Purpose:

To review consecutive retinal detachments repaired with PR over a recent three year period and compare the outcome of failed cases regarding final anatomic success, final visual acuity and overall cost versus eyes successfully repaired with one operation. Regarding retinal detachment repair, CMS has determined single operation success (SOS), not visual recovery, will be used as the primary parameter to measure quality of care and physician reimbursement will be adjusted by both SOS and cost. They assume single operation success is least costly and results in best visual outcomes. It is the purpose of this presentation to challenge that assumption.

Methods:

We retrospecitvely reviewed 43 consecutive primary retinal detachments repaired with PR between 9/2011 and 9/2014 and followed for a minimum of 4 months.

Results:

33% were pseudophakic, in 35% the macula was detached preoperatively. The pneumatic SOS rate was 81% (35/43), 84% (36/84) attained > 20/40 acuity. 19% (8/43) failed. Of these 8 eyes, 5 were phakic, and in 4 the macula was detached preoperatively. The interval between the primary repair and the reoperation was 5 days to 3.5 months, with about half the eyes operated within two weeks. All 8 (19%) failed eyes were ultimately reattached successfully with vitrectomy, 3 eyes required a second vitrectomy, one for PVRC2 and two for ERM peeling. 7/8 (88%) of the pneumatic failures attained >=20/40, 8/8 (100%) attained >20/60. No eye required silicone oil. The cost (surgeon and facility) of 43 eyes repaired initially with PR including reoperations was $78,710. The cost to repair 43 eyes with primary vitrectomy, assuming a 95% SOS was calculated to $166,496. Thus PR including reoperations is half the cost of PPV.

Conclusions:

A failed pneumatic, if properly performed and operated upon in a timely fashion, does not disadvantage the eye to ultimate retinal reattachment or recovery of visual acuity. Operations which have a higher single operation success rate may not be as effective in restoring pre detachment visual acuity and may be more expensive. CMS should consider visual recovery and cost as quality measures and not single operation success.

Contact Details:

Email: tornambepe@aol.com
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