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.
Can J Ophthalmol
; 58(2): 97-112, 2023 04.
Article
en En
| MEDLINE
| ID: mdl-34798054
ABSTRACT
OBJECTIVE:
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; SMDâ¯=â¯-0.10, 95% CI -0.24 to 0.04), nor was a final BVCA difference found between SB and PPV (SMDâ¯=â¯0.01, 95% CI -0.05 to 0.08), combined SBâ¯+â¯PPV and PPV (SMDâ¯=â¯0.02, 95% CI -0.08 to 0.12), or combined SBâ¯+â¯PPV and SB (SMDâ¯=â¯0.01, 95% CI -0.11 to 0.12). SB had an elevated risk of choroidal detachment (RRâ¯=â¯5.17, 95% CI 1.68-15.97), hypotony (RRâ¯=â¯12.26, 95% CI 1.63-92.04), and strabismus or diplopia (RRâ¯=â¯5.86, 95% CI 1.04-32.91) compared with PPV but a lower risk of iatrogenic breaks (RRâ¯=â¯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, pâ¯=â¯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.
Texto completo:
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Bases de datos:
MEDLINE
Asunto principal:
Desprendimiento de Retina
Tipo de estudio:
Clinical_trials
/
Prognostic_studies
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Can J Ophthalmol
Año:
2023
Tipo del documento:
Article