Adverse Events After Pars Plana Vitrectomy Among Medicare Beneficiaries

Stein, Joshua D.

doi:10.1001/archophthalmol.2009.300

Cited by 69 publications

(59 citation statements)

References 51 publications

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“…38 Initial studies examining 23-gauge vitrectomy have had relatively small sample sizes but have described intraoperative choroidal effusion rates of 0% to 1.8% with incidences of 1 of 118, 32 0 of 100, 31 0 of 92, 30 0 of 57, 39 and 8 of 442. 40 The single case of intraoperative choroidal effusion during 23-gauge vitrectomy described in the series published by Chieh et al 32 occurred when the infusion cannula migrated into the suprachoroidal space and resolved spontaneously with infusion repositioning.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Choroidal Detachment During 23-Gauge Vitrectomy

Tarantola¹,

Folk²,

Shah³

et al. 2011

Retina

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Section: Discussionmentioning

confidence: 99%

Intraoperative Choroidal Detachment During 23-Gauge Vitrectomy

Tarantola¹,

Folk²,

Shah³

et al. 2011

Retina

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“…The rationale for selecting these 4 conditions as “severe complications” for this analysis was to enable comparison of the findings from the current analysis with rates of previously published findings of severe complications following glaucoma surgery and pars plana vitrectomy. 12,13 The only one of these 4 complications that may not be as applicable for this particular analysis was tractional retinal detachment, but this condition was extremely rare, only occurring in 0.03–0.04% of the cases for each of the 3 cohorts.…”

Section: Methodsmentioning

confidence: 98%

Severe Adverse Events after Cataract Surgery Among Medicare Beneficiaries

et al. 2011

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Purpose To determine rates and risk factors associated with severe post-operative complications following cataract surgery and whether they have been changing over the past decade. Design Retrospective longitudinal cohort study Participants 221,594 Medicare beneficiaries who underwent cataract surgery during 1994–2006. Methods Beneficiaries were stratified into 3 cohorts, those who underwent initial cataract surgery during 1994-5, 1999–2000, or 2005-6. One year rates of post-operative severe adverse events (endophthalmitis, suprachoroidal hemorrhage, retinal detachment) were determined for each cohort. Cox regression analyses determined the hazard of developing severe adverse events for each cohort with adjustment for demographic factors, ocular and medical conditions, and surgeon case-mix. Main Outcome Measures Time period rates of development of severe post-operative adverse events. Results Among the 221,594 individuals who underwent cataract surgery, 0.5% (1,086) had at least one severe post-operative complication. After adjustment for confounders, individuals who underwent cataract surgery during 1994-5 had a 21% increased hazard of being diagnosed with a severe post-operative complication (Hazard Ratio (HR): 1.21; [95% Confidence Interval (CI): 1.05–1.41]) relative to individuals who underwent cataract surgery during 2005-6. Those who underwent cataract surgery during 1999–2000 had a 20% increased hazard of experiencing a severe complication (HR: 1.20 [95% CI: 1.04–1.39]) relative to the 2005-6 cohort. Risk factors associated with severe adverse events include a prior diagnosis of proliferative diabetic retinopathy (HR: 1.62 [95% CI: 1.07–2.45]) and cataract surgery combined with another intraocular surgical procedure on the same day (HR: 2.51 [95% CI: 2.07–3.04]). Individuals receiving surgery by surgeons with the case-mix least prone to developing a severe adverse event (HR: 0.52 [95% CI: 0.44–0.62]) had a 48% reduced hazard of a severe adverse event relative to recipients of cataract surgery performed by surgeons with the case-mix most prone to developing such outcomes. Conclusion Rates of sight-threatening adverse events following cataract surgery declined during 1994–2006. Future efforts should be directed to identifying ways to reduce severe adverse events in high-risk groups.

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“…Several ocular pathologies such as retinal tear, rhegmatogenous or tractional retinal detachment, retinal edema, choroidal detachment, vitreous hemorrhage, and glaucoma can arise as a result of vitreous related complications, which occur mostly due to the vitreous humor's macromolecular organization and viscoelastic properties (Sebag, 1989;Stein, 2009). Furthermore, besides its viscoelastic nature, which renders its removal tricky, the tight adherence to the surrounding anatomical structures poses some challenges during vitrectomy.…”

Section: Introductionmentioning

confidence: 99%