Retrospective study characterizes success of retinal detachment surgery in large cohorts

April 20, 2018

An analysis of data from the Intelligent Research in Sight (IRIS) Registry provides insights about real-world success rates for primary repair of retinal detachments, said Richard S. Kaiser, MD.

 

An analysis of data from the Intelligent Research in Sight (IRIS) Registry provides insights about real-world success rates for primary repair of retinal detachments, said Richard S. Kaiser, MD.

The retrospective, nonrandomized review included data from 27,489 unique patients, of which 8,643 had a complex or high-risk retinal detachment, said Dr. Kaiser, professor of ophthalmology, Thomas Jefferson University, Philadelphia.

Success, defined by re-attachment at 1 year with only one surgical intervention, was 87.9% in the overall cohort and 86.8% in the subgroup with a complex or high-risk retinal detachment.

The difference between groups was statistically significant and driven by slightly lower success rates in eyes with giant retinal tears (81.9%) or primary proliferative vitreoretinopathy (PVR, 83.8%).

 

Results with eyes stratified by procedure showed that both in the overall population and the subgroup with a complex or high-risk retinal detachment, the success rate was nearly identical comparing eyes operated on with a primary scleral buckle versus with primary vitrectomy with or without scleral buckle.

“There are countless published papers reporting outcomes of retinal detachment repair, and they have variable results,” Dr. Kaiser said. “However, there is tremendous selection bias in each paper, and they generally represent small series with unreliable data that are nontransferable.”

The purpose of this analysis was to establish real-world data on re-attachment rates for patients undergoing primary retinal detachment repair and to determine what to expect in eyes with high-risk or complex retinal detachment diagnoses, according to Dr. Kaiser.

“Answering the age-old question of which is better, primary vitrectomy or primary buckle, was also a key issue that prompted this study,” he said. “Considering that the results with these two approaches were nearly identical in both the whole cohort and the high-risk/complex subgroup, it appears the decision should be the surgeon’s choice.”

 

The analysis identified patients entered into the IRIS registry from 2013 through the second quarter of 2016 using ICD-9 and ICD-10 codes. Patients were excluded that had a CPT code with an unspecified eye or bilateral pathology.

In the overall cohort, about 11% of eyes had a scleral buckle, about 80% had primary vitrectomy with or without a buckle, and about 9% had a repair with a complex retinal detachment code. Success rates for those three procedures were 87.8%, 88.2%, and 85.1%, respectively.

High-risk or complex retinal detachment was defined by having codes for multiple breaks, total retinal detachment, giant retinal tears, or primary PVR. The procedures performed in the high-risk/complex cohort were similar to the overall population, with about 10% of eyes having a primary buckle, 77.5% having vitrectomy with or without a buckle, and almost 13% having a complex repair.

Success rates with scleral buckle and vitrectomy were not significantly different (86.4% vs. 86.8%), but both procedures were associated with a significantly higher success rate compared with a complex repair (85.9%).

 


Dr. Kaiser noted there are limitations to using the IRIS registry data.

“Although these are very large cohorts, patients were not randomized to the different procedures, and it is not possible to differentiate within the vitrectomy codes which patients did and which did not have a scleral buckle,” he said. “In addition, the data may have been skewed by our elimination of patients with bilateral pathology.”

Most importantly, there are more than 16,000 physicians who have contributed to the IRIS registry and we are dependent on the accuracy of the coding, Dr. Kaiser noted.

 

Richard S. Kaiser, MD

E: RichardSKaiserMD@gmail.com

This article was adapted from Dr. Kaiser’s presentation during Retina Subspecialty Day at the 2017 meeting of the American Academy of Ophthalmology. Prethy Rao, MD, Associated Retinal Consultants, William Beaumont Hospital, collaborated with Dr. Kaiser in this project. He has no relevant financial interests to disclose.