National Health Care data system analysis of glaucoma surgery activity in France in 2016

Two-year outcomes of Xen 45 gel stent implantation in patients with open-angle glaucoma: real-world data from the Fight Glaucoma Blindness registry

OBJECTIVE

To evaluate efficacy and safety outcomes of the Xen 45 gel stent implant over 24 months of follow-up.

METHODS

A retrospective analysis of prospectively collected data from the Fight Glaucoma Blindness observational registry. Complete success (CS) was defined as intraocular pressure (IOP) reduction ≥20% from preoperative and an IOP ≤18 mm Hg and ≥6 mm Hg with no secondary procedure at 2 years and without IOP-lowering medications. Qualified success (QS) was defined similarly, allowing the use of IOP-lowering medications.

RESULTS

The Xen 45 gel stent implant was implanted in 646 eyes of 515 patients. Preoperative IOP was 21.4±7.6 (mean±SD) mm Hg on 2.7±1.3 IOP-lowering medication and mean deviation was -10.2±8.4 dB. After 24-month follow-up, IOP was 16.8±7.3 mm Hg (mean reduction of 21.7%) on 1.2±1.4 IOP-lowering medications. CS and QS rates at 24 months were 26% and 48%, respectively. CS and QS were higher in the Xen stand-alone group (33% and 52%, respectively) than in the Xen+cataract group (16% and 42%, respectively). Bleb needling was performed in 28.4% of cases, and 18% underwent a secondary procedure.

CONCLUSIONS

The Xen 45 gel stent implant offers acceptable long-term efficacy for the treatment of open-angle glaucoma. However, there is a significant rate of reoperation and needling, and outcomes are less effective if combined with cataract surgery.

Analysis of pediatric ophthalmology surgical activity in metropolitan France in 2016: Its impact on training capacities

AIMS

To describe pediatric ophthalmology surgery activity in private or public practice in metropolitan France in 2016 and to anticipate training needs in surgical pediatric ophthalmology.

METHODS

We used the French National Health Care System database to identify all pediatric ophthalmology surgical procedures performed in 2016. The study included all children aged ≤14 years who had undergone ophthalmologic surgery. We calculated the incidence of surgeries per 100,000 inhabitants aged ≤14 years, the number of surgeons, the mean age of the practitioners, and the number of surgeons aged >55 years.

RESULTS

In 2016, the overall incidence of pediatric ophthalmic surgery activity was 150.42/100,000 children aged ≤14 years. Out of 17,657 pediatric surgeries, 31.3 % were done by private surgeons performing at least 20 surgeries per year, 45.9 % in public centers with ≥20 surgeries per year, and 22.8 % by surgeons (public or private centers) doing <20 surgeries per year. This analysis included 204 surgeons, with a mean age of 41.7 ± 11.2 years (60.8 % female) in the public sector and 51.0 ± 9.5 years (37.3 % female) in private practice. More than a third of the surgeries (37.7 %) were performed in children aged 6-11 years, and the most frequent procedure was strabismus surgery (42.1 %). University regions with the fewest surgeons and regions with surgeons aged >55 years were identified. Within 5 years, to maintain pediatric ophthalmic surgical activity, it will be necessary to train 46 surgeons.

CONCLUSIONS

This study demonstrated disparities in the geographic distribution of pediatric ophthalmic surgeries in France and identified regions that need increased training capacities and/or incorporate new surgeons to ensure a sufficient activity.

Analysis of vitreoretinal surgery activity in metropolitan France in 2016: impact on training capacities

PURPOSE

The purpose of the study was to describe vitreoretinal surgery activity and vitreoretinal surgeons in private or public practice in metropolitan France over the year 2016 to anticipate surgical training needs.

METHODS

Patients aged ≥20 years who had undergone vitreoretinal surgery, alone or combined with cataract surgery were included using the French National Healthcare system database. For surgery performed by ophthalmologists carrying out ≥50 procedures during the year, the incidence per 100 000 of population ≥ 20 years of age, the number and mean age of surgeons and the number of surgeons aged >55 years were calculated.

RESULTS

Overall, 57 947 posterior segment surgical procedures were included, 40% in the public sector and 49% in the private sector for private surgeons and/or public centres performing ≥50 procedures/year. The remaining 11% of procedures were from private surgeons and/or public centres performing <50 procedures/year. The analysis included 356 surgeons with a mean age of 41 ± 10 years (39% female) in the public sector and 47 ± 10 years (14% female) in the private sector. The majority of urgent surgery was for retinal detachment (n = 30 290 [52% of total surgical procedures]). Scheduled surgery involved surgery for macular holes and epiretinal membranes (n = 16 454 [28% of total surgical procedures]). Combined vitrectomy-phacoemulsification surgery (n = 10 120) represented 17% of all vitreoretinal surgery. University regions with the fewest surgeons and regions with surgeons >55 years of age were identified, to anticipate the training need for new surgeons.

CONCLUSION

This study demonstrated disparities in the geographic distribution of vitreoretinal surgery in France and identified regions that need increased training capacities to ensure a sufficient number of surgeons.