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Safety and efficacy of office-based vitreoretinal surgery: A case series of 173 procedures in a vendor-agnostic suite
David Almeida
Presenter:
David RP Almeida MD MBA PhD, Vinit B Mahajan MD PhD, Mahita Kadmiel PhD
Authors:
Affiliation:
1. The Centers for Advanced Surgical Exploration (CASExERIE), Erie PA USA
2. Molecular Surgery Laboratory, Byers Eye Institute, Stanford University, Palo Alto, USA
3. Erie Retina Research, Erie PA USA
PURPOSE: To evaluate the safety, efficacy, and operational viability of vitreoretinal surgery performed in a highly efficient, vendor-agnostic Office-Based Surgery (OBS) suite. While OBS adoption is increasing, many practices rely on third-party management vendors that dilute practice revenue and autonomy. We tested the hypothesis that a surgeon-led, independent OBS model (CASEx) can achieve safety outcomes equivalent to those of Ambulatory Surgery Centers (ASCs) while maximizing surgeon autonomy and minimizing overhead costs, particularly for vitreoretinal indications, which are often excluded from OBS protocols.
METHODS: This retrospective, interventional case series reviewed 173 consecutive vitreoretinal procedures performed between [January 2025] and [July 2025] at the Center for Advanced Surgical Exploration (CASEx), a Joint Commission-accredited, vendor-agnostic OBS suite. Procedures included pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment, epiretinal membrane peeling, and vitreous hemorrhage. All cases utilized local anesthesia with minimal oral sedation (Class A), bypassing the need for an anesthesiologist. The suite was operationalized independently, utilizing direct procurement and internal sterile processing without external facility fees or management retainers. Primary outcomes were best-corrected visual acuity (BCVA) and adverse events (endophthalmitis, TASS, unplanned hospital transfer). Secondary outcomes analyzed procedural efficiency and turnover times.
RESULTS: A total of 173 eyes from 173 patients were included in the study. The procedural mix included rhegmatogenous retinal detachment repair (48/173, 27.7%); macular hole repair (35/173, 20.2%); epiretinal membrane peel (58/173, 33.5%); and other complex procedures, including subretinal gene therapy administration and Port Delivery Platform implantation (32/173, 18.5%). No anesthetic complications or intraoperative events requiring hospital transfer occurred. The postoperative endophthalmitis rate was 0%. Other postoperative complications were observed at rates comparable to those reported for similar procedures in ambulatory surgery center (ASC) settings.
CONCLUSIONS: Vitreoretinal surgery can be performed safely and efficiently in a vendor-agnostic office-based setting.
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