952 patients were identified with glaucoma-related diagnoses and 643 patients with RVOs, including 386 with types of BRVO and 286 with types of CRVO. The rate of glaucoma-related diagnoses was significantly greater in patients with retinal vein occlusions compared with a reference group (9.8% versus 5.4%, p< 0.001). The rate of diagnosed open angle glaucoma was significantly higher in patients having BRVOs (4.1%) and CRVOs (4.5%) compared with a reference group of patients having dry eye (1.7%, p<0.001). There was no significant difference when comparing the rate of suspected glaucoma. A review of the medical records of all patients without a previous glaucoma-related diagnosis identified a significantly greater number of patients with BRVO (28.6%) and CRVO (33.3%) who met the clinical risk criteria compared with those in the reference group (18.2%, p<0.001). At-risk patients with RVOs were more likely to be identified because of features of the optic disc than elevated IOP when compared with the reference group (59% vs 49%, p=0.030).
Patients with BRVOs and CRVOs had a similar rate of diagnosed glaucoma-related conditions. Patients with RVOs without diagnosed glaucoma were more likely to meet clinical risk criteria for glaucoma, compared with a reference group, suggesting an underdiagnosis.
Mergen B, Ramsey DJ. Underdiagnosis of glaucoma in patients with exudative age-related macular degeneration. Eye (Lond). 2021 Feb 3. doi: 10.1038/s41433-021-01417-0. Epub ahead of print. PMID: 33536592.
Financial Support: D.J.R.: Supported by the Harry N. Lee Family Chair in Innovation at the Lahey Hospital & Medical Center, Beth Israel Lahey Health.
Conflict of Interest: The authors declare no conflict of interest.
Tej Ganti, Shiyoung Roh, David Ramsey
METHODS A retrospective chart review was conducted to determine the rate of return for in-person eye examinations for patients with glaucoma-related diagnoses who had been seen in the Department of Ophthalmology at the Lahey Hospital & Medical Center in 2019. Since TH appointments were not initiated at the Lahey Hospital & Medical Center until March 16, 2020 in response to the COVID-19 pandemic, this study looked at only patients who were seen after this date. The main outcome was the likelihood of return for in-person eye exam in patients who had a prior TH encounter compared with those that did not have a TH encounter. Other variables measured included patient demographics (age, sex, race/ethnicity, insurance, distance to eye clinic), appointment logistics (type of TH visit, past appointment completion), and clinical characteristics (type of glaucoma, history of ophthalmic testing). RESULTS Of the 5472 patients with a glaucoma-related diagnosis, 1945 (35.5%) completed TH appointments. The rate of return for subsequent in-person visits was significantly greater for the cohort of patients who completed a TH appointment compared with those who did not (60% compared with 56%, OR: 1.16 95% CI: 1.04 - 1.30, p=0.008). Patients with a diagnosis of open-angle glaucoma were more likely to receive telehealth (42% vs 29%, p<0.001) and also more likely to follow-up (40% vs 25%, p<0.001). In contrast, patients with only suspected glaucoma were less likely to receive telehealth (43% vs 59%, p<0.001) and less likely to follow up (46% vs 61%, p<0.001). Other variables associated with a lower rate of return included younger age (p<0.001), Medicaid/Commercial insurance rather than Medicare (p=0.002), TH visit with an ophthalmologist versus an optometrist (p<0.001), past no show appointments (p<0.001), RNFL testing performed in 2019 (p<0.001), and lack of prior VF testing (p<0.001). CONCLUSION TH appointments are an effective method to improve the likelihood that patients with glaucoma-related diagnoses, particularly open-angle glaucoma, return for in-person eye care. Financial Support: D.J.R.: Supported by the Harry N. Lee Family Chair in Innovation at the Lahey Hospital & Medical Center, Beth Israel Lahey Health. Conflict of Interest: The authors declare no conflict of interest.
Ashley Sohn, George Sanchez, Jacob McGinnis, Dimosthenis Mantopoulos
Title: Significance of patient’s age in prognosis after scleral buckle (SB) for repair of primary macula-off rhegmatogenous retinal detachment
Ashley Sohn BA1, George Sanchez BS1, Jacob McGinnis BA1,2, Dimosthenis Mantopoulos MD PhD1,2
1Geisel School of Medicine at Dartmouth, Hanover, NH, United States
2Department of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
Purpose: To assess whether a patient’s age has a significant effect on prognosis after scleral buckle (SB) for treatment of a primary macula-off rhegmatogenous retinal detachment (RRD).
Methods: Retrospective, consecutive case series.
The charts of patients who presented to our institution and NJ Retina with a primary macula-off RRD between 2012 and 2020 were reviewed. Those who underwent treatment with SB were included. These patients were divided into the following two age groups:
- Group A: <= 54 years-old
- Group B: >= 55 years-old
The primary outcome was the post-operative best-corrected visual acuity (BCVA) at final follow-up. The secondary outcome was single-surgery anatomic success (SSAS) rate of scleral buckle.
Results: Of the 138 patients who underwent scleral buckle, 38 met inclusion criteria. Twenty-five of them were male. The mean age ± SD was 54.2 ± 16.1 years-old. The mean follow-up period was 14.3 ± 12.8 months. From these, 15 (39%) were in age group A and 23 (61%) were in age group B. The final mean logMAR (Snellen equivalent) BCVA was 0.39 (20/50) for group A and 0.66 (20/90) for group B (p = 0.07). The SSAS rate of scleral buckle was 93% in group A compared to 82% in group B (p = 0.34).
Conclusion: Although there was a strong trend for different outcomes between the two groups, ultimately the patient’s age was not found to have a strong prognostic significance for the final surgical or visual outcome after RRD repair with scleral buckle. Further analysis with a larger sample size is needed to confirm or reject this hypothesis.
George Sanchez, Ashley Sohn, Jacob McGinnis, Dimosthenis Mantopoulos
Purpose: To determine how age affects the postoperative best-corrected visual acuity (BCVA) and single surgery success rate (SSSR) following macula-off rhegmatogenous retinal detachment (RRD) repair with pars plana vitrectomy (PPV) ± scleral buckle (SB). Secondarily, the post-operative central retinal thickness (CRT) was also examined.
Methods: Retrospective evaluation of consecutive patients with RRD presenting at a single center who underwent PPV or PPV/SB. Patients who met inclusion criteria were stratified into three age groups: (A) ?60 years-old, (B) 61-75 years-old, and (C) ?76 years-old. Outcome measures included BCVA, SSSR, and CRT based on optical coherence tomography (OCT).
Results: Of 412 patients screened, 86 met inclusion criteria. Sixty-four (74.4%) of them were male. Twenty-nine of them were in group A, 39 were in group B, and 18 were in group C. The mean age ± SD was 66.3 ± 9.9 years old. The mean follow-up period was 22.1 ± 18.1 months. The mean pre-operative and post-operative logMAR (Snellen) BCVA was 1.5 ± 0.8 (20/630) and 0.5 ± 0.5 (20/60), respectively. At final follow-up, logMAR (Snellen) BCVA was 0.25 (20/35), 0.57 (20/74) and 0.62 (20/83) in groups A, B, and C, respectively (p < 0.05). The SSSR was 93.1% (27/29), 84.6% (33/39), and 77.8% (14/18) for groups A, B, and C, respectively (p = 0.32). The final CRT on OCT for the age groups was 316.9 ?m in group A, 313.2 ?m in group B, and 310.2 ?m in group C (p = 0.69).
Conclusion: Patient’s age has a significant negative correlation with the postoperative BCVA after successful surgical repair of macula-off primary RRD. The differences in SSSR and CRT between age subgroups were not significant