Vision-related functioning in patients undergoing pneumatic retinopexy vs. vitrectomy for primary rhegmatogenous retinal detachment: Sub-analysis of the PIVOT trial
What:
Paper Presentation | Présentation d'article
Part of:
When:
2:30 PM, Sunday 3 Jun 2018
(10 minutes)
Where:
How:
Authors: Carolina L. M. Francisconi, Roxane J. Hillier, Tina Felfeli, Louis R. Giavedoni, David T. Wong, Alan R. Berger, Filiberto Altomare, Rahda P. Kohly, Rajeev H. Muni
Author Disclosure Block: C.L.M. Francisconi: None. R.J. Hillier: None. T. Felfeli: None. L.R. Giavedoni: None. D.T. Wong: None. A.R. Berger: None. F. Altomare: None. R.P. Kohly: None. R.H. Muni: None.
Abstract Body:
Purpose: The management of rhegmatogenous retinal detachment (RRD) varies markedly among surgeons largely based on prior experience, local culture, patient age and lens status. PIVOT was a prospective RCT that compared long-term outcomes of RRD repair in patients undergoing pneumatic retinopexy (PnR) vs. pars plana vitrectomy (PPV). Patients undergoing PnR had superior visual acuity and reduced morbidity with fewer patients requiring cataract surgery at 1 year. The PnR group had a lower primary anatomical success rate (81%PnR vs 93% with PPV), however both groups achieved a 99% final retinal reattachment (secondary success). Patients who had PnR demonstrated higher overall vision-related functioning (NEI-VFQ25 Composite Score) at 3 and 6 months, with no significant difference at 1 year. The purpose of this study was to determine which subscales within the NEI-VFQ25 were significantly different between groups.
Study Design: RCT
Methods: Prospective RCT conducted between August 2012 and May 2017. RRDs presenting with a single retinal break, or group of breaks no larger than one clock hour, above the 8 and 4 o’clock meridians were included. Macula-on and -off RRDs were assigned to each group by stratified randomization and treated within 24 and 72 hours respectively. Patient reported visual-related functioning was assessed at 3, 6 and 12 months using the NEI-VFQ25 questionnaire. The NEI-VFQ25 is composed by 12 subscales: General Health, General Vision, Ocular Pain, Near Activities, Distance Activities, Vision Specific:Social Functioning, Vision Specific:Mental Health, Vision Specific: Role Difficulties, Vision Specific:Dependency, Driving, Color Vision and Peripheral Vision.
Results: 157 patients were included in this sub-analysis. PnR was associated with superior vision-related functioning; specifically, significant differences (p<0.05) were noted in the Distance Activities (PnR 88±14,PPV 81±19), Mental Health (PnR 82±18,PPV 74±24), Role Difficulties (PnR 85±20,PPV 77±23), Dependency (PnR 94±13,PPV 88±20) and Peripheral Vision (PnR 88±19,PPV 79±24) at 3 months and Distance Activities (PnR 89±13,PPV 83±17), Mental Health (PnR 84±17,PPV 79±21) and Peripheral Vision (PnR 91±16,PPV 81±24) at 6 months. There was no significant difference between the two groups at 1 year.
Conclusions: This is the first RCT that compared PnR vs PPV from the patient’s perspective using the NEIVFQ25. The results of this study demonstrate that patients undergoing PnR have superior vision-related functioning during the first 6 months after retinal detachment repair. PnR was associated with a faster recovery of functioning related to distance vision, peripheral vision, independence and daily activities. The differences between PnR and PPV in the NEI-VFQ25 Composite Score and various subscales scores are likely explained by PnR being a less invasive procedure, with faster recovery, superior visual acuity and less morbidity when compared to PPV for patients enrolled in the PIVOT trial.
Author Disclosure Block: C.L.M. Francisconi: None. R.J. Hillier: None. T. Felfeli: None. L.R. Giavedoni: None. D.T. Wong: None. A.R. Berger: None. F. Altomare: None. R.P. Kohly: None. R.H. Muni: None.
Abstract Body:
Purpose: The management of rhegmatogenous retinal detachment (RRD) varies markedly among surgeons largely based on prior experience, local culture, patient age and lens status. PIVOT was a prospective RCT that compared long-term outcomes of RRD repair in patients undergoing pneumatic retinopexy (PnR) vs. pars plana vitrectomy (PPV). Patients undergoing PnR had superior visual acuity and reduced morbidity with fewer patients requiring cataract surgery at 1 year. The PnR group had a lower primary anatomical success rate (81%PnR vs 93% with PPV), however both groups achieved a 99% final retinal reattachment (secondary success). Patients who had PnR demonstrated higher overall vision-related functioning (NEI-VFQ25 Composite Score) at 3 and 6 months, with no significant difference at 1 year. The purpose of this study was to determine which subscales within the NEI-VFQ25 were significantly different between groups.
Study Design: RCT
Methods: Prospective RCT conducted between August 2012 and May 2017. RRDs presenting with a single retinal break, or group of breaks no larger than one clock hour, above the 8 and 4 o’clock meridians were included. Macula-on and -off RRDs were assigned to each group by stratified randomization and treated within 24 and 72 hours respectively. Patient reported visual-related functioning was assessed at 3, 6 and 12 months using the NEI-VFQ25 questionnaire. The NEI-VFQ25 is composed by 12 subscales: General Health, General Vision, Ocular Pain, Near Activities, Distance Activities, Vision Specific:Social Functioning, Vision Specific:Mental Health, Vision Specific: Role Difficulties, Vision Specific:Dependency, Driving, Color Vision and Peripheral Vision.
Results: 157 patients were included in this sub-analysis. PnR was associated with superior vision-related functioning; specifically, significant differences (p<0.05) were noted in the Distance Activities (PnR 88±14,PPV 81±19), Mental Health (PnR 82±18,PPV 74±24), Role Difficulties (PnR 85±20,PPV 77±23), Dependency (PnR 94±13,PPV 88±20) and Peripheral Vision (PnR 88±19,PPV 79±24) at 3 months and Distance Activities (PnR 89±13,PPV 83±17), Mental Health (PnR 84±17,PPV 79±21) and Peripheral Vision (PnR 91±16,PPV 81±24) at 6 months. There was no significant difference between the two groups at 1 year.
Conclusions: This is the first RCT that compared PnR vs PPV from the patient’s perspective using the NEIVFQ25. The results of this study demonstrate that patients undergoing PnR have superior vision-related functioning during the first 6 months after retinal detachment repair. PnR was associated with a faster recovery of functioning related to distance vision, peripheral vision, independence and daily activities. The differences between PnR and PPV in the NEI-VFQ25 Composite Score and various subscales scores are likely explained by PnR being a less invasive procedure, with faster recovery, superior visual acuity and less morbidity when compared to PPV for patients enrolled in the PIVOT trial.
