Photo Credit: romanzaiets
During AAO 2024, researchers presented new findings regarding retinal structure, detachment surgery, retinal repair costs, and more.
Andrea Cusumano, MD, and colleagues reviewed retinal changes associated with cefuroxime ocular toxicity syndrome (COTS) following cataract surgery. Four patients who experienced serous retinal detachments after intracameral cefuroxime injection (1.0 mg/0.1 mL) underwent comprehensive ophthalmological evaluations, including optical coherence tomography (OCT) at preoperative (T0) and postoperative intervals (1 day [T1], 1 week [T2], and 1 month [T3]). Two patients also underwent electroretinography (ERG) and one underwent OCT angiography and perimetry.
At T1, all patients had significantly reduced visual acuity (< 20/200), which improved to 20/20 at T2-T3. OCT findings revealed serous retinal detachments at T1 that resolved by T2. However, vessel density, which decreased at T1, showed only partial recovery at T2-T3. Abnormal ERG and perimetric values at T1 similarly exhibited partial improvement over time. Two patients with prior vitrectomy and internal limiting membrane (ILM) peeling, and one patient with intraoperative posterior capsule rupture requiring anterior vitrectomy, were identified, suggesting these conditions may increase susceptibility to COTS-related retinal changes.
The study concluded that while visual acuity and subretinal fluid resolve over time, retinal changes, including reduced vessel density, may persist. Previous vitrectomy with ILM peeling or anterior vitrectomy could be potential risk factors for developing COTS-related retinal complications.
For a retrospective case-control study, Glenn Oh, MD, and colleagues analyzed the impact of post-penetrating keratoplasty (PK) pars plana vitrectomy (PPV), laser treatments, retinal detachment (RD), and vitreous hemorrhage (VH) on corneal graft survival. Data from 835 eyes of 835 patients treated at a tertiary center between May 2007 and September 2018 were reviewed. The study included demographics, medical and ocular history, and surgical outcomes, with multivariate Cox regression analysis applied to 32 selected variables.
The mean age of participants was 57.1 ± 22.0 years, with an average follow-up period of 4.22 ± 3.05 years. Graft failure occurred in 35% of cases, typically 1.90 ± 1.95 years after PK. Of the 32 variables analyzed, 12 were significantly associated with graft failure. Four post-PK retinal factors were notably linked to increased risk of failure: PPV (P=0.018), silicone oil tamponade (P=0.020), air tamponade (P=0.039), and VH (P=0.002).
The study concluded that graft failure remains a significant complication of PK, with specific post-PK retinal procedures and conditions, such as PPV and VH, increasing the risk. According to the researchers, these findings highlight the need for careful monitoring and management of retinal conditions in post-PK patients to enhance graft survival.
Finally, Akash Maheshwari, MBA, and colleagues used time-driven activity-based costing (TDABC) to analyze the cost structure of complex retinal detachment repair (CPT code 67113) at two academic medical centers. Process flow mapping identified time and resource allocation across various steps, with data sourced from electronic health records and manual recordings. Costs of materials, personnel, and space utilization were calculated using internal and external benchmarks.
The TDABC analysis revealed that the average cost of performing CPT 67113 ranged from $6,722.21 to $9,502.74, with operating room time being the primary cost driver. By comparison, the Medicare hospital outpatient department reimbursement for CPT 67113, including physician and facility fees and patient copay, was estimated at $6,266. This represents a 7% to 52% underestimation of the actual cost of the procedure.
The study concluded that the costs of complex retinal detachment repair at academic centers exceed the Medicare maximum allowable reimbursement, highlighting potential financial disparities and the need for revised reimbursement policies to align with the actual expenses of high-complexity surgical care.
