INTRODUCTION AND PRIMARY OBJECTIVE:Pediatric rhegmatogenous retinal detachment (RRD) presents unique challenges in diagnosis and management. A thorough evaluation of family, medical, and ocular history is helpful, as systemic and genetic conditions can predispose children to RRD. Trauma, high myopia, and history of prematurity are also common risk factors. Examining young children in the outpatient setting may have limitations, but the yield can be maximized by modifying examination techniques and utilizing imaging technologies. In this manscript, the considerations for diagnosis and management of pediatric rhegmatogenous retinal detachment are outlined. CONCLUSIONS:Primary scleral buckling is the treatment of choice for the vast majority of pediatric RRDs, as it offers a higher single surgery success rate in these young eyes with firmly adherent posterior hyaloid. Primary vitrectomy is not recommended due to this reason. Scleral buckling is the mainstay of pediatric RRD surgery, even in cases that may typically undergo vitrectomy in adults. Prophylactic treatment of the fellow eye may also be warranted in certain clinical scenarios. Understanding the unique challenges these patients face is important for early diagnosis, timely intervention, and tailored surgical strategies to optimize visual outcomes in this vulnerable patient population.

See-saw nystagmus (SSN) is a rare form of nystagmus characterised by alternating elevation with incyclotorsion of one eye and concomitant depression with excyclotorsion of the other eye, often due to abnormalities involving the midbrain and parasellar region. Herein, we highlight a rare case of pendular SSN, which demonstrated complete resolution following resection of a pituitary macroadenoma. A patient in their 40s was identified to have SSN and was diagnosed with a pituitary macroadenoma. They underwent an endoscopic endonasal transsellar approach for resection of the pituitary adenoma. Their nystagmus resolved immediately after surgery. From a review of the literature, resolution and/or significant improvement in SSN occurred in 74% of cases following treatment, with 100%, 86% and 50% following treatment for medication-induced, neurological infarcts, and mass-effect aetiologies of SSN, respectively. SSN is a rare entity with a wide array of aetiologies. Identification of the causative aetiology and appropriate treatment can lead to significant improvement or resolution of the nystagmus in most cases.

Purpose of review With a decline in the use of scleral buckling for rhegmatogenous retinal detachment (RRD) repair in recent years, this review seeks to provide a summary of the most recent research findings regarding the role of scleral buckling in the repair of RRD. Recent findings Many recent studies have compared visual and anatomic outcomes between scleral buckling and pars plana vitrectomy (PPV) for RRD repair. Some suggest superior outcomes with primary scleral buckling, particularly in younger, phakic patients, and in association with other risk factors that we review. Children do best with primary scleral buckling surgery. Functionally, scleral buckling may also result in lower rates of retinal displacement compared to PPV. When PPV is necessary, a supplemental buckle may benefit certain patients, while the advantage remains unclear in other clinical scenarios and necessitates further investigation. Summary Scleral buckling is an important technique for the repair of RRD and it is crucial to continue training retina surgeons in this technique to maximize patient outcomes.

PURPOSE:To describe the syndromic, clinical, and retinal findings of a patient with an extremely-rare genetic condition known as Hardikar syndrome (HS) with presentation of optical coherence tomography, fundus autofluorescence, fluorescein angiographic, and indocyanine green angiographic findings. METHODS:Clinical course was detailed and followed over time with examinations and multimodal imaging. PATIENT AND RESULTS:A 17-year-old patient with HS was referred for possible retinitis pigmentosa. Dilated fundoscopic examination revealed large, multifocal cauliform patches of chorioretinal retinal pigment epithelium changes with retinal pigment epithelium drop-out involving the macula and periphery in both eyes. Additionally, an inactive choroidal neovascular membrane was present in the left eye. Multimodal imaging with optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography correlated with the clinical findings of focal patches of chorioretinal degeneration in both eyes. Additionally, an anomalous finding of the superior retinal arterial vessels filling in tandem with the choroidal was present in the left eye. The patient's clinical findings were consistent with HS, and genetic testing with whole-exome sequencing revealed a pathogenic mutation in the MED12 gene, confirming diagnosis. DISCUSSION AND CONCLUSIONS:Hardikar syndrome is associated with retinal pigment epithelium degeneration, creating focal patches of pigmentary chorioretinal atrophic lesions. Vision loss can occur because of the development of choroidal neovascular membranes. The authors recommend close evaluation and follow-up for HS patients with multimodal retinal imaging.

Background/Purpose: To describe the clinical, optical coherence tomography (OCT), fundus autofluorescence and ultrasound findings of a patient with a choroidal nevus actively exuding vitelliform material in the setting of autosomal dominant Best dystrophy (BD). Methods: The patient's clinical course was followed over time with ophthalmic examinations and multimodal imaging. Results: A 71-year-old male patient with BD was referred for evaluation of a choroidal nevus in the right eye. Dilated fundoscopic examination showed a small pigmented choroidal nevus in the temporal periphery. Over a 3-year period, the nevus developed progressive deposition of vitelliform material along its inferior border. Meanwhile, OCT and fundus photography showed only slight growth. Ultrasound showed no change in height; basal measurements were confounded by the increased vitelliform deposits. Genetic testing confirmed a heterozygous mutation in the BEST1 gene and electrophysiology was consistent with BD. Conclusions: Dysfunction of the retinal pigment epithelium associated with BD may cause novel presentations of other conditions such as choroidal nevi. The implication for malignant transformation of a choroidal nevus associated with vitelliform deposit accumulation in this context is unknown.

BACKGROUND AND OBJECTIVE:The objective was to evaluate factors associated with clinical presentation of uveal melanoma (UM) during the initial two years of the coronavirus disease 2019 pandemic. PATIENTS AND METHODS:This was a multi-site, retrospective cohort study of patients treated for uveal melanoma during the first (early) and second (late) year of the pandemic compared with the year prior (control). RESULTS:A total of 48, 67, and 75 patients were in the control, early, and late cohorts, respectively. The early cohort had a higher frequency of large tumors (control: 29.2%, early: 40.3%, late: 29.3%; P < 0.001) at presentation. Both the early and late cohorts had higher rates of enucleation (control: 8.33%, early: 20.9%, late: 18.67%; P ≤ 0.0338) compared to the control cohort. CONCLUSIONS:While there was an increase in large tumors along with a rise in enucleation during the first year of the pandemic, enucleation rates remained elevated even while tumor sizes normalized. [Ophthalmic Surg Lasers Imaging Retina 2024;55:278-284.].

PURPOSE:To highlight spontaneous resolution or improvement of myopic retinoschisis (MR) in actively surveilled patients. METHODS:Case series of five patients diagnosed with MR who did not undergo pars plana vitrectomy and were carefully monitored by a single retina specialist. Ocular and medical history were reviewed, and clinical characteristics including visual acuity and the status of the MR were monitored with spectral domain optical coherence tomography (SD-OCT) at each clinic visit. RESULTS:Five patients were identified to have MR without vitreomacular traction, or macular hole formation. Two patients exhibited spontaneous and complete resolution of MR without surgical intervention over an average observation time of 52.5 months. In these cases, a clinical posterior vitreous detachment was documented preceding the resolution of MR over an average time of 26.5 months. Snellen best-corrected visual acuity in these patients improved (Case 1 from 20/50 to 20/40, Case 2 from 20/30 to 20/25). The remaining three patients were monitored for an average of 52 months and showed improvement of MR via OCT imaging. Snellen best-corrected visual acuity either remained stable or improved from baseline (Case 3 stable at 20/30, Case 4 improved from 20/40 to 20/30, and Case 5 stable at 20/20). CONCLUSION:These findings suggest that conservative management of MR with observation can be considered especially in patients with challenging comorbidities (such as monocular status), and with a clinically identified posterior vitreous detachment without vitreomacular traction.

Purpose: To evaluate prophylactic treatment (PTx) of lattice degeneration (LD) on retinal tear (RT) and rhegmatogenous retinal detachment (RRD) risk in fellow eyes of patients after primary RRD repair in the first eye. Methods: This was a consecutive case series with cohort control involving patients with RRD repair from January 1, 2013, through December 31, 2017. Patients received PTx (PTx cohort) or no PTx (No-PTx cohort) in fellow eye with 5-year follow-up. Primary outcome measure was proportion with new fellow eye RT/RRD. Secondary outcomes included logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and status of myopia, posterior vitreous detachment, and pseudophakia. Results: Four hundred ninety-eight patients were divided into 146 and 352 in PTx and No-PTx cohorts, respectively. PTx cohort developed significantly ( P < 0.05) fewer RT/RRD (17%) than No-PTx cohort (41%). PTx significantly ( P < 0.05) lowered RT/RRD irrespective of posterior vitreous detachment and myopia status. PTx patients undergoing phacoemulsification demonstrated significantly ( P < 0.05) less RT/RRD (22%) than No-PTx cohort (31%). There was no significant ( P = 0.96) final BCVA difference between PTx (median = 0 logMAR) and No-PTx (median = 0 logMAR) cohorts. Conclusion: PTx of asymptomatic fellow eye LD reduced RT/RRD risk.

Purpose: To compare patients with acute endophthalmitis after intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors vs. steroids. Methods: Retrospective single-center, nonrandomized interventional study from 2013 to 2021. Patients underwent vitreous biopsy before initiating treatment and were divided into the following cohorts: (1) anti-VEGF managed medically (T&I–anti-VEGF), (2) anti-VEGF managed by immediate pars plana vitrectomy (PPV–anti-VEGF), and (3) steroid therapy and managed medically or by pars plana vitrectomy (steroid). Results: A total of 141 patients were analyzed. The steroid cohort demonstrated significantly worse presenting (median = 2.80 logarithm of the minimum angle of resolution [logMAR]; P ≤ 0.01) and final (median = 2.30 logMAR) best-corrected visual acuity compared with T&I–anti-VEGF (presenting: median = 2.00 logMAR; final: median = 0.40 logMAR) and pars plana vitrectomy–anti-VEGF cohorts (presenting: median = 2.30 logMAR; final: median = 0.48 logMAR). There was no significant ( P = 0.33) difference in the final best-corrected visual acuity between T&I–anti-VEGF and pars plana vitrectomy–anti-VEGF cohorts. There were no significant ( P ≥ 0.63) differences among cohorts in best-corrected visual acuity before acute endophthalmitis diagnosis (T&I–anti-VEGF: median = 0.40 logMAR; pars plana vitrectomy–anti-VEGF: median = 0.40 logMAR; steroid: median = 0.44 logMAR). Microbial cultures revealed similar profiles for all cohorts. Conclusion: Acute endophthalmitis after intravitreal injection steroid therapy had worse outcomes compared with anti-VEGF therapy.

Background and Objectives: Describe risk factors, findings, and outcomes of acute endophthalmitis (AE) following small-gauge pars plana vitrectomy (PPV). Patients and Methods: This was a retrospective single-center, nonrandomized study of post-PPV AE patients from 2013 to 2021. All received vitreous biopsy before treatment. Patients were divided into cohorts: 1) PPV within 3 days of diagnosis (Urgent-PPV), and 2) no urgent PPV (Other-treatment [Tx]). Main outcome was best-corrected visual acuity (BCVA) at 6 months. Results: Twenty-one patients were analyzed. Epiretinal membrane was the most common indication for PPV (48%). Incidence was 0.074%. Culture-positive rate was 57%. For final BCVA, there was no significant ( P = 0.85) difference between Urgent-PPV (median = 0.40 logMAR) and Other Tx cohorts (median = 0.35 logMAR). Sclerotomy wounds were not sutured in 71% of patients. Approximately 24% and 38% of patients analyzed had either no tamponade or partial tamponade, respectively. Conclusion: Tamponade agents and sclerotomy suturing may be important factors when evaluating post-small-gauge PPV-associated AE. Further studies are necessary for clarification. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:395–400.]

Scleral buckling (SB) has served as an important modality for addressing rhegmatogenous retinal detachments (RRD) for over 60 years. Historically, RRDs were deemed irreparable; however, in the early 20th century, ophthalmologists like Gonin, Schepens and Lincoff introduced techniques to seal retinal breaks. Custodis first described the SB technique. Modern SB refined by Schepens resolves RRDs by using an encircling band to reduce vitreoretinal traction and promote chorioretinal adhesions via an indentation effect. With the advent of pars plana vitrectomy (PPV), there has been a preference shift in the repair of RRDs. Studies have demonstrated a trend among surgeons choosing PPV for RRDs with less emphasis on SB.4–6 Although vitrectomy offers several advantages, including a wider intraoperative field of view, easier identification and management of complex retinal breaks, the ability to address vitreous haemorrhage, and effectively drain subretinal fluid, SB remains important, particularly in young, phakic patients. The SB versus Primary Vitrectomy in RRD study was a prospective, randomised, multicenter trial that aimed to assess the outcomes of primary SB compared to primary PPV in cases of medium complexity RRDs. The study of 681 patients (416 phakic) demonstrated greater visual outcomes with SB compared with PPV. Additionally, in their pseudophakic group, no difference was identified in the visual outcomes between SB and PPV, although the anatomic success rate was significantly better with PPV. The results of this study indicated that SB was beneficial for phakic eyes due to the superior visual acuity outcomes. Vitrectomy was recommended for pseudophakic eyes due to the superior anatomic outcomes. However, another recent large multicenter retrospective outcomes project (Primary Retinal Detachment Outcomes Studies) revealed that for phakic patients, the single surgery anatomic success (SSAS) rate and visual acuity outcomes were better with SB compared to PPV alone. Additionally, the SSAS rate in pseudophakic patients was better in patients treated with combined SBPPV compared to with PPV alone. In the era of microincisional vitrectomy, the focus of vitreoretinal fellowship programmes has shifted towards developing competency in PPV, with a decreased emphasis on SB. This is evident in the guidelines set by the Association of University Professors of Ophthalmology's (AUPO) Fellowship compliance committee, which reduced the minimum number of required SB cases from 75 in 2007 to 20 in 2015. However, at least one study highlighted that completion of at least 30 primary SB cases was required to achieve stable clinical results with low re-detachment rates. With the success rate of SB dependent on the surgeon's experience, the current trend for decreasing operative minimums for training in SB procedures is discordant with preparing fellows for successful independent practice. The COVID-19 pandemic had a profound impact on the practice of ophthalmology. In light of the pandemic, the American Academy of Ophthalmology (AAO) issued a recommendation to suspend non-urgent care. However, surgeries for RRDs were classified as emergent both by the AAO and the American Society of Retinal Specialists (ASRS). This recognition highlights the critical nature of RRDs and underscores the necessity of addressing these cases promptly even during the challenging circumstances posed by the pandemic. The study by Wu et al in this issue highlights the impact of the COVID-19 pandemic on the surgical repair trends of RRDs among young ophthalmologists in the Asia-Pacific region. The study employed an observational survey-based method to evaluate the experiences of ophthalmologists regarding retinal detachment repairs, including their confidence levels in performing SB, pneumatic retinopexy (PR), and PPV. Twenty-four vitreoretinal fellows and 93 vitreoretinal attendings/consultants from 11 different countries participated in the study. The median duration of fellowship affected by the COVID-19 pandemic was 5 months for fellows, and 0 months for attendings/consultants. The volume of surgeries completed during fellowship was highest for PPV with lower volumes of PR and SB procedures performed. Among those who were in fellowship during the pandemic, 36.7% reported a decrease in surgical volume of up to 25%, 16.3% reported a decrease of 25%–50%. Only 22.4% reported no change in volume. Received: 11 June 2023 Accepted: 24 June 2023

PurposeDevelop treatment algorithm for acute endophthalmitis (AE) following cataract surgery.MethodsRetrospective single-center, non-randomized interventional study involving patients with AE divided into cohorts according to our novel scoring system, the Acute Cataract surgery-related Endophthalmitis Severity (ACES) score. Total score >= 3 points indicated need for urgent pars plana vitrectomy (PPV; within 24 hours), whereas <3 points indicated urgent PPV was unnecessary. Patients were retrospectively evaluated for visual outcomes based on whether their clinical course followed with or deviated from ACES score recommendations. Main outcome was best-corrected visual acuity (BCVA) at 6-month or longer after treatment.ResultsTotal of 150 patients were analyzed. Patients whose clinical course followed the ACES score recommendation for immediate surgery had significantly (P < 0.01) better final BCVA (median = 0.18 logMAR, 20/30 Snellen) compared to those that deviated (median = 0.70 logMAR, 20/100 Snellen). For those where the ACES score deemed urgent PPV was unnecessary, no significant (P = 0.19) difference was observed between patients that followed with (median = 0.18 logMAR, 20/30 Snellen) and those that deviated from (median = 0.10 logMAR, 20/25 Snellen) recommendation.ConclusionsThe ACES score may potentially provide critical and updated management guidance at presentation for when to recommend urgent PPV for patients suffering from post-cataract surgery AE.

OBJECTIVE:To evaluate the impact on trends in clinical presentation of acute, primary rhegmatogenous retinal detachments (RRD) from early to late phases of the COVID-19 pandemic. METHODS:This study was a single-center, consecutive case series of 1,727 patients treated after vaccine availability ("late"; 3/29/21 to 9/26/21), corresponding time frame in previous year of pandemic ("early"; 3/30/20 to 9/27/20), and prior to pandemic ("pre"; 4/1/19 to 9/29/19). Primary outcome was proportion of patients presenting with macula-off RRD. Secondary outcomes included best-corrected visual acuity (BCVA) and primary proliferative vitreoretinopathy (PVR). RESULTS:While macula-off RRD rates were significantly (P < 0.0001) elevated in early and late cohorts compared to the pre cohort, only the early cohort showed a significant (P < 0.0001) increase in both primary PVR presentation and complex RRD repair. Patients lost to follow-up in early cohort were significantly (P < 0.0001) higher than others. Early cohort showed significantly (P < 0.0001) worse final BCVA compared to others. CONCLUSION:Patients in late pandemic were less likely to exhibit clinical features of worse RRD disease and have improved visual outcomes compared to those in early pandemic. [Ophthalmic Surg Lasers Imaging Retina 2023;54:78-83.].

Supplemental Digital Content is Available in the Text.

Supplemental Digital Content is Available in the Text.

PURPOSE:To perform a retrospective characterization of one-star reviews of ophthalmologists on Yelp.com and to increase understanding of patient complaints on Yelp.com. METHODS:A search was performed for reviews on Yelp.com using the keyword "ophthalmologist" for the top 8 most population-dense metropolitan areas in the United States. One-star reviews were collected and classified as procedural or nonprocedural. Complaints were also categorized as clinical, nonclinical, or both. Clinical complaints cited issues such as complications, reoperations, uncontrolled pain, misdiagnosis, unclear treatment plan, etc. Nonclinical complaints included comments such as physician bedside manner, other staff interpersonal manner, wait time, brevity of appointment time, etc. RESULTS:5,532 total reviews were assessed, of which 477 (9%) one-star reviews were included in the study for analysis. These reviews amounted to 1,120 distinct complaints. 287 (26%) were clinical in nature and 833 (74%) were nonclinical. Technical incompetence or error (50: 4%), unsatisfactory results (46: 4%), and complications (43: 4%) represented the most common clinical complaints while office staff interpersonal manner (182: 16%), wait time (174: 16%), and physician interpersonal manner (141: 13%) were the most common nonclinical complaints. Refractive surgery was the most frequently mentioned subspecialty (89: 8%). Patients undergoing an ophthalmic procedure (surgery, injection, etc.) wrote 64 reviews that resulted in 193 (17%) complaints. Nonprocedural patients wrote 413 reviews that resulted in 927 (83%) complaints. Compared with procedural reviews, nonprocedural reviews were less likely to include a clinical complaint (rate ratio, 0.3: P < .001). DISCUSSION:The majority of one-star reviews of ophthalmologists included in this study were nonclinical. Complaints referencing a procedural episode were more likely to include a clinical component in the review. In the era of intense medical consumerism and increased physician and health care institution competition for patient acquisition and retention, the characterization of excessively negative reviews allows identification of potential areas of concern for patients that use online review sites such as Yelp.com.

Purpose. To describe an alternative treatment for a patient with serpiginous choroiditis (SC) who was not tolerant to systemic therapies. Methods. Case report of a patient with serpiginous choroiditis with their clinical course followed with ophthalmic examinations and multimodal imaging overtime. Patients and Results. A 57-year-old female with serpiginous choroiditis was treated for seven years with numerous therapies including systemic steroids, immunosuppressive agents, and repeated dexamethasone intravitreal implants. The patient was intolerant of systemic therapies and would flare if dexamethasone injections were performed less frequently than every 8 weeks, making a viable long-term treatment plan problematic. Following one injection of the fluocinolone acetonide 0.18 mg intravitreal implant, she has experienced sustained control for 20 months. Discussion and Conclusions. Real-world treatment of SC is complex as long-term control is necessary, and associated side effects of the therapies provided may limit sustained use. The fluocinolone acetonide implant lasts 36 months and may be an alternative long-term management option, especially in the setting of systemic medication intolerance for some patients with SC.

Introduction: To study the site of medial rectus (MR) insertion in surgical candidate children with esotropia and its relation to the angle of deviation.Methods: A prospective study that had been done on 110 children scheduled for surgical management of esotropia.We divided them, according to age, into three groups: \2 years, 2-6 years, and 6-12 years.We documented the angle of deviation.During surgery we measured the distance between MR insertion and limbus using the caliber viewing by microscope.We created similar control age groups of non-strabismus 98 children.They were admitted to operating theatre for other reasons.After written permission we measured MR insertion site.Results: The mean insertion site in control group 1 (age below 2) was 4.33 AE 0.39.While it was significantly less in patient group 1 (P \ 0.001), 3.81 AE 0.48 and 3.78 AE 0.56 for right and left eyes.For group 2, it was 4.63 AE 0.48 in control group.While it was significantly less in esotropia (P \ 0.001), 3.99 AE 0.38 and 3.98 AE 0.40 for right and left eye.For group 3 (6-12 years), it was 5.27 AE 0.24 in control and 4.91 AE 0.46 and 4.26 AE 0.47 in esotropia (P \ 0.001).There was significant negative correlation between angle of deviation and MR insertion site (P \ 0.001) in all age group patients.Conclusion/Relevance: The medial rectus is significantly closer to limbus in children with esotropia than nonstrabismus.Also, there is negative correlation between MR insertion site and severity of esotropia.

Objective: To evaluate, in the setting of persistent diabetic macular edema, the impact that continuous fluocinolone acetonide delivery has on treatment burden, visual acuity, central retinal thickness, and intraocular pressure. Materials and methods: A single-center, retrospective, cohort study of patients with persistent diabetic macular edema, previously treated with anti-vascular endothelial growth factor injections, dexamethasone implants, or focal laser, who were subsequently treated with fluocinolone acetonide was conducted. All retinal visits were analyzed prior to fluocinolone acetonide, until the most recent follow-up visit. Primary outcomes were pre- and post-fluocinolone acetonide changes in the best-corrected visual acuity and number of treatments required for diabetic macular edema. Secondary outcomes included changes in the central retinal thickness and intraocular pressure. Results: A total of 19 eyes with persistent diabetic macular edema were included and followed for a mean (SD) of 399.3 (222.9) days. Post-fluocinolone acetonide, the mean best-corrected visual acuity improved by 0.4 ETDRS letters for all eyes (p = 0.895) and the central retinal thickness decreased by 34.2 mu m (p = 0.077). After fluocinolone acetonide, the number of treatments decreased from an average of one treatment every 2.7 months to one every 6 months (p = 0.009). Furthermore, post-fluocinolone acetonide, 10/19 eyes (52.6%) did not require additional treatment due to a dry macula, and those who did experienced a non-statistically significant reduction of treatments, from one every 2.6 months pre-fluocinolone acetonide, to one every 2.8 months post-fluocinolone acetonide (p = 0.622). Conclusions: In the setting of persistent diabetic macular edema, fluocinolone acetonide significantly reduces the therapeutic burden, while maintaining best-corrected visual acuity and improving the central retinal thickness. In patient-centered discussions, judiciously employing fluocinolone acetonide should be performed to mitigate this therapeutic burden for patients.

Background: Unplanned reoperation rates represent an important metric in monitoring quality in orthopedic surgery. Previous studies have focused on 30-day reoperation rates, not accounting for complications that may arise beyond this time. This study aimed to understand the frequency, timing, and procedure type of orthopedic reoperations, as well as the complications leading up to these reoperations over a 1-year period. Methods: A single-center, retrospective cohort study reviewed all orthopedic surgeries performed within a three-year period and subsequently identified reoperations within a year following the initial case. Exclusion criteria for reoperations included those that were planned, involved a different body part, or had a different laterality from the first operation. The cases were analyzed by procedure type, timing of reoperation, and causes of reoperation. Results: Of the 10,449 orthopedic surgeries performed between 2012 and 2015, 947 (9.1%) were unplanned reoperations within 1 year. Most (775; 81.8%) unplanned reoperations occurred after 30 days. Infections/wound complications (58.2%) were the most common reason for unplanned reoperations at 1 month from the initial operation, and mechanical complications (49.5%) predominated at the 6-months-to-1-year time frame. Conclusion: This study demonstrated that the current paradigm of focusing on reoperations occurring within 30 days of the initial operation captures only a fraction of unplanned reoperations. Stratification of this metric by time and precipitating complication type provides additional information that quality improvement programs may target. A 1-year unplanned reoperation rate could be used as a broad indicator of surgical quality across institutions.