Breaking News
December 13, 2018 - NIH offers support for HIV care and prevention research in the southern United States
December 12, 2018 - Activating brain region could revive the urge to socialize among opioid addicts
December 12, 2018 - Relationship impairment appears to interfere with seeking mental health treatment in men
December 12, 2018 - Sleep, Don’t Cram, Before Finals for Better Grades
December 12, 2018 - Effective treatments for urticarial vasculitis
December 12, 2018 - Gun violence is a public health issue: One physician’s story
December 12, 2018 - The Science of Healthy Aging
December 12, 2018 - Yes to yoghurt and cheese: New improved Mediterranean diet
December 12, 2018 - Researchers uncover a number of previously unknown insecticide resistance mechanisms
December 12, 2018 - Regulating the immune system’s ‘regulator’
December 12, 2018 - In breaking bad news, the comfort of silence
December 12, 2018 - Study finds upward link between alcohol consumption and physical activity in college students
December 12, 2018 - FDA issues warning letter to Zhejiang Huahai Pharmaceutical involved in valsartan recall
December 12, 2018 - Presence of antiphospholipid antibodies tied to first-time MI
December 12, 2018 - New study could help inform research on preventing falls
December 12, 2018 - Women and men with heart attack symptoms receive different care from EMS
December 12, 2018 - Disrupted biological clock can contribute to onset of diseases, USC study shows
December 12, 2018 - New publications generate controversy over the value of reducing salt consumption in populations
December 12, 2018 - New data from TAILORx trial confirms lack of chemo benefit regardless of race or ethnicity
December 12, 2018 - Specific class of biomarkers can accurately indicate the severity of cancer
December 12, 2018 - Meds Taken Do Not Vary With ADL Impairment in Heart Failure
December 12, 2018 - Long-term study shows that HIV-2 is deadlier than previously thought
December 12, 2018 - People living near oil and gas wells show early signs of cardiovascular disease
December 12, 2018 - IONTAS founder and pioneer in phage display technology attends Nobel Prize Award Ceremony
December 12, 2018 - People who eat red meat have high levels of chemical associated with heart disease, study finds
December 12, 2018 - New method uses water molecules to unlock neurons’ secrets
December 12, 2018 - Genetics study offers hope for new acne treatment
December 12, 2018 - New computer model predicts prostate cancer progression
December 12, 2018 - Nobel Laureates lecture about immune checkpoint therapy for cancer treatment
December 12, 2018 - More Illnesses From Tainted Romaine Lettuce Reported
December 12, 2018 - Aspirin could reduce HIV infections in women
December 12, 2018 - The EORTC Brain Tumor Group and Protagen AG collaborate to study immuno-competence of long-term glioblastoma survivors
December 12, 2018 - Insights into magnetotactic bacteria could guide development of biological nanorobots
December 12, 2018 - Sacrificial immune cells alert body to infection
December 12, 2018 - Low-salt diet may be more beneficial for females than males
December 12, 2018 - Major soil organic matter compound battles chronic wasting disease
December 12, 2018 - Findings may open up new ways to treat dwarfism and other ER-stress-related conditions
December 12, 2018 - New computational model provides clearer picture of shape-changing cells’ structure and mechanics
December 12, 2018 - 10 Facts on Patient Safety
December 12, 2018 - Poorest dying nearly 10 years younger than the rich in ‘deeply worrying’ trend for UK
December 12, 2018 - Innovative care model for children with ASD reduces use of behavioral drugs in ED
December 12, 2018 - Spending time in and around Hong Kong’s waters linked to better health and wellbeing
December 12, 2018 - Simple measures to prevent weight gain over Christmas
December 12, 2018 - Research advances offer hope for patient-tailored AML treatment
December 12, 2018 - Researchers discover a ‘blind spot’ in atomic force microscopy
December 12, 2018 - Sprayable gel could help prevent recurrences of cancer after surgery
December 12, 2018 - SLU researchers explore how fetal exposure to inflammation can alter immunity in newborns
December 12, 2018 - How do patients want to discuss symptoms with clinicians?
December 12, 2018 - Zinc chelation may be able to deliver drug to insulin-producing cells
December 12, 2018 - Brigham researchers develop automated, low-cost tool to predict a woman’s ovulation
December 12, 2018 - Some people with Type 2 diabetes may be testing their blood sugar more often than needed
December 12, 2018 - Slow-growing type of glioma may be vulnerable to immunotherapy, suggests study
December 12, 2018 - Study provides new information regarding microRNA function in cellular homeostasis of zebrafish
December 12, 2018 - Study provides new understanding of mysterious ‘hereditary swelling’
December 12, 2018 - Researchers shed new light on how to combat Shiga and ricin toxins
December 12, 2018 - Pregnant Women Commonly Refuse Vaccines
December 12, 2018 - Drug treatment could offer new hope for some patients with brain bleeding
December 12, 2018 - Health care financial burden of animal-related injuries is growing, study says
December 12, 2018 - Macrophage cells could help repair the heart following a heart attack, study finds
December 12, 2018 - Researchers develop new system for efficiently producing human norovirus
December 12, 2018 - New artificial intelligence-based system to differentiate between different types of cancer cells
December 11, 2018 - Brazilian professors propose guidelines for therapeutic use of melatonin
December 11, 2018 - Healthy Lifestyle Lowers Odds of Breast Cancer’s Return
December 11, 2018 - New research identifies two genes linked to serious congenital heart condition
December 11, 2018 - NIH Director talks science, STEM careers with preteens
December 11, 2018 - Disabling a Cellular Antivirus System Could Improve Gene Therapy
December 11, 2018 - New tool swiftly provides accurate measure of patients’ cognitive difficulties
December 11, 2018 - NICE releases new guidelines for diagnosis and management of COPD
December 11, 2018 - Without Obamacare penalty, think it’ll be nice to drop your plan? Better think twice
December 11, 2018 - Researchers capture high-resolution X-ray and NMR image of key immune regulator
December 11, 2018 - Natural flavonoid is effective at treating leishmanisis infections, study shows
December 11, 2018 - Avoidant grievers unconsciously monitor and block mind-wandering contents, study shows
December 11, 2018 - Study identifies how hantaviruses infect lung cells
December 11, 2018 - Improving PTSD care through genetics
December 11, 2018 - Dermatology providers show interest in recommending cannabinoids to patients
December 11, 2018 - Researchers to study effects of electroconvulsive therapy on Alzheimer’s patients with aggression
December 11, 2018 - Four dried fruits have lower glycemic index than starchy foods, study finds
December 11, 2018 - Optimization of drug dose sizes can reduce pharmaceutical wastage
December 11, 2018 - Ultrarestrictive opioid prescribing strategy linked with reduction in number of pills dispensed
December 11, 2018 - PET scans to optimize tuberculosis meningitis treatments and personalize care, study finds
Trial results show minimally invasive retinal detachment improves outcomes in patients

Trial results show minimally invasive retinal detachment improves outcomes in patients

image_pdfDownload PDFimage_print

A minimally invasive treatment for retinal detachment gives patients sharper vision, less distortion and reduced side-effects, according to the findings of a randomized controlled trial performed at St. Michael’s Hospital in Toronto.

The findings have been published in Ophthalmology, the journal of the American Academy of Ophthalmology.

“The most commonly offered treatment for a retinal detachment in North America is an operating room surgery called a vitrectomy. The results of this study clearly demonstrate that many retinal detachments will have better results for patients with an alternative minimally invasive office procedure,” said co-principal investigator Dr. Rajeev H. Muni, a vitreoretinal surgeon at St. Michael’s and researcher at the hospital’s Li Ka Shing Knowledge Institute.

“Although the better vision with the minimally invasive treatment (called pneumatic retinopexy, or PnR) is the most important finding of the study — and it should change how most retina specialists treat simple retinal detachments — we cannot ignore that PnR is also significantly less expensive to perform than vitrectomy (PPV), and offers significant hope to patients with retinal detachments in developing countries who would otherwise not be able to access care,” said Dr. Muni.

“There are many countries where patients simply don’t get treated in time because they can’t afford it. There are places where people with a detached retina just go blind.”

Dr. Roxane J. Hillier, the trial’s other co-principal investigator who is now based in the United Kingdom, said Europe has not yet fully embraced PnR primarily because of traditional practice patterns and misconceptions about the minimally invasive procedure.

“These findings cannot be ignored, by physicians and patients alike,” said Dr. Hillier. “The next step is to educate surgeons worldwide about the ‘art’ of this elegant procedure, so that the excellent outcomes achieved in this trial can be replicated worldwide.”

The trial involved 176 patients who were randomly assigned to either PnR or PPV after being diagnosed with a retinal detachment. The primary outcome being researched was visual acuity one year after treatment, as well as a metamorphopsia score for visual distortion, and anatomical success.

Patients who underwent PnR scored an average of 4.9 letters better on a standardized visual acuity test compared to those who had PPV, and had less visual distortion. A greater proportion of patients who had PnR achieved driving vision (20/40) in the affected eye (90.3 percent vs 75.3 percent). Although patients who had PPV treatment did have higher rates of primary anatomical success (93.2 percent versus 80.8 percent), patients who failed PnR still had very good visual outcomes, with secondary anatomical success being virtually identical between the groups.

Patients in the PnR group also reported quicker recoveries and better quality of life in the six months after being treated.

“One downside of PPV is that many patients will require a second operation, cataract surgery, within a year. This significantly delays visual recovery and can be avoided for the most part with PnR,” said Dr. Hillier.

Dr. Paul E. Tornambe, past president of the American Society of Retina Specialists, congratulated Drs. Muni and Hillier and the rest of their team “for completing a well-conceived and well-done” prospective randomized clinical trial.

“It is rare to prove a procedure (in this case PnR) not only results in better vision, is less invasive, restores the anatomy of the eye to its pre-detachment state, and avoids the operating room, but also costs significantly less than the more commonly used operation,” said Dr. Tornambe.

Dr. Muni also highlighted that the trial was the first to demonstrate that PnR can minimize visual distortion following retinal detachment repair and potentially avoid the so-called “Picasso effect,” which causes some patients to suffer significant impairments to their vision.

“It can be debilitating, patients can read the letters on the eye chart, but everything is warped,” Dr. Muni said. “Many people end up learning to completely ignore the involved eye. The issue of distortion is very important for patients, and the fact that it can be minimized with PnR is likely related to the better quality of retinal reattachment obtained with the procedure.”

Dr. Hillier and Dr. Muni also have ongoing studies trying to explain specifically why patients with PnR seem to have a better quality retinal reattachment, and they expect to present convincing data within the next year that compares the two treatments from an anatomical perspective at the microscopic level.

“Our group at St. Michael’s is taking this work one step further and currently enrolling patients in another randomized controlled trial comparing the two treatments in more complex retinal detachments,” said Dr. Muni.

Source:

http://www.stmichaelshospital.com/

Tagged with:

About author

Related Articles