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Outer Retinal Folds Following Pars Plana Vitrectomy vs Pneumatic Retinopexy for Retinal Detachment Repair: Post Hoc Analysis from PIVOT

  • Wei Wei Lee
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, CANADA

    Department of Ophthalmology, St. Michael’s Hospital, Unity Health Toronto, CANADA
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  • Aditya Bansal
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, CANADA

    Department of Ophthalmology, St. Michael’s Hospital, Unity Health Toronto, CANADA
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  • Srinivas Sadda
    Affiliations
    Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA

    Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • David Sarraf
    Affiliations
    Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA

    Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • Alan R. Berger
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, CANADA

    Department of Ophthalmology, St. Michael’s Hospital, Unity Health Toronto, CANADA
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  • David T. Wong
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, CANADA

    Department of Ophthalmology, St. Michael’s Hospital, Unity Health Toronto, CANADA
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  • Peter J. Kertes
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, CANADA

    The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, CANADA

    Kensington Vision and Research Centre, University of Toronto, CANADA
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  • Radha P. Kohly
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, CANADA

    The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, CANADA

    Kensington Vision and Research Centre, University of Toronto, CANADA
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  • Roxane J. Hillier
    Affiliations
    Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK

    Institute of Translational and Clinical Research, Newcastle University, UK
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  • Rajeev H. Muni
    Correspondence
    Corresponding Author and Reprint Requests: Rajeev H. Muni, MD, MSc, FRCSC, Department of Ophthalmology, St. Michael’s Hospital, Unity Health Toronto, 8th floor, Donnelly Wing, St. Michael’s Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Phone: 416 867 7411, Fax: 416 867 7491
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, CANADA

    Department of Ophthalmology, St. Michael’s Hospital, Unity Health Toronto, CANADA

    Kensington Vision and Research Centre, University of Toronto, CANADA

    Keenan Research Centre for Biomedical Science/ Li Ka Shing Knowledge Institute, Toronto, Canada
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Published:September 11, 2021DOI:https://doi.org/10.1016/j.oret.2021.09.001

      ABSTRACT

      Purpose

      To assess the incidence of post-operative outer retinal folds (ORFs) in pars plana vitrectomy (PPV) vs pneumatic retinopexy (PnR) following rhegmatogenous retinal detachment (RRD) repair and to determine the association of ORFs with functional outcomes at 1 year.

      Design

      Randomized controlled trial

      Participants

      Patients with primary macula-off RRD meeting PIVOT trial criteria randomly assigned to PPV vs PnR.

      Methods

      Post-hoc analysis of the PIVOT trial. Incidence and quantitative morphological features of ORFs were assessed with en face and cross-sectional OCT at 1 month post-operatively by two masked graders. ETDRS letter score and quantitative metamorphopsia were measured at 1 year.

      Main Outcome Measures

      Proportion of patients with ORFs following PPV vs PnR at 1 month post-operatively. Secondary outcomes include the association of ORFs with visual acuity (ETDRS letter score) and metamorphopsia (M-CHARTS) at 12 months post-operatively.

      Results

      Eighty-eight of the 176 participants enrolled in PIVOT were macula-off RRD. 94.3% (83/88) of these macula-off eyes had month 1 post-operative OCT scans that were gradable, 93.2% (41/44) in the PPV group and 95.5% (42/44) in the PnR group. The incidence of ORFs formation was 34.1% (14/41) in the PPV group and 14.3% (6/42) in the PnR group (p=0.034). ETDRS letter score at 1 year was 65.7±6.6 letters in patients with ORFs versus 75.1±1.4 letters in those without ORFs (difference=9.4 letters, 95% CI=7.5-11.3, p=0.047). Among patients in the PPV group only, mean ETDRS letter score at 1 year in patients with ORFs was 62.8 ± 24.7 letters compared to 75.4 ± 9.2 letters in patients without ORF formation (difference=12.6 letters, 95% CI=0.05-24.59, p=0.04).
      Horizontal and vertical metamorphopsia scores were similar in patients with vs without ORFs: horizontal: 0.35 ± 0.12 versus 0.29 ± 0.07 (difference=0.06, 95% CI=0.01-0.11, p=0.69) and vertical: 0.25±0.07 versus 0.29±0.07 (difference=0.04, 95%CI=0-0.08, p=0.60) respectively. There was a negative correlation between the closest distance of the ORFs from the fovea and the vertical metamorphopsia score (r=-0.507, p=0.045).

      Conclusions

      There is a greater risk of developing ORFs following PPV compared to PnR for RRD. ORFs at 1 month are associated with significantly worse ETDRS visual acuity letter score at 1 year.

      Key Words

      Abbreviations and Acronyms:

      ELM (external limiting membrane), ETDRS (Early Treatment Diabetic Retinopathy Study), EZ (ellipsoid zone), LIRA (low-integrity retinal attachment), OCT (optical coherence tomography), ORCs (outer retinal corrugations), ORFs (outer retinal folds), PIVOT (The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial), PnR (pneumatic retinopexy), PPV (pars plana vitrectomy), RRD (rhegmatogenous retinal detachment)
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