The EURETINA database has been a groundbreaking tool for vitreoretinal surgeons, allowing for anonymous, accessible, and robust data collection, significantly improving clinical outcomes for conditions such as retinal detachment and macular holes. Dr. David Yorston (UK) delivered the esteemed Gisbert Richard Lecture, reflecting on the development and impact of the EURETINA database over the last 10 years.
Initiated by Bill Aylward during his presidency, the EURETINA database aims to improve how vitreoretinal surgeons audit their outcomes.
Recognizing the inadequacies in existing methods, he formed working groups to develop standard datasets for retinal detachment and macular hole surgeries. The database now holds data on 15,600 retinal detachments and 5,300 macular hole surgeries, noted Dr. Yorston.
He emphasized that the database’s guiding principles include complete anonymity for both surgeons and patients, ensuring data accessibility for users to analyze their own outcomes at any time. It employs software for accurate data collection and is classified as a service evaluation, thus negating the need for ethics approval.
According to Dr. Yorston, the EURETINA database has revealed that the failure rate of retinal detachment surgery in patients over 80 is twice that of middle-aged patients. It was previously assumed that older patients had a worse prognosis due to difficulty positioning or non-ophthalmic co-morbidity.
However, the data indicates that older patients have a worse prognosis to start with, being more likely to have a total detachment and have proliferative vitreoretinopathy (PVR), he noted.
Recent findings reveal important trends and improvements in the management of retinal conditions. Notably, “women are more likely to have larger full thickness macular holes with poor prognosis,” Dr. Yorston said. “Additionally, older patients and pseudophakic eyes are more likely to present with complex detachments that may require further surgery.”
Other key results have also come out of this treasure trove of data. The definition of a large macular hole, for example, has been refined to 500 microns or greater—and it has been shown that surgery for recent onset macular holes should be performed urgently.
The data also indicates that inferior breaks and inferior detachments correlate with an increased risk of surgical failure. Using chromatin gas during surgery and instilling a bubble with sponges while releasing subretinal fluid may enhance outcomes, Dr. Yorston suggested.
He also stressed that early surgical intervention, ideally within the first 72 hours, is also crucial for better visual results in cases of macular detachments.
Research coming out of the database has also demonstrated that an eyelid flap is superior to eyelid peels in large holes, and denser gas yields better visual and anatomical outcomes than lighter gas in eyes with predominantly inferior morphology.
The impact of these strategies is evident in the data: the median duration of retinal detachment in macular off patients has decreased from five days to four days, reflecting a significant change in practice.
In concluding his lecture, Dr. Yorston reflected on the ongoing advancements made possible by the Euretina database. “We live in a world characterized by increasing polarization and division. The retina database reminds us of how much we can achieve when we work collaboratively together,” he said.
Editor’s Note: Reporting for this story took place at the 24th Congress of the European Society of Retina Specialists (EURETINA 2024), held from 19-22 September in Barcelona, Spain.
