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A prospective cohort study of IRD patients report the frequency and distributions of ophthalmic surgical procedures at the Wilmer Eye Institute.

Researchers at the Wilmer Eye Institute, Johns Hopkins University, Baltimore, has reported that an estimate cohort of one-third of inherited retinal dystrophy (IRD) patients had a history of laser or incisional surgery. Researchers found that cataract extraction with intraocular lens implantation (CEIOL) was the most common surgery and its frequency and timing may be associated with an IRD phenotype.  The outcome may be valuable for clinical decision-making and may contribute surgical strategies “on the development for cell and gene therapy delivery”.

Researchers had previously known that certain IRD patients may have a high-risk of post-surgery on cataract extraction and cystoid macular oedema, and found that some “IRD eyes respond to surgery in unique ways that are poorly understood at present”.  In addition, researchers have inquired that, “it is plausible that other surgical procedures (such as vitrectomy, trabeculectomy, and strabismus surgery) may also pose unique or particularly severe risks in IRD patients”.  Without a comprehensive evidence-base on “standard-care surgical outcomes in IRD cases”, clinicians may require more support on decision-making, including a useful guide on strengthening the informed consent process.  As a result, the recent study was aimed to characterize the frequency and distribution of ocular surgeries in patients IRDs and thereafter evaluate associated patient and disease factors.

In a retrospective cohort of patients, subjects were categorized into two groups: central dysfunction (macular/cone/cone-rod dystrophy, “MCCRD group”) and pan-retinal or peripheral dysfunction (retinitis pigmentosa-like, “RP group”).   Following their results, there was a total of 1,472 eyes of 736 subjects evaluated and among them, 31.3% (n = 230) had undergone ocular surgery, and 78.3% of those (n=180/230) had a history of more than one surgery. The researchers catalogued a total of 602 surgical procedures indicating that CEIOL was the most common (51.2%), followed by YAG capsulotomy, refractive surgery, retinal surgery, and others. CEIOL occurred more frequently in RP than in MCCRD subjects (prevalence odds ratio [POR] 2.59, p = 0.002). RP subjects underwent CEIOL at a younger age than MCCRD patients (HR = 2.11, p < 0.001).  Commenting on the study report, the researchers stated that, “the data show that ocular surgery in subjects with IRD is relatively common, and many types of procedures can occur in this population. Ocular surgery occurred with a frequency of approximately 1:3 when considered from the per-subject and per-eye perspectives. About one in three eyes underwent multiple procedures”.