Persistent subfoveal fluid and increased preoperative foveal thickness impair visual outcome after macula-off retinal detachment repair.

PURPOSE: To investigate the influence of subfoveal fluid and foveal thickness on visual outcome in patients who underwent reattachment surgery for rhegmatogenous retinal detachment (RRD). METHODS: This prospective study included 53 patients who were undergoing successful scleral buckling surgery for primary RRD. A thorough ophthalmologic examination including best-corrected visual acuity, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and optical coherence tomography scanning was performed preoperatively and during all subsequent follow-up visits at 1, 3, 6, 9, 12, and 24 months postoperatively. RESULTS: Preoperative foveal thickness was significantly higher in the macula-off group (n = 38) compared with the macula-on group (n = 15) (P < 0.0001), whereas postoperative measurements were normal in both the groups. Linear mixed-model analysis revealed that persistent subfoveal fluid (P = 0.0004) was an independent predictor of a worse visual outcome after scleral buckling surgery for primary macula-off RRD, although the effect on visual outcome was small (0.1 logarithm of the minimal angle of resolution units). Moreover, increased preoperative foveal thickness was associated with a worse visual prognosis in macula-off RRD (P = 0.010). CONCLUSION: Persistent subfoveal fluid and increased preoperative foveal thickness were associated with a worse visual prognosis in macula-off RRD patients, albeit the effect of persistent subfoveal fluid was small and temporary.

Late outcome after stenting or coronary artery bypass surgery for the treatment of multivessel disease: a single-center matched-propensity controlled cohort study.

BACKGROUND: Although several randomized controlled trials examined the relative benefits of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI), the most appropriate treatment remains a matter of debate, at least in some subsets of patients. Therefore, we evaluated the 8-year outcome after multivessel stent implantation (stent group) or coronary artery bypass surgery (CABG group) in a single-center propensity-matched cohort study. METHODS: The stent study population consisted of all 409 consecutive patients who underwent an elective coronary intervention between 1995 and 1999 in whom at least 2 stents were implanted in multiple vessels. They were matched by using the propensity score method with 409 CABG patients of 1,723 CABG patients with multivessel disease who underwent elective CABG in the same period of time. The two populations were very different before matching. After matching, the CABG population resembled a stent population. RESULTS: The cumulative survival rates after stent were 93%, 90%, and 82% at, respectively, 3, 5, and 8 years; and after CABG 97%, 93%, and 87% (p = 0.02). This was caused mainly by patients with left main disease (p = 0.03). Event-free survival was only 70%, 68%, and 64% after stent and 89%, 82%, and 78% after CABG at, respectively, 3, 5, and 8 years (p < 0.0001). After adjusting, stent was an independent predictor of higher mortality. CONCLUSIONS: In this matched cohort study with an 8-year follow-up, survival was better and less repeat revascularizations were needed among patients undergoing elective CABG for the treatment of multivessel disease as compared with the stent group.