RESUMO
Purpose: The goal of this research is to investigate the characteristics and surgical techniques for repairing rhegmatogenous retinal detachment (RRD) and their influence on anatomical and functional success of the treatment with a special emphasis on the economic costs and outcome quality-adjusted life years (QALYs) of the procedures. Methods: This retrospective study analyzed data from 151 patients with RRD treated at the Department of Ophthalmology, Clinical Hospital Centre Split, Croatia, in a 3-year period, using one of three surgical techniques: pneumoretinopexy (PR), scleral buckling (SB) or pars plana vitrectomy (PPV), followed-up for at least 6 months. Demographic, pre- and post-operative ophthalmic exam parameters and surgical technique used were collected accordingly. Statistical analysis of the influence of the studied parameters upon anatomical and functional outcomes was performed, as well as health economic analysis on costs and derived utilities/QALYs of these surgical methods. Results: Of all patients, 130 (86%) were successfully operated on, and 21 patients (14%) required another surgical procedure. No statistically significant differences in the anatomical success between the 3 surgical techniques were found. However, the functional outcome (based on the final best corrected visual acuity (BCVA)) differed significantly. Despite improvement in the final BCVA, BCVA ≥ 0.5 was achieved in only 52 (34.4%) patients. The final BCVA showed significant association with the time elapsed from the onset of RRD to the surgical intervention, pre-operative BCVA, macular- and preoperative lens- status and type of surgery. The estimated diagnosis-related group (DRG) cost for day and inpatient surgery was based upon existing DRG cost for PPV, which for PR and SB was calculated accordingly. Based upon the success of the procedure and visual outcome, the overall calculated QALYs for PR and SB appeared to be similar, while the QALYs were lower for PPV. Conclusions: The success rate of treating RRD mostly depends on performing an early surgical procedure (especially in the case of attached macula), identification of all retina tears and, most importantly, choosing the appropriate surgical technique. Decisions on treatment for RRD should also be based upon cost-effective and QALYs-assessed procedures, especially in countries like Croatia, where limited healthcare resources exist. This study shows PR to be efficient and most cost-effective for RRD repairment in appropriate cases.
RESUMO
The aim of the study was to determine the incidence of monosymptomatic optic neuritis (MON) in residents of Split-Dalmatia County, Croatia. The 127 cases (83 female, aged 26.2+/-9.9 and 44 male aged 26.9+/-11.2) with MON presented between January 1985 and December 2001 were analyzed from hospital data. The annual incidence was 1.6 per 100,000 (95% CI, 0-3). The incidence among females was 2.2 (95% CI, 0-4.6) cases / 100,000 per year and 1.1 (95% CI, 0-3) among males. The difference in incidence rates for women vs. men was not significant (chi2=0.41; p=0.52), although it is more likely that a true difference exists. The peak incidence in both sexes observed in the group 20-29 years of age was 4.2 (95% CI, 0-10). The highest incidence of MON was found in spring (46 cases). In summary, the incidence of MON in Split-Dalmatia County during the 17 years period is relatively low.
