Surgical management of vitreoretinal diseases in Bhutan: A 3-year national study

Purpose: To describe the pattern of vitreoretinal surgeries performed in Bhutan. This first national study informs policy making and resource development. Methods: We reviewed the surgical registers of the three hospitals in Bhutan providing VR operations or interventional procedures for VR diseases over three years. Patient demography, indications and types of vitreoretinal surgeries were logged and quantified. Comparisons of the expected and observed frequency used Chi-squared tests. Results: A total of 214 patients received vitreoretinal surgeries, 36 paediatric cases received examination under anaesthesia for diagnostic confirmation followed by vitreoretinal surgery or retinal laser. Additionally, 381 cases received intravitreal anti-vascular endothelial growth factor injections in the operating theatres as mandated in Bhutan. The mean age was 56.2 ± 22.3 years. The majority, 375 cases (59.4%) were males (p<0.001). The common indications for VR surgery were retinal detachment (45.1%), vitreous haemorrhage (13.6%), and macular hole (7.7%). Retinal detachment surgery was the most common surgery performed, followed by silicon oil removal with cataract surgery. The common indications for anti-vascular endothelial growth factor injection were neovascular age-related macular degeneration (168 cases, 44.12%), retinal vein occlusion (132 cases, 34.6%), and diabetic macular oedema and retinopathy (50 cases, 13.1%). Conclusion: Performing high-tech vitreoretinal surgeries in a resource-limited setting is challenging. With an ever-increasing load of vitreoretinal diseases such as retinal detachment, age-related macular degeneration and macular hole, and the complications of systemic diseases such as retinal vein occlusion, vitreous haemorrhage, and diabetic macular oedema and retinopathy, there is a need to improve vitreoretinal services in Bhutan.