Which Reparative Retinal Detachment Surgery Results in Superior Vision-Related Quality of Life?

June 24, 2020

Patients who undergo pneumatic retinopexy for rhegmatogenous retinal detachment repair report superior vision-related functioning scores and higher mental health scores during the first 6 months post operation, compared with those who undergo pars plana vitrectomy, according to a study published in JAMA Ophthalmology.

Patients who undergo pneumatic retinopexy (PnR) for rhegmatogenous retinal detachment (RRD) repair report superior vision-related functioning scores and higher mental health scores during the first 6 months post operation, compared with those who undergo pars plana vitrectomy (PPV), according to a study published in JAMA Ophthalmology.

“RRD is an acute, sight-threatening condition, with an incidence of approximately 10 per 100,000 people,” the authors write. However, “the optimal surgical technique for the treatment of RRD remains controversial.”

In a post hoc explanatory analysis, the researchers explored the difference in vision-related quality of life (VRQoL) between patients who underwent PnR and PPV, 2 common RRD repair techniques. Current anatomical reattachment rates are comparable for each surgery, with success as high as 81% for PnR and 94% for PPV. An additional treatment, scleral buckle, has a success rate of 92%.

Researchers used data from the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes (PIVOT) randomized clinical trial , which was conducted between August 2012 and May 2017 in Canada. Of the 176 participants, 160 were included in the current analysis.

To assess VRQoL, the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was completed during 1 or more follow-up visits at 3, 6, or 12 months by 81 and 79 patients in the PnR and PPV groups, respectively. Of the 152 patients who completed a 6-month follow-up questionnaire, 75 underwent PnR while 77 underwent PPV.

According to the authors, a previous study found “a 4-point change in the composite scores, and a 5-point change in individual subscale scores may be considered the minimum clinically meaningful changes in the NEI VFQ-25 score.”

After adjusting for age, sex, baseline macular status, and other factors, data revealed that after 6 months, those who underwent PnR reported higher scores for the following indicators:

  • Distance activities (mean [SD] PnR, 88.7 [13.4]; PPV, 82.8 [17.1]; adjusted difference, 6.5; 95% CI, 1.6-11.4; P = .01)
  • Mental health (mean PnR, 84.3 [17.4]; PPV, 78.7 [21.1]; adjusted difference, 6.7; 95% CI, 0.4-13; P = .04)
  • Dependency (mean PnR, 96.1 [10.1]; PPV, 91.1 [18.6]; adjusted difference, 5.7; 95% CI, 0.6-10.8; P = .03)
  • Peripheral vision (mean PnR, 91.6 [16.2]; PPV, 81.2 [24.4]; adjusted difference, 10.8; 95% CI, 4.3-17.4; P = .001)

The researchers found no difference between groups at the 1-year follow-up. In addition, no differences were identified between groups for fellow-eye Snellen visual acuity (VA) during any of the visits. In 2018, the researchers compared long-term visual outcomes between patients who underwent PnR or PPC who initially enrolled in PIVOT. They found the PnR group exhibited superior VA and less vertical distortion.

The authors hypothesize lower visual function scores in the PPV group may be due to other factors affecting VRQoL, including “PnR being a less invasive treatment, with less morbidity compared with PPV, and faster recovery of VA in the first 6 months.” General health, mental health, and social functioning may have also been confounding factors in the study.

They note future studies comparing RRD treatments should not be limited to anatomical and VA evaluation but should include assessments of VRQoL and other functional outcomes.

Reference

Muni RH, Francisconi CL, Felfeli T, et al. Vision-related functioning in patients undergoing pneumatic retinopexy vs vitrectomy for primary rhegmatogenous retinal detachment. JAMA Ophthalmol. Published online June 18, 2020. doi:10.1001/jamaophthalmol.2020.2007