Retina Surgery

Single Surgery Reattachment Rate for Primary Rhegmatogenous Retinal Detachment

^The decrease in the number of included surgeries is due in part to an increasing number of complex cases managed by the Retina Service in addition to an increase in cases with insufficient follow up due to COVID-19.

At the Retina Service, primary rhegmatogenous retinal detachment (RRD) is one of the most common retinal conditions that requires surgical repair. Our clinicians repair RRDs with pneumatic retinopexy, pars plana vitrectomy, and/or scleral buckle surgery.

During calendar year 2023, the Retina Service performed a total of 1,679 procedures, of which 833 were for retinal detachments (RDs). From these 833 cases, the following were excluded: chronic RDs of greater than one month duration; exudative and tractional RDs; RDs associated with proliferative vitreoretinopathy, macular holes, or trauma; prior pars plana vitrectomy; patients younger than 18 years of age; cases associated with Marfan’s or Stickler’s syndrome; and cases with insufficient follow-up. After exclusion criteria were applied, 401 uncomplicated primary RRD surgeries remained for the following analysis. The single surgery reattachment rate, defined as an attached retina 3-5 months post-operatively, was 95.01% (or 381 of 401 eyes). Similar results were reported for calendar years 2014 to 2022.

Benchmarks were determined from a literature review of studies that reported single surgery reattachment rates for at least two of the three surgical techniques in this analysis (e.g., pneumatic retinopexy, pars plana vitrectomy, and/or scleral buckle).

Final Retinal Reattachment Rate for Primary Rhegmatogenous Retinal Detachment

^The decrease in the number of included surgeries was due in part to an increasing number of complex cases managed by the Retina Service in addition to an increase in cases with insufficient follow-up during COVID-19.

During calendar year 2023, 401 uncomplicated primary RRD surgeries were analyzed to determine the final retinal reattachment rate.

Retinal reattachment was successfully achieved in 100% of the 401 eyes. This reattachment rate reflects eyes that had one or more surgeries, which may have included pars plana vitrectomy, scleral buckle, and pneumatic retinopexy. These 401 eyes had at least three months of follow-up from the date of the last surgery. Data were collected from visits closest to three months, but up to five months, postoperatively.

Macular Hole Surgery: Single Surgery Closure Rate at Five Months Follow-Up

*Beginning in 2020, macular hole follow-up was included between one week to five months, taking the status of the macular hole closest to the patient's five-month follow-up.

During calendar year 2023, the Retina Service performed 133 macular hole surgeries. Of these, the following were excluded: macular holes associated with RRD or trauma, holes with a history of prior pars plana vitrectomy, macular holes of greater than 6 months duration, and cases with insufficient follow-up. After exclusion criteria were applied, a total of 59 primary macular hole surgeries on 59 eyes (which included pars plana vitrectomy, membrane peel, and gas tamponade) were included in the following analysis.

Of the 59 eyes, 58 (98.3%) achieved surgical success with a single operation. Success was defined as any primary macular hole that was fully closed on an exam between one week and five months following their first surgery, taking the status of the macular hole closest to the patient’s five-month follow-up. A review of the literature suggests that single surgery success rates for macular hole surgery range from 89.8% to 93.0%.^1-3 Of the 59 eyes included for analysis in calendar year 2023, 100% of the 59 eyes achieved surgical success after one or two surgeries.

Rates of Endophthalmitis After Intravitreal Injection

During the 2023 calendar year, the Retina Service performed 22,424 intravitreal injections (IVIs). Of these, eight cases of infectious endophthalmitis were identified after IVI.

Over a five-year period, the overall incidence rate of endophthalmitis subsequent to intravitreal injection was 0.015% (14 of 90,806 injections).

Management of Intraocular Tumors

The Ocular Melanoma Center at Mass Eye and Ear is an international referral center for the diagnosis and treatment of eye neoplasms.

Uveal melanoma can be treated effectively with proton beam irradiation, achieving high rates of local control, and preserving visual function in many patients. The Ocular Melanoma Center closely examines the recurrence rate at three years following treatment. Results of patients diagnosed and treated in 2020 are presented above.

Eighty-six patients were diagnosed with primary uveal melanoma (UM) and one patient was diagnosed with recurrent melanoma in calendar year 2020. Of these, eighty patients received proton beam irradiation, three patients had an enucleation, one patient elected to participate in a clinical trial, and the remaining three patients were treated elsewhere. Of those treated with proton therapy, seventy-seven returned for at least one follow-up visit after completion of PBI, and sixty-three patients (81.8%) had three or more years (defined as a follow-up visit at 33 months or later) of follow-up. Median follow-up time was 42.7 months (range: 5.6 months to 54.4 months). Three patients (3/77; 3.9%) developed recurrences, and the eyes were enucleated in all cases. One patient who developed a recurrence at 5.2 months after PBI developed metastasis approximately 6 months after the local recurrence and died 6 months later despite receiving immunotherapy. The tumor recurred at 15.9 months and 26.7 months after initial treatment in the remaining patients. These two patients are alive and metastasis free 53.6 months and 47.5 months after receiving PBI, respectively.