Dataset Information

Iatrogenic retinal breaks and postoperative retinal detachments in microincision vitrectomy surgery compared with conventional 20-gauge vitrectomy: a meta-analysis.

ABSTRACT:

Purpose

To assess the incidence of iatrogenic retinal breaks (IRBs) and postoperative retinal detachments (RDs) in microincision vitrectomy surgery (MIVS) compared with 20-gauge (20?G) vitrectomy.

Methods

A comprehensive literature search was performed to find relevant studies and a meta-analysis of the IRBs and postoperative RDs rates after 20?G vitrectomy versus MIVS was conducted.

Results

Thirty-two studies were selected, including 14,373 eyes (6932 eyes in the 20?G group, 7441 eyes in the MIVS group). The meta-analysis demonstrated that the incidence of IRBs was significantly higher in 20?G vitrectomy vs. MIVS (OR?=?2.22, 95% CI, 1.93-2.57, P?ConclusionThis meta-analysis demonstrated that MIVS is associated with a lower risk of IRBs and postoperative RDs compared to 20?G vitrectomy.

SUBMITTER: Chen GH

PROVIDER: S-EPMC6707291 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Publications

Iatrogenic retinal breaks and postoperative retinal detachments in microincision vitrectomy surgery compared with conventional 20-gauge vitrectomy: a meta-analysis.

Chen G H GH Tzekov R R Jiang F Z FZ Mao S H SH Tong Y H YH Li W S WS

Eye (London, England) 20181218 5

<h4>Purpose</h4>To assess the incidence of iatrogenic retinal breaks (IRBs) and postoperative retinal detachments (RDs) in microincision vitrectomy surgery (MIVS) compared with 20-gauge (20 G) vitrectomy.<h4>Methods</h4>A comprehensive literature search was performed to find relevant studies and a meta-analysis of the IRBs and postoperative RDs rates after 20 G vitrectomy versus MIVS was conducted.<h4>Results</h4>Thirty-two studies were selected, including 14,373 eyes (6932 eyes in the 20 G grou ...[more]

PMID: 30560911

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Project description:PURPOSE:To report the surgical outcomes of primary rhegmatogenous retinal detachment (RRD) repaired by 27-gauge pars plana vitrectomy combined with Healaflow patch and air tamponade. METHODS:In an initial vitro experiment, we observed and compared the dissolution and displacement of the dispersion spots of 0.05-mL Healaflow and sodium hyaluronate. We then performed a prospective, interventional cohort study on 38 eyes in 37 consecutive patients with primary rhegmatogenous retinal detachment. All eyes underwent pars plana vitrectomy combined with Healaflow patch and air tamponade; the postoperative period did not involve prone positioning. The primary and final anatomical attachment rate, best-corrected visual acuity, and intraoperative and postoperative complications were evaluated. RESULTS:In the in vitro experiment, the viscoelastic Healaflow remained adherent with no change in the size of the area; however, the control dissolved completely in the balance solution. The patient study included 16 women (43.2%) and 21 men (56.8%) (mean age, 59.5 ± 9.5 years; mean follow-up period, 8.9 ± 3.8 months). A single break was present in 21 (55.3%) and 2 to 5 breaks in 17 cases (44.8%). The macula was involved in 25 (65.8%) and attached in 13 cases (34.2%) intraoperatively. Initial reattachment was achieved in 37 (97.4%) and final reattachment in 38 cases (100%). In one case (2.6%), the macula redetached because of failure of the chorioretinal scar to develop around the treated break. Mean preoperative and postoperative best-corrected visual acuities were 1.02 ± 0.82 logarithm of the minimum angle of resolution (median Snellen acuity: 20/125, range: 20/20,000-20/20) and 0.23 ± 0.17 logarithm of the minimum angle of resolution (median Snellen acuity: 20/32, range: 20/100-20/20), respectively (P < 0.001). Intraocular pressure was elevated transiently in 28 eyes (73.7%). There were no other intraoperative complications or postoperative scleral incision leakage. CONCLUSION:A 27-gauge pars plana vitrectomy combined with Healaflow patch, and air tamponade results in a high reattachment rate in the treatment of rhegmatogenous retinal detachment. Thus, patients can benefit from early visual recovery and less complications.

Project description:PurposeThe occurrence of iatrogenic retinal breaks (RB) in pars plana vitrectomy (PPV) is a complication that compromises the overall efficacy of the surgery. A subset of iatrogenic RB occurs when the retina (rather than the vitreous gel) is cut accidentally by the vitrector. We developed a smart vitrector that can detect in real-time potential iatrogenic RB and activate promptly a PPV machine response to prevent them.MethodsWe fabricated the smart vitrectors by attaching a miniaturized fiber-based OCT sensor on commercial vitrectors (25G). The system's response time to an iatrogenic RB onset was measured and compared to the literature reported physiologically limited response time of the average surgeon. Two surgeons validated its ability to prevent simulated iatrogenic RB by performing PPV in pigs. Note that the system is meant to control the PPV machine and requires no visual or audio signal interpretation by the surgeons.ResultsWe found that the response time of the system (28.9 ± 6.5 ms) is 11 times shorter compared to the literature reported physiologically limited reaction time of the average surgeon (P < 0.0001). Ex vivo validation (porcine eyes) showed that the system prevents 78.95% (15/19) (95% confidence interval [CI] 54.43-93.95) of intentional attempts at creating RB, whereas in vivo validation showed that the system, prevents 55.68% (30/54) (95% CI 41.40-69.08), and prevents or mitigates 70.37% (38/54) (95% CI 56.39-82.02) of such attempts. A subset of failures was classified as "early stop" (i.e., false positive), having a prevalence of 5.26% (1 /19) in ex vivo tests and 24.07% (13/54) in in vivo tests.ConclusionsOur results indicate the smart vitrector can prevent iatrogenic RB by providing seamless intraoperative feedback to the PPV machine. Importantly, the use of the smart vitrector requires no modifications of the established PPV procedure. It can mitigate a significant proportion of iatrogenic RB and thus improve the overall efficacy of the surgery.Translational relevancePotential clinical adoption of the smart vitrector can reduce the incidence of iatrogenic RB in PPV and thus increase the therapeutic outcome of the surgery.

Dataset Information

Iatrogenic retinal breaks and postoperative retinal detachments in microincision vitrectomy surgery compared with conventional 20-gauge vitrectomy: a meta-analysis.

Purpose

Methods

Results

Publications

Iatrogenic retinal breaks and postoperative retinal detachments in microincision vitrectomy surgery compared with conventional 20-gauge vitrectomy: a meta-analysis.

Similar Datasets

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