Clinical trial finds minimally invasive retinal detachment treatment offers patients better outcomes

By Michael Oliveira

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.

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 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. 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.

These papers are an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

St. Michael’s Hospital with Providence Healthcare and St. Joseph’s Health Centre now operate under one corporate entity as of August 1, 2017. United, the three organizations serve patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.