Surgical Retina

Audit and Research

The number of surgeries, diagnoses and outcomes for RD and ERM are shown in Figures 10.3 to 10.7 and in Table 10.4.

The most common diagnosis includes RRD and GRT, diabetic eye diseases and macular puckers.

Retinal Detachment

Final success (defined as success after one or more surgical attempts) was achieved by 98.1% of patients, while primary success (defined as success after one surgery attempt) was achieved by 86.8% of patients.

41% of patients achieved an overall best-corrected visual best-corrected visual acuity (BCVA) of 6/12 or better. Of these patients, 35 of the 65 patients had a detached macula.

Table 10.4. Retina surgery: success by macular status in 2013
	Retina flat		Retina not flat
	Count	Mean +/- SD VA LogMAR	Count	Mean +/- SD VA LogMAR	Total Count
Macula attached	58	0.45 +/- 0.43	-	-	58
Macula detached	98	0.78 +/- 0.60	3	0.85 +/- 0.75	101
Grand total	156	0.66 +/- 0.57	3	0.85 +/- 0.75	159

LogMAR Logarithm of the Minimum Angle of Resolution; SD, standard deviation; VA, visual acuity.

Eyes presenting RD with attached macula suggest better visual prognosis and success as 100% achieved flat retina after surgery and better vision as determined by the Logarithm of the Minimum Angle of Resolution scoring system.

Visual outcome at 6 months following surgical peeling of ERM

Of the 148 ERM cases in 2012, 54 of the 80 patients (67.5%) achieved a BCVA of 6/12 or better after 6 months.

Benchmarks of success

Success rates of retinal surgeries performed at SNEC are comparable or better than those achieved in multiple international studies.

Table 10.5. Success of RD surgeries performed at SNEC versus those in international studies.
	Overall primary success	Overall success
UK Eye Audit, 2002 (Thompson et al., 2002)	77% (95% CI 73.9-80.2)	-
The Retina 1 project: Report 3, 2012 (Spain) (Sanabria et al., 2012)	TPPV 86.4
European vitreo-retinal society retinal detachment study report 2, 2013 (Adelman, Parnes, Sipperley, & Ducournau, 2013)	-	SB better than TPPV
Study in Israel (Kinori et al., 2011)	TPPV 81.3% SB/TPPV 87.1%	TPPV 98.9% SB/TPPV 98.8%
Study in Japan (Kobashi et al., 2014)	SB 93.7% TPPV 96.3%	100%
SNEC 2013 SNEC 2014	86.8% 89.9%	98.1% 97.8%

Latest audit results

The latest audit results for RD, ERM and PVR are shown in Table 10.6.

Table 10.6. Audit results for RD, ERM and PVR
	Year (s) of audit	Total number of cases	Cases with primary disease	Cases analysed	Cases with post-operative success(%)	Cases with BCVA of 6/12 or better (%)
RD	2014	279	257	178	89.9	55
ERM	2012	204	148	148	-	66.7
PVR	2009 to 2013	245	71	71	73.2	73.2

BCVA, best-corrected visual acuity; ERM, epiretinal membrane; PVR, proliferative vitreoretinopathies; RD, retinal detachment.

References

Adelman, R. A., Parnes, A. J., Sipperley, J. O., & Ducournau, D. (2013). Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2. Ophthalmology, 120, 1809-1813.
Kinori, M., Moisseiev, E., Shoshany, N., Fabian, I. D., Skatt, A., Barak, A.,…Moisseiev, J. (2011). Comparison of pars plana vitrectomy with and without scleral buckle for the repair of primary rhegmatogenous retinal detachment. American Journal of Ophthalmology, 152, 291-297.
Kobashi, H., Takano, M., Yanagita, T., Shiratani, T., Wang, G., Hoshi, K., & Shimizu, K. *2014). Scleral buckling and pars plana vitrectomy for rhegmatogenous retinal detachment: an analysis of 542 eyes. Current Eye Research, 39, 204-211.
Sanabria, M. R., Fernandez, I., Sala-Puigdollers, A., Rojas, J., Alfaiate, M.,Elizalde, J.,…Pastor, J. C. (2012). A propensity score-matching application: indications and results of adding scleral buckle to vitectomy: The Retina 1 Project: Report 3. European Journal of Ophthalmology, 21, 244-253.
Thompson, J. A., Snead, M. P., Billington, B. M., Barrie, T., Thompson, J. R., & Sparrow, J. M. (2002). National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes. Eye, 16, 771-777.

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