Variations in Functional and Anatomical Outcomes and in Proliferative Vitreoretinopathy Rate along a Prospective Collaborative Study on Primary Rhegmatogenous Retinal Detachments: The Retina 1 Project—Report 4
Purpose. To analyse variations in the anatomical and functional outcomes and in proliferative vitreoretinopathy (PVR) rate of a prospective multicentric study that was primarily designed for identification of clinical risk factors for PVR. Methods. 1,046 retinal detachment (RD) cases were analysed. Cases were divided into two series based upon variation in PVR rate determined by logistic regression analysis. Series 1 (S1) included RD treated during 2004-2005 ( ) and Series 2 (S2) during 2006–2008 ( ). Pre-, intra-, and postoperative characteristics were recorded. Results. There were few differences in the preoperative characteristics. S2 had more vitrectomies and scleral bands and fewer explants and associated cataract extractions than S1. Anatomic reattachment improved from 87.9% to 92.9% in S1 and S2, respectively, ( ). Visual acuity at 3 months ≥20/40 increased from 36.5% of S1 to 44.2% in S2 ( ). PVR rate diminished from 14.1% in S1 to 8.1% in S2 ( ). Centres with higher rates of PVR in S1 showed the greatest reductions in S2. Conclusion. An improvement in anatomical and functional outcome and PVR rate occurred in participating centres cannot be attributed to the learning curve of surgeons. We speculated that it could be an effect of their participation in the study. 1. Introduction In 2005, after a retrospective case-controlled study involving five clinical centres, we developed a formula to estimate the risk of proliferative vitreoretinopathy (PVR) onset after rhegmatogenous retinal detachment (RD) surgery [1]. Even though the sensitivity and specificity values of that formula were higher than other predictive formulas [2], it was not considered appropriate for routine clinical use. Thus the Retina 1 project was designed to improve that predictive formula by increasing the sample. This project consisted of a prospective study involving 17 centres in Spain and Portugal that collected pre-, intra-, and postoperative data for consecutive, noncomplicated RDs for over 1,000 cases between 2004 and 2008. Statistical analysis of the collected data performed after closing the recruitment period revealed an inflexion point indicating a significant reduction in PVR rate at the end of 2005. Careful analysis of the pre- and post-2005 data also showed improvements in reattachment rate which could not be attributed to differences in preoperative and intraoperative characteristics. Thus, we hypothesized that active collaborative participation of surgeons in the project might have had a positive influence in their outcomes. Although the main purpose of the Retina
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