After a Decade of Changes In RD Surgery, Are We Any Better Off?
Retinal detachment surgery has seen some serious changes in the 21st century, but have success rates changed?
In a recent episode of the Retina Today Journal Club, moderators Jonathan L. Prenner, MD, and Richard S. Kaiser, MD, asked Paul Hahn, MD, PhD, to review his recent research on differences in retinal detachment (RD) surgery success rates over time.
“With all of this improved technology—faster cut rates and smaller-gauge instruments and fancy vitrectomy machines,” Dr. Hahn said. “You’d think we’d be better, but the question is: Are we really better?”
To answer this question, Dr. Hahn examined surgical success rates for patients with primary untreated RDs who presented at the Duke Eye Center in Durham, N.C. He collected and compared data from patients who presented in 2002 with data from patients who presented in 2012. Pediatric patients, trauma patients, and patients with endophthalmitis-related RDs were excluded from the study—in short, the study examined noncomplex cases.
Dr. Hahn noted that trends in procedures differed from 2002 to 2012. In 2002, approximately two-thirds of RD cases were treated with a primary buckle, whereas only about a third of RD cases in 2012 were treated with a primary buckle. In 2002, approximately 5% of cases were treated with primary vitrectomy; there was a slight uptick in 2012, but still less than 10% of cases were treated in this fashion. Cases not treated with a primary buckle or primary vitrectomy were treated with a vit-buckle procedure.
According to Dr. Hahn, the success rate was 78% in 2002 and 88% in 2012; the difference was not statistically significant.
RECENT RETINA TODAY JOURNAL CLUB EPISODES
• Shifting Trends in Retinal Detachment Treatment with Jonathan L. Prenner, MD, Paul Hahn, MD, PhD, Richard S. Kaiser, MD
• Managing Diabetics After Cataract Surgery, with Eric Nudleman, MD, PhD; Jonathan L. Prenner, MD; and Rishi P. Singh, MD
• Robotics in Retina, with Jean-Pierre Hubschman, MD, and Richard S. Kaiser, MD
Still, Dr. Kaiser noted, a 10% improvement in success rate is clinically relevant. He said that an increased success rate occurring simultaneously with an increased vit-buckle rate likely means that surgeons have become more discerning in identifying patients who are best suited for a buckle versus a vit-buckle or vitrectomy alone.
Dr. Prenner agreed. “In my own practice, most of my buckles are relatively simple,” he said. “If I have to do anything complicated, then I’ll do a vitrectomy as well.”
Dr. Kaiser closed the conversation by emphasizing the need to teach fellows how to buckle. “I think we need a coalition to make sure we train fellows to use buckles,” he said. Having more options available, he explained, means that surgeons can provide the most targeted surgery possible for patients.