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Novel classification system for management of rhegmatogenous retinal detachment with minimally invasive detachment surgery: a network meta-analysis of randomized trials focused on patient-centred outcomes

Lookup NU author(s): Roxane Hillier

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Abstract

© 2021 Canadian Ophthalmological SocietyObjective: To describe a novel classification system for primary rhegmatogenous retinal detachment (RRD) based on level 1 evidence assessing the functional outcomes of repair techniques with the goal of using a minimally invasive detachment surgery. Methods: A systematic review and network meta-analysis of randomized, controlled trials comparing pneumatic retinopexy (PnR), scleral buckle (SB), or pars plana vitrectomy (PPV) for RRD was conducted. Primary outcomes were best-corrected visual acuity (BCVA), metamorphopsia, and operative complications. A meta-analysis was performed with a random effects maximum likelihood model, with outcomes of standardized mean difference (SMD) or risk ratio (RR) and 95% confidence interval. Inclusion and exclusion criteria were assessed to inform a classification system. Results: Fourteen trials were included. RRDs were classified from categories 1–3 based on configuration (simple to complex). There was no significant difference in final BCVA between PnR and PPV (categories 1 and 2; SMD = –0.10, 95% CI –0.24 to 0.04), nor was a final BVCA difference found between SB and PPV (SMD = 0.01, 95% CI –0.05 to 0.08), combined SB + PPV and PPV (SMD = 0.02, 95% CI –0.08 to 0.12), or combined SB + PPV and SB (SMD = 0.01, 95% CI –0.11 to 0.12). SB had an elevated risk of choroidal detachment (RR = 5.17, 95% CI 1.68–15.97), hypotony (RR = 12.26, 95% CI 1.63–92.04), and strabismus or diplopia (RR = 5.86, 95% CI 1.04–32.91) compared with PPV but a lower risk of iatrogenic breaks (RR = 0.08, 95% CI 0.02–0.43). Vertical metamorphopsia scores were superior for PnR over PPV at 12 months (Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial, p = 0.026). Conclusion: This novel classification system may be useful for future trials assessing morphologic categories of RRD in a systematic manner. Minimally invasive detachment surgery may allow for trials to focus on maximizing functional outcomes while minimizing morbidity.

Publication metadata

Author(s): Muni RH, Minaker SA, Mason RH, Popovic MM, Kertes PJ, Hillier RJ

Publication type: Article

Publication status: Published

Journal: Canadian Journal of Ophthalmology

Year: 2023

Volume: 58

Issue: 2

Pages: P97-112

Print publication date: 01/04/2023

Online publication date: 16/11/2021

Acceptance date: 06/10/2021

ISSN (print): 0008-4182

ISSN (electronic): 1715-3360

Publisher: Elsevier B.V.

URL: https://doi.org/10.1016/j.jcjo.2021.10.002

DOI: 10.1016/j.jcjo.2021.10.002

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