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  • Persistent subfoveal fluid in pneumatic retinopexy versus pars plana vitrectomy for rhegmatogenous retinal detachment: posthoc analysis of the PIVOT randomised trial

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Clinical science
Persistent subfoveal fluid in pneumatic retinopexy versus pars plana vitrectomy for rhegmatogenous retinal detachment: posthoc analysis of the PIVOT randomised trial
  1. Aditya Bansal1,2,
  2. Wei Wei Lee2,
  3. David Sarraf3,
  4. SriniVas R. Sadda4,5,
  5. Alan R Berger1,2,
  6. David T Wong1,2,
  7. Peter J. Kertes2,6,
  8. Radha P. Kohly2,6,7,
  9. Roxane Jo Hillier8,9,
  10. Rajeev H. Muni1,2,7
  1. 1 Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
  2. 2 Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  3. 3 Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  4. 4 Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
  5. 5 Ophthalmology, University of California—Los Angeles, Los Angeles, California, USA
  6. 6 The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  7. 7 Kensington Vision and Research Centre, University of Toronto, Toronto, Ontario, Canada
  8. 8 Newcastle Eye Centre, Newcastle upon Tyne, UK
  9. 9 Institute of Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Rajeev H. Muni, Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, 8th floor Donnelly Wing, 30 Bond Street, Toronto, Ontario, Canada, M5B1W8; rajeev.muni{at}gmail.com

Abstract

Purpose To assess the incidence of persistent subfoveal fluid (PSFF) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) following rhegmatogenous retinal detachment (RRD) repair and to determine its association with functional outcomes.

Methods Posthoc analysis of the PIVOT randomised trial. Eyes with gradable en face and cross-sectional spectral-domain optical coherence tomography (SD-OCT) scans at 1–2 months postoperatively were included. Primary outcome was the proportion of patients with PSFF following PnR versus PPV at 1–2 months postoperatively. Secondary outcomes included association of PSFF with Early Treatment Diabetic Retinopathy Study (ETDRS) letter score at 3, 6 and 12 months and metamorphopsia score (MCHARTs) at 12 months.

Results Of 176 participants enrolled in PIVOT, 158 (89.8%) had gradable SD-OCT scans. Intergrader agreement was 0.870 (Cohen’s kappa). The incidence of PSFF was 16% (13/81) following PnR and 10.4% (8/77) following PPV (p=0.298; OR=1.65, 95% CI 0.64 to 4.23). Median ETDRS score at 3 months postoperatively between eyes with and without PSFF was 71 (IQR=58–78) and 78 (IQR=70–84), respectively (difference=7 letters, p=0.037), with no significant difference at subsequent 6-month and 12-month visits. Median metamorphopsia scores in patients with versus without PSFF were: horizontal: 0.1 (IQR=0–0.3) vs 0 (IQR=0–0.2) (difference=0.1, p=0.228) and vertical: 0.25 (IQR=0–0.4) vs 0 (IQR=0–0.2) (difference=0.25, p=0.148), respectively.

Conclusions There was no significant difference in the incidence of PSFF in eyes undergoing PnR versus PPV for RRD. The presence of PSFF at 1–2 months postoperatively was associated with worse ETDRS letter score at 3 months, but there was no difference at 1 year.

Trial registration number NCT01639209.

  • Retina

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bjo-2021-320981

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @roxanehillier

    • Contributors Aquisition, analysis and interpretation of data: AB, DS, SRS, RJH, RHM. Guarantor: RHM.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.