UPFRONT

European-style Surgical Retina

Peter K. Kaiser, MD

The other day, in our weekly Cole Retina Service surgical rounds, one of our graduating fellows polled how the retina faculty would repair various clinical scenarios involving primary rhegmatogenous retinal detachments. The results were interesting in that, depending on when and where you performed your retina fellowship, your answer to the scenario was different.

Makes sense. We tend to repair primary retinal detachments with techniques we learned in our fellowships. Historically, this treatment was based on applying cryopexy and imbricating the sclera with a scleral buckle, as popularized by Dr. Charles Schepens and others.

This technique has worked for years, but recently, more and more retina specialists finish their fellowships preferring primary pars plana vitrectomy to fix these problems. (On page 22, Dr. Steve Charles, a pioneer in vitrectomy surgery, describes tips and tricks on performing this surgery.)

But do new retina specialists prefer pars plana vitrectomy because it’s a better way to repair primary retinal detachments, or are fewer retina fellowships teaching proper scleral buckling techniques?

Over the years, newer instruments, better surgical machines, and different treatment ideas have been proposed, but like many things we do in surgery, what works best is often based on personal opinion and prior results.

At the Cole Eye Institute, we have been performing outcomes analysis of our retinal surgeries for years, but the numbers are too small to prove which method is better.

Outside of diabetes, and in contrast to the excellent clinical studies for medical therapies, there have been very few randomized clinical trials in retinal surgery. So how do we decide what is best?

The European Vitreo-Retinal Society has set out to answer this question with a retrospective registry of its members. (Results of this study appear on page 31). The results may surprise you, because they may not coincide with how you repair retinal detachments.

But there are many important caveats before you reach too many conclusions from the study, including the most important, which is that this was a retrospective registry which carried significant reporting bias.

The importance of this study cannot be overstated, and it points to the need for additional prospective studies, especially in diagnosis, in which we perform so many surgeries, such as retinal detachments.

The EVRS is not waiting and is continuing to forge ahead with other retrospective analyses of other surgical techniques. We look forward to seeing these in the years to come.