Retinopexia neumática en el tratamiento del desprendimiento de retina regmatógeno: Análisis comparativo basado en el ensayo pivot
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Fecha
2024
Autores
Salgado Gómez, Danny
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Ediciones Universidad Simón Bolívar
Facultad Ciencias de la Salud
Facultad Ciencias de la Salud
Resumen
Objetivo: Identificar el éxito de la retinopexia neumática en el tratamiento del desprendimiento de retina regmatógeno en pacientes que cumplen los criterios del ensayo PIVOT. Materiales y Métodos: Se realizó un estudio observacional, retrospectivo y unicéntrico con el objetivo de identificar el éxito de la retinopexia neumática en el tratamiento del desprendimiento de retina regmatógeno en pacientes que cumplen los criterios del ensayo Retinopexia Neumática versus Vitrectomía (PIVOT). El estudio se llevó a cabo en un centro oftalmológico de referencia. Los datos se obtuvieron de una base de datos proporcionada por el centro, donde se seleccionaron los casos teniendo en cuenta los siguientes criterios de inclusión: una única rotura de retina o un grupo de roturas no mayor a una hora (30 grados) en el área desprendida, todas las roturas ubicadas por encima del meridiano de las 8 y las 4 en punto, y roturas o degeneración reticular en la retina adherida en cualquier localización (incluso inferior). Los criterios de exclusión incluyeron: roturas inferiores en desprendimiento de retina, opacidad media significativa (como hemorragia vítrea o cataratas que dificultan un examen detallado de la retina), vitreorretinopatía proliferativa (PVR) grado B o peor, antecedentes de desprendimiento de retina previo u operación de vitrectomía previa en el ojo afectado, edad menor de 18 años, incapacidad mental y física para mantener una postura postoperatoria adecuada. Las variables evaluadas incluyeron edad, sexo, estado preoperatorio del cristalino, estado macular, tamaño del desprendimiento, localización de los desgarros, presencia de desgarros en retina adherida, degeneración lattice en retina adherida, hemorragia vítrea, días transcurridos desde la aparición de los síntomas hasta la cirugía y días desde la primera consulta hasta la cirugía. Se verificó la normalidad de las variables continuas mediante la prueba de Kolmogórov-Smirnov. Las variables continuas se presentaron como media ± desviación estándar o mediana con rango intercuartílico, según correspondía. Las variables categóricas se expresaron en términos de valores absolutos y porcentajes. Resultados: La RP tuvo una tasa de éxito anatómico con una sola intervención (SOS) del 85,71% (90 pacientes). 15 pacientes (14,29%) requirieron vitrectomía pars plana (VPP) adicional (RN fallida). No se observaron diferencias significativas en las características demográficas, estado del cristalino preoperatorio o estado macular preoperatorio entre los grupos SOS y RN fallida. Las complicaciones menores incluyeron hemorragia vítrea leve (5 pacientes en SOS; 1 en RN fallida). La mediana de tiempo desde el inicio de síntomas hasta la intervención fue similar entre grupos (10 días en SOS vs 7 días en RN fallida). Conclusiones: Los resultados del estudio indican que un número significativo de pacientes con Desprendimiento de Retina Regmatógeno (DRR) cumplen con los criterios del ensayo PIVOT, lo que sugiere que la retinopexia neumática (RN) podría ser una opción terapéutica viable para un grupo más amplio de pacientes de lo previamente considerado. La preferencia por la RN en pacientes elegibles refleja una tendencia hacia técnicas menos invasivas, respaldada por excelentes resultados anatómicos y tasas de éxito consistentes que no dependen de características demográficas. La efectividad de la RN se extiende a una población diversa, lo que amplía su aplicabilidad. El análisis del manejo preoperatorio resalta la naturaleza multimodal de la RN y la importancia del láser postoperatorio en el éxito a largo plazo. Sin embargo, la necesidad ocasional de intervenciones adicionales resalta la importancia del seguimiento individualizado y la flexibilidad en el tratamiento.
Objective: To identify the success of pneumatic retinopexy in the treatment of rhegmatogenous retinal detachment in patients meeting the PIVOT trial criteria. Materials and Methods: An observational, retrospective, single-center study was conducted with the objective of identifying the success of pneumatic retinopexy in the treatment of rhegmatogenous retinal detachment in patients who met the inclusion criteria of the Pneumatic Retinopexy versus Vitrectomy (PIVOT) trial. The study was carried out in a reference ophthalmological center. The data were obtained from a database provided by the center, selecting cases that met the following inclusion criteria: a single retinal break or a group of breaks no longer tan one hour (30 degrees) in the detached area, all breaks located above the 8 and 4 o'clock meridian, and breaks or reticular degeneration in the attached retina at any location (even inferior). Exclusion criteria included: inferior breaks in retinal detachment, significant media opacity (such as vitreous hemorrhage or cataracts that make detailed examination of the retina difficult), proliferative vitreoretinopathy (PVR) grade B or worse, history of previous retinal detachment or operation of previous vitrectomy in the affected eye, age under 18 years, mental and physical inability to maintain an adequate postoperative posture. The variables evaluated included age, sex, preoperative lens status, macular status, size of the detachment, location of the tears, presence of tears in the attached retina, lattice degeneration in the attached retina, vitreous hemorrhage, days elapsed from the onset of symptoms to surgery and days from the first consultation to surgery. The normality of continuous variables was verified using the Kolmogorov-Smirnov test. Continuous variables were presented as mean ± standard deviation or median with interquartile range, as appropriate. Categorical variables were expressed in terms of absolute values and percentages. Results: Pneumatic Retinopexy (PR) had an anatomical success rate with a single intervention (SOS) of 85.71% (90 patients). 15 patients (14.29%) required additional pars plana vitrectomy (PPV) (failed PR). A single operation success for patients with retinal detachment > 2 quadrants was evidenced (p=0.045). No significant differences in demographic characteristics, preoperative lens status, or preoperative macular status were observed between the SOS and failed PR groups. The median time from symptom onset to intervention was similar between groups (10 days in SOS vs. 7 days in failed PR). Conclusions: Study results indicate that a significant number of patients with Rhegmatogenous retinal detachment (RRD) meet the PIVOT trial criteria, suggesting that pneumatic retinopexy (PR) could be a viable therapeutic option for a broader group of patients than previously considered. The preference for PR in eligible patients reflects a trend toward less invasive techniques, supported by excellent anatomical outcomes and consistent success rates that are not dependent on demographic characteristics. The effectiveness of PR extends to a diverse population, broadening its applicability. Analysis of preoperative management highlights the multimodal nature of PR and the importance of postoperative laser in long-term success. However, the occasional need for additional interventions highlights the importance of individualized follow-up and flexibility in treatment.
Objective: To identify the success of pneumatic retinopexy in the treatment of rhegmatogenous retinal detachment in patients meeting the PIVOT trial criteria. Materials and Methods: An observational, retrospective, single-center study was conducted with the objective of identifying the success of pneumatic retinopexy in the treatment of rhegmatogenous retinal detachment in patients who met the inclusion criteria of the Pneumatic Retinopexy versus Vitrectomy (PIVOT) trial. The study was carried out in a reference ophthalmological center. The data were obtained from a database provided by the center, selecting cases that met the following inclusion criteria: a single retinal break or a group of breaks no longer tan one hour (30 degrees) in the detached area, all breaks located above the 8 and 4 o'clock meridian, and breaks or reticular degeneration in the attached retina at any location (even inferior). Exclusion criteria included: inferior breaks in retinal detachment, significant media opacity (such as vitreous hemorrhage or cataracts that make detailed examination of the retina difficult), proliferative vitreoretinopathy (PVR) grade B or worse, history of previous retinal detachment or operation of previous vitrectomy in the affected eye, age under 18 years, mental and physical inability to maintain an adequate postoperative posture. The variables evaluated included age, sex, preoperative lens status, macular status, size of the detachment, location of the tears, presence of tears in the attached retina, lattice degeneration in the attached retina, vitreous hemorrhage, days elapsed from the onset of symptoms to surgery and days from the first consultation to surgery. The normality of continuous variables was verified using the Kolmogorov-Smirnov test. Continuous variables were presented as mean ± standard deviation or median with interquartile range, as appropriate. Categorical variables were expressed in terms of absolute values and percentages. Results: Pneumatic Retinopexy (PR) had an anatomical success rate with a single intervention (SOS) of 85.71% (90 patients). 15 patients (14.29%) required additional pars plana vitrectomy (PPV) (failed PR). A single operation success for patients with retinal detachment > 2 quadrants was evidenced (p=0.045). No significant differences in demographic characteristics, preoperative lens status, or preoperative macular status were observed between the SOS and failed PR groups. The median time from symptom onset to intervention was similar between groups (10 days in SOS vs. 7 days in failed PR). Conclusions: Study results indicate that a significant number of patients with Rhegmatogenous retinal detachment (RRD) meet the PIVOT trial criteria, suggesting that pneumatic retinopexy (PR) could be a viable therapeutic option for a broader group of patients than previously considered. The preference for PR in eligible patients reflects a trend toward less invasive techniques, supported by excellent anatomical outcomes and consistent success rates that are not dependent on demographic characteristics. The effectiveness of PR extends to a diverse population, broadening its applicability. Analysis of preoperative management highlights the multimodal nature of PR and the importance of postoperative laser in long-term success. However, the occasional need for additional interventions highlights the importance of individualized follow-up and flexibility in treatment.
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Palabras clave
Retina, Desprendimiento de retina, Enfermedades de la retina, Vitrectomia